Skip to main content

Advertisement

SpringerLink
Log in

High-resolution CT features distinguishing usual interstitial pneumonia pattern in chronic hypersensitivity pneumonitis from those with idiopathic pulmonary fibrosis

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

Radiologic diagnosis of chronic hypersensitivity pneumonitis (CHP) presenting a usual interstitial pneumonia (UIP) pattern is challenging. The aim of this study was to identify the high-resolution CT (HRCT) findings which are useful to discriminate CHP–UIP from idiopathic pulmonary fibrosis (IPF).

Materials and methods

This study included 49 patients with well-established bird-related CHP–UIP, histologically confirmed, and 49 patients with IPF. Two groups of observers independently assessed HRCT, evaluated the extent of each abnormal HRCT finding. When their radiological diagnosis was CHP–UIP, they noted the HRCT findings inconsistent with IPF.

Results

Correct CT diagnoses were made in 79% of CHP–UIP and 53% of IPF. Although no apparent difference was seen in the extent of each HRCT finding, upper or mid-lung predominance, extensive ground-glass abnormality, and profuse micronodules were more frequently pointed out as inconsistent findings in CHP–UIP than IPF (p = 0.007, 0.010, 0.001, respectively). On regression analysis, profuse micronodules [OR 13.34 (2.85–62.37); p = 0.001] and upper or mid-lung predominance of findings [OR 2.86 (1.16–7.01); p = 0.022] remained as variables in the equation.

Conclusion

In this cohort, some IPF cases were misdiagnosed as CHP–UIP. Profuse micronodules and upper or mid-lung predominance are important clues for the differentiation of CHP–UIP from IPF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Fink J. Hypersensitivity pneumonitis. J Allergy Clin Immunol. 1984;74(1):1–10.

    Article  CAS  Google Scholar 

  2. Tateishi T, Ohtani Y, Takemura T, Akashi T, Miyazaki Y, Inase N, et al. Serial high-resolution computed tomography findings of acute and chronic hypersensitivity pneumonitis induced by avian antigen. J Comput Assist Tomogr. 2011;35(2):272–9.

    Article  Google Scholar 

  3. Lynch DA, Newell JD, Logan PM, King TE Jr, Muller NL. Can CT distinguish hypersensitivity pneumonitis from idiopathic pulmonary fibrosis? AJR Am J Roentgenol. 1995;165(4):807–11.

    Article  CAS  Google Scholar 

  4. Vasakova M, Morell F, Walsh S, Leslie K, Raghu G. Hypersensitivity pneumonitis: perspectives in diagnosis and management. Am J Respir Crit Care Med. 2017;196(6):680–9.

    Article  Google Scholar 

  5. Silva CI, Muller NL, Lynch DA, Curran-Everett D, Brown KK, Lee KS, et al. Chronic hypersensitivity pneumonitis: differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT. Radiology. 2008;246(1):288–97.

    Article  Google Scholar 

  6. Buschman DL, Gamsu G, Waldron JA Jr, Klein JS, King TE Jr. Chronic hypersensitivity pneumonitis: use of CT in diagnosis. AJR Am J Roentgenol. 1992;159(5):957–60.

    Article  CAS  Google Scholar 

  7. Adler B, Padley S, Müller N, Remy-Jardin M, Remy J. Chronic hypersensitivity pneumonitis: high-resolution CT and radiographic features in 16 patients. Radiology. 1992;185(1):91–5.

    Article  CAS  Google Scholar 

  8. Akira M, Kita N, Higashihara T, Sakatani M, Kozuka T. Summer-type hypersensitivity pneumonitis: comparison of high-resolution CT and plain radiographic findings. AJR Am J Roentgenol. 1992;158(6):1223–8.

    Article  CAS  Google Scholar 

  9. Remy-Jardin M, Remy J, Wallaert B, Muller NL. Subacute and chronic bird breeder hypersensitivity pneumonitis: sequential evaluation with CT and correlation with lung function tests and bronchoalveolar lavage. Radiology. 1993;189(1):111–8.

    Article  CAS  Google Scholar 

  10. Patel RA, Sellami D, Gotway MB, Golden JA, Webb WR. Hypersensitivity pneumonitis: patterns on high-resolution CT. J Comput Assist Tomogr. 2000;24(6):965–70.

    Article  CAS  Google Scholar 

  11. Morell F, Villar A, Montero MA, Munoz X, Colby TV, Pipvath S, et al. Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study. Lancet Respir Med. 2013;1(9):685–94.

    Article  Google Scholar 

  12. Ohtani Y, Saiki S, Kitaichi M, Usui Y, Inase N, Costabel U, et al. Chronic bird fancier's lung: histopathological and clinical correlation. An application of the 2002 ATS/ERS consensus classification of the idiopathic interstitial pneumonias. Thorax. 2005;60(8):665–71.

    Article  CAS  Google Scholar 

  13. Ohtani Y, Saiki S, Sumi Y, Inase N, Miyake S, Costabel U, et al. Clinical features of recurrent and insidious chronic bird fancier's lung. Ann Allergy Asthma Immunol. 2003;90(6):604–10.

    Article  Google Scholar 

  14. Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183(6):788–824.

    Article  Google Scholar 

  15. Raghu G, Remy-Jardin M, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, et al. Diagnosis of idiopathic pulmonary fibrosis. An official ATS/ERS/JRS/ALAT clinical practice guideline. Am J Respir Crit Care Med. 2018;198(5):e44–e68.

