慢性过敏性肺炎：通过薄层CT与特发性肺纤维化和非特异性间质性肺炎进行鉴别

Chronic hypersensitivity pneumonitis: differentiation from idiopathic pulmonary fibrosis and nonspecific interstitial pneumonia by using thin-section CT.

作者信息

Silva C Isabela S, Müller Nestor L, Lynch David A, Curran-Everett Douglas, Brown Kevin K, Lee Kyung Soo, Chung Man Pyo, Churg Andrew

机构信息

Department of Radiology, Vancouver General Hospital, University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 4E3.

出版信息

Radiology. 2008 Jan;246(1):288-97. doi: 10.1148/radiol.2453061881.

DOI:10.1148/radiol.2453061881

PMID:18096541

Abstract

PURPOSE

To retrospectively assess the accuracy of thin-section computed tomography (CT) in distinguishing chronic hypersensitivity pneumonitis (HP) from idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonia (NSIP), with histologic results as the reference standard.

MATERIALS AND METHODS

This retrospective study was approved by the institutional research boards of the participating centers, and informed consent was waived. There was HIPAA compliance for all U.S. patients. The study included 66 patients (36 men, 30 women; mean age, 58.8 years +/- 10.9 [standard deviation]) with proved chronic HP (n = 18), IPF (n = 23), or NSIP (n = 25) who underwent CT. Two independent readers assessed the CT images, made a first-choice diagnosis, and noted the degree of confidence in the diagnosis. A general linear model was used to identify CT features that independently differentiated chronic HP from IPF and NSIP. Weighted kappa statistic was used to assess interobserver agreement.

RESULTS

The CT features that best differentiated chronic HP were lobular areas with decreased attenuation and vascularity, centrilobular nodules, and absence of lower zone predominance of abnormalities (P < or = .008). The features that best differentiated NSIP were relative subpleural sparing, absence of lobular areas with decreased attenuation, and lack of honeycombing (P < or = .002). The features that best differentiated IPF were basal predominance of honeycombing, absence of relative subpleural sparing, and absence centrilobular nodules (P < or = .004). A confident diagnosis was made in 70 (53%) of 132 readings. This diagnosis was correct in 66 (94%) of 70 readings. The accuracy for the entire cohort was 80%. Interobserver agreement for confident diagnosis was good to excellent (kappa = 0.77-0.96).

CONCLUSION

Characteristic CT features of chronic HP, IPF, and NSIP allow confident distinction between these entities in approximately 50% of patients.

摘要

目的

以组织学结果作为参考标准，回顾性评估薄层计算机断层扫描（CT）在鉴别慢性过敏性肺炎（HP）与特发性肺纤维化（IPF）及非特异性间质性肺炎（NSIP）方面的准确性。

材料与方法

本回顾性研究经参与中心的机构研究委员会批准，且豁免了知情同意书。所有美国患者均符合健康保险流通与责任法案（HIPAA）规定。该研究纳入了66例患者（36例男性，30例女性；平均年龄58.8岁±10.9[标准差]），这些患者均经证实患有慢性HP（n = 18）、IPF（n = 23）或NSIP（n = 25）并接受了CT检查。两名独立阅片者评估CT图像，做出首选诊断，并记录对诊断的信心程度。采用一般线性模型来识别能够独立区分慢性HP与IPF及NSIP的CT特征。加权kappa统计量用于评估观察者间的一致性。

结果

最能区分慢性HP的CT特征为肺小叶区域密度减低和血管减少、小叶中心结节以及异常在下肺区域无优势分布（P≤0.008）。最能区分NSIP的特征为相对胸膜下 sparing、无密度减低的肺小叶区域以及无蜂窝状改变（P≤0.002）。最能区分IPF的特征为蜂窝状改变以肺底部为主、无相对胸膜下 sparing以及无小叶中心结节（P≤0.004）。在132次读片中，70次（53%）做出了有信心的诊断。这70次诊断中有66次（94%）正确。整个队列的准确率为80%。观察者间对有信心诊断的一致性良好至优秀（kappa = 0.77 - 0.96）。