MacDonald S L, Rubens M B, Hansell D M, Copley S J, Desai S R, du Bois R M, Nicholson A G, Colby T V, Wells A U
Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England.
Radiology. 2001 Dec;221(3):600-5. doi: 10.1148/radiol.2213010158.
To compare the morphologic abnormalities on thin-section computed tomographic (CT) images in a group of patients with histopathologically confirmed nonspecific interstitial pneumonia (NSIP) or usual interstitial pneumonia (UIP) and a clinical presentation of idiopathic pulmonary fibrosis.
Thin-section CT imaging patterns and distribution of disease in 53 patients with histologic diagnoses of NSIP (n = 21) or UIP (n = 32) were quantified retrospectively and independently by four observers. The appearances of NSIP and UIP at CT were compared with univariate and multivariate techniques.
The use of thin-section CT proved to have moderate sensitivity (70%), specificity (63%), and accuracy (66%) in the diagnosis of NSIP. An increased proportion of ground-glass attenuation was the cardinal feature of NSIP at CT (odds ratio: 1.04 for each 1% increase in the proportion of ground-glass attenuation). A histologic diagnosis of NSIP was most frequent (in 24 of 35 observations [69%]) when ground-glass attenuation predominated, and was more frequent with mixed (35 of 79 observations [44%]) than with predominantly reticular disease (25 of 98 [26%] observations, P < .005). Logistic regression analysis of the data indicated that misdiagnosis of UIP in patients with NSIP was associated with less ground-glass attenuation (P < .005) at CT and a subpleural disease distribution (P = .02), with the converse being true for UIP cases misdiagnosed as NSIP.
In patients with a clinical presentation of idiopathic pulmonary fibrosis, the accuracy of thin-section CT in identifying NSIP is considerably higher than previously reported. At CT, NSIP is characterized by more ground-glass attenuation and a finer reticular pattern than is UIP. Nevertheless, considerable overlap in thin-section CT patterns exists between NSIP and UIP.
比较一组经组织病理学证实为非特异性间质性肺炎（NSIP）或寻常型间质性肺炎（UIP）且临床表现为特发性肺纤维化的患者在薄层计算机断层扫描（CT）图像上的形态学异常。
由四名观察者对53例经组织学诊断为NSIP（n = 21）或UIP（n = 32）的患者的薄层CT成像模式和疾病分布进行回顾性独立定量分析。采用单变量和多变量技术比较NSIP和UIP在CT上的表现。
薄层CT在NSIP诊断中显示出中等的敏感性（70%）、特异性（63%）和准确性（66%）。磨玻璃样衰减比例增加是NSIP在CT上的主要特征（磨玻璃样衰减比例每增加1%，优势比为1.04）。当磨玻璃样衰减为主时，NSIP的组织学诊断最为常见（35例观察中有24例[69%]），混合性病变时更常见（79例观察中有35例[44%]），而以网状病变为主时较少见（98例观察中有25例[26%]]]，P <.005）。对数据进行逻辑回归分析表明，NSIP患者误诊为UIP与CT上磨玻璃样衰减较少（P <.005）和胸膜下疾病分布有关（P =.02），而误诊为NSIP的UIP病例情况则相反。
在临床表现为特发性肺纤维化的患者中，薄层CT识别NSIP的准确性明显高于先前报道。在CT上，NSIP的特征是磨玻璃样衰减比UIP更多，网状模式更细。然而，NSIP和UIP在薄层CT模式上存在相当大的重叠。