    Article  Google Scholar 

  16. Sumikawa H, Johkoh T, Ichikado K, Taniguchi H, Kondoh Y, Fujimoto K, et al. Usual interstitial pneumonia and chronic idiopathic interstitial pneumonia: analysis of CT appearance in 92 patients. Radiology. 2006;241(1):258–66.

    Article  Google Scholar 

  17. Sumikawa H, Johkoh T, Colby TV, Ichikado K, Suga M, Taniguchi H, et al. Computed tomography findings in pathological usual interstitial pneumonia: relationship to survival. Am J Respir Crit Care Med. 2008;177(4):433–9.

    Article  Google Scholar 

  18. Ohtani Y, Kojima K, Sumi Y, Sawada M, Inase N, Miyake S, et al. Inhalation provocation tests in chronic bird fancier's lung. Chest. 2000;118(5):1382–9.

    Article  CAS  Google Scholar 

  19. Takemura T, Akashi T, Kamiya H, Ikushima S, Ando T, Oritsu M, et al. Pathological differentiation of chronic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis/usual interstitial pneumonia. Histopathology. 2012;61(6):1026–35.

    Article  Google Scholar 

  20. Austin J, Müller N, Friedman P, Hansell D, Naidich D, Remy-Jardin M, et al. Glossary of terms for CT of the lungs: recommendations of the Nomenclature Committee of the Fleischner Society. Radiology. 1996;200(2):327–31.

    Article  CAS  Google Scholar 

  21. Ichikado K, Johkoh T, Ikezoe J, Takeuchi N, Kohno N, Arisawa J, et al. Acute interstitial pneumonia: high-resolution CT findings correlated with pathology. AJR Am J Roentgenol. 1997;168(2):333–8.

    Article  CAS  Google Scholar 

  22. Ichikado K, Suga M, Muller NL, Taniguchi H, Kondoh Y, Akira M, et al. Acute interstitial pneumonia: comparison of high-resolution computed tomography findings between survivors and nonsurvivors. Am J Respir Crit Care Med. 2002;165(11):1551–6.

    Article  Google Scholar 

  23. Ichikado K, Suga M, Muranaka H, Gushima Y, Miyakawa H, Tsubamoto M, et al. Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology. 2006;238(1):321–9.

    Article  Google Scholar 

  24. Mai C, Verleden SE, McDonough JE, Willems S, De Wever W, Coolen J, et al. Thin-section CT features of idiopathic pulmonary fibrosis correlated with micro-CT and histologic analysis. Radiology. 2017;283(1):252–63.

    Article  Google Scholar 

  25. Franquet T, Hansell DM, Senbanjo T, Remy-Jardin M, Muller NL. Lung cysts in subacute hypersensitivity pneumonitis. J Comput Assist Tomogr. 2003;27(4):475–8.

    Article  Google Scholar 

  26. Lynch DA, Sverzellati N, Travis WD, Brown KK, Colby TV, Galvin JR, et al. Diagnostic criteria for idiopathic pulmonary fibrosis: a Fleischner Society white paper. Lancet Respir Med. 2018;6(2):138–53.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, Tokyo Medical and Dental University, 5-45 Yushima 1-chome, Bunkyo-ku, Tokyo, 113-8519, Japan

    Tomoya Tateishi, Yasunari Miyazaki & Naohiko Inase

  2. Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan

    Takeshi Johkoh

  3. Department of Diagnostic Radiology, Saitama Medical University, Saitama, Japan

    Fumikazu Sakai

  4. Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan

    Takashi Ogura

  5. Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan

    Kazuya Ichikado

  6. Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Takafumi Suda

  7. Department of Respiratory Medicine, Tenri Hospital, Nara, Japan

    Yoshio Taguchi

  8. Clinical Research Center, National Hospital Organization, Kinki-Chuo Chest Medical Center, Osaka, Japan

    Yoshikazu Inoue

  9. Department of Pathology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Kanagawa, Japan

    Tamiko Takemura

  10. Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Arizona, USA

    Thomas V. Colby

  11. Department of Radiology, Sakai City Medical Center, Osaka, Japan

    Hiromitsu Sumikawa

  12. Department of Radiology, Kurume University School of Medicine, Fukuoka, Japan

    Kiminori Fujimoto

  13. Department of Radiology, Dokkyo Medical University School of Medicine, Tochigi, Japan

    Hiroaki Arakawa

  14. Division of Pulmonary Medicine, Lenox Hill Hospital, New York, NY, USA

    Suhail Raoof

Authors
  1. Tomoya Tateishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Johkoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fumikazu Sakai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasunari Miyazaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Ogura
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazuya Ichikado
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takafumi Suda
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yoshio Taguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Yoshikazu Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tamiko Takemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Thomas V. Colby
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Hiromitsu Sumikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Kiminori Fujimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hiroaki Arakawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Suhail Raoof
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Naohiko Inase
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tomoya Tateishi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest in this study.

Ethical approval

This research protocol was approved by the committees on human research in six institutes, and general approval number was M2000-1167. This was a retrospective study, and the requirement for written informed consent was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tateishi, T., Johkoh, T., Sakai, F. et al. High-resolution CT features distinguishing usual interstitial pneumonia pattern in chronic hypersensitivity pneumonitis from those with idiopathic pulmonary fibrosis. Jpn J Radiol 38, 524–532 (2020). https://doi.org/10.1007/s11604-020-00932-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-020-00932-6

Keywords

Search

Navigation