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Idiopathic interstitial pneumonias: do HRCT criteria established by ATS/ERS/JRS/ALAT in 2011 predict disease progression and prognosis?

La radiologia medica volume 120, pages 930–940 (2015)Cite this article

Abstract

Purpose

The objective of the study was to determine whether HRCT criteria for Usual Interstitial Pneumonia (UIP), possible UIP or no-UIP pattern recommended by ATS/ERS/JRS/ALAT guidelines 2011 are able to predict progression and prognosis of the disease in a group of patients with fibrotic idiopathic interstitial pneumonia (IIP).

Materials and methods

This was a retrospective study conducted with the approval of the ethics committee. Two radiologists at baseline HRCT distributed 70 patients with fibrotic IIP into three groups on the basis of the 2011 guidelines: UIP pattern (group 1), possible UIP pattern (group 2), inconsistent with UIP pattern (group 3). The different abnormalities (honeycombing, reticulation, ground-glass and traction bronchiectasis), fibrotic score (reticulation + honeycombing) and overall CT score were visually scored at baseline and during the follow-up (total HRCT 178). The mortality rate of the three groups was compared. The baseline abnormalities were then correlated with the mortality rate in the UIP group.

Results

The inter-observer agreement in the classification of the abnormalities in the three groups was almost perfect (k = 0.92). After consensus, 44 patients were classified into group 1, 13 into group 2 and 13 into group 3. During a mean follow-up of 1386 days, overall CT score, fibrotic score, honeycombing and traction bronchiectasis showed a significant progression in group 1. The mortality rate was significantly higher in group 1 (18 deaths) versus group 2 and 3 (1 death each). In group 1, baseline honeycombing rate higher than 25 %, fibrotic score higher than 30, overall CT score greater than 45 and traction bronchiectasis in more than 4 lobes defined the worst prognosis.

Conclusion

HRCT classification based on 2011 guidelines showed high accuracy in stratifying fibrotic changes because in our study UIP, possible UIP and inconsistent with UIP pattern seem to be correlated with different disease progression and mortality rate.

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Conflict of interest

All the authors have no disclosures of possible conflict of interest and/or commercial involvement.

Ethical standards

This article does not contain any studies with human participants or animals performed by any of the authors.

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Affiliations

  1. 2nd Radiology Unit, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Chiara Romei, Annalisa De Liperi & Fabio Falaschi

  2. Pneumology Unit, Cardio-thoracic Department, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Laura Tavanti, Laura Carrozzi, Ferruccio Aquilini & Antonio Palla

  3. 1st Radiology Unit, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Paola Sbragia

Authors
  1. Chiara Romei
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  2. Laura Tavanti
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Correspondence to Chiara Romei.

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Romei, C., Tavanti, L., Sbragia, P. et al. Idiopathic interstitial pneumonias: do HRCT criteria established by ATS/ERS/JRS/ALAT in 2011 predict disease progression and prognosis?. Radiol med 120, 930–940 (2015). https://doi.org/10.1007/s11547-015-0526-0

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  • DOI: https://doi.org/10.1007/s11547-015-0526-0

Keywords

  • Idiopathic interstitial pneumonia
  • Usual interstitial pneumonia (UIP)
  • Idiopathic pulmonary fibrosis (IPF)
  • Prognosis