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Asbestosis and other pulmonary fibrosis in asbestos-exposed workers: high-resolution CT features with pathological correlations

Abstract

Objective

The purpose was to identify distinguishing CT features of pathologically diagnosed asbestosis, and correlate diagnostic confidence with asbestos body burden.

Methods

Thirty-three workers (mean age at CT: 73 years) with clinical diagnoses of asbestosis, who were autopsied (n = 30) or underwent lobectomy (n = 3), were collected. Two radiologists independently scored high-resolution CT images for various CT findings and the likelihood of asbestosis was scored. Two pathologists reviewed the pathology specimens and scored the confidence of their diagnoses. Asbestos body count was correlated with CT and pathology scores.

Results

Pathologically, 15 cases were diagnosed as asbestosis and 18 cases with various lung fibroses other than asbestosis. On CT, only the score of the subpleural curvilinear lines was significantly higher in asbestosis (p = 0.03). Accuracy of CT diagnosis of asbestosis with a high confidence ranged from 0.73 to 0.79. Asbestos body count positively correlated with CT likelihood of asbestosis (r = 0.503, p = 0.003), and with the confidence level of pathological diagnosis (r = 0.637, p < 0.001).

Conclusions

Subpleural curvilinear lines were the only clue for the diagnosis of asbestosis. However, this was complicated by other lung fibrosis, especially at low asbestos body burden.

Key points

Various patterns of pulmonary fibrosis occurred in asbestos-exposed workers.

The fibre burden in lungs paralleled confident CT diagnosis of asbestosis.

The fibre burden in lungs paralleled confident pathological diagnosis of asbestosis.

Subpleural curvilinear lines were an important CT finding favouring asbestosis.

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Acknowledgments

The authors wish to thank Masaaki Fujiki MT, Department of Asbestos Research Center, Okayama Rosai Hospital, for counting asbestos bodies for this study. The scientific guarantor of this publication is Takumi Kishimoto, MD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by Japanese Ministry of Health, Labour and Welfare. No.11102539. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. This paper included 16 patients (four asbestosis and 12 with other diseases) who were previously reported in Kishimoto T, Kato K, Arakawa H. et al. (2011) Clinical, radiological and pathological investigation of asbestosis. Int J Environ Res Public Health 8(3):899-912. Methodology: retrospective, observational, multicenter study.

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Correspondence to Hiroaki Arakawa.

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Arakawa, H., Kishimoto, T., Ashizawa, K. et al. Asbestosis and other pulmonary fibrosis in asbestos-exposed workers: high-resolution CT features with pathological correlations. Eur Radiol 26, 1485–1492 (2016). https://doi.org/10.1007/s00330-015-3973-z

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  • DOI: https://doi.org/10.1007/s00330-015-3973-z

Keywords

  • Computed tomography, radiography
  • Asbestos
  • Pulmonary fibrosis
  • Asbestosis
  • Chronic interstitial pneumonia