High-resolution chest tomography in idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia: utility and challenges.

PURPOSE OF REVIEW

High-resolution computed tomography (HRCT) scan is regarded as the imaging modality of choice to evaluate patients with known or suspected interstitial lung disease. With current technology, HRCT allows for detailed assessment of interstitial compartments. We examine recent data on its role in the diagnostic evaluation, clinical decision-making, and prognosis of patients with interstitial lung disease, and we highlight the challenges related to its application in this field.

RECENT FINDINGS

HRCT findings are either diagnostic or strongly suggestive of underlying pathologic patterns. By identifying the presence of certain characteristics, radiologists have developed a clearer understanding of HRCT patterns that coincide with underlying pathology. Challenges and controversies still remain, however. For example, recent studies indicate that the diagnostic accuracy and performance characteristics of HRCT depend predominantly on the study setting; intra-observer and inter-observer variability are less between academic radiologists than between community radiologists. Despite this, clinicians tend to rely primarily on HRCT when a radiologic pattern characteristic for histologic usual interstitial pneumonia is identified.

SUMMARY

Specific HRCT patterns help to differentiate and prognosticate different interstitial lung diseases. It is important for clinicians to understand the utility and limitations of HRCT in managing their patients. A multidisciplinary approach remains the gold standard.