Department of Clinical Sciences, Section of Diagnostic Imaging, University of Parma Padiglione Barbieri, University Hospital of Parma, V. Gramsci 14, 43100 Parma, Italy.
Radiology. 2010 Mar;254(3):957-64. doi: 10.1148/radiol.0990898.
To document the spectrum of misleading thin-section computed tomographic (CT) diagnoses in patients with biopsy-proved idiopathic pulmonary fibrosis (IPF).
This study had institutional review board approval, and patient consent was not required. Three observers, blinded to any clinical information and the purpose of the study, recorded thin-section CT differential diagnoses and assigned a percentage likelihood to each for a group of 123 patients (79 men, 44 women; age range, 27-82 years) with various chronic interstitial lung diseases, including a core group of 55 biopsy-proved cases of IPF. Patients with IPF in the core group, in whom IPF was diagnosed as low-grade probability (<30%) by at least two observers, were considered to have atypical IPF cases, and the alternative diagnoses were analyzed further.
Thirty-four (62%) of 55 biopsy-proved IPF cases were regarded as alternative diagnoses. In these atypical IPF cases, the first-choice diagnoses, expressed with high degree of probability, were nonspecific interstitial pneumonia (NSIP; 18 [53%] of 34), chronic hypersensitivity pneumonitis (HP; four [12%] of 34), sarcoidosis (three [9%] of 34), and organizing pneumonia (one [3%] of 34); in eight (23%) of 34 cases, no single diagnosis was favored by more than one observer. Frequent differential diagnoses, although not always the first-choice diagnosis, were NSIP (n = 29), chronic HP (n = 23), and sarcoidosis (n = 9).
In the correct clinical setting, a diagnosis of IPF is not excluded by thin-section CT appearances more suggestive of NSIP, chronic HP, or sarcoidosis. (c) RSNA, 2010.
记录经活检证实的特发性肺纤维化（IPF）患者中，有误导性的薄层 CT 诊断的表现谱。
本研究经机构审查委员会批准，无需患者同意。3 位观察者对各种慢性间质性肺疾病患者的薄层 CT 鉴别诊断进行了盲法记录，并对每种诊断的可能性进行了百分比赋值，共涉及 123 例患者（79 名男性，44 名女性；年龄 27~82 岁），其中包括一组 55 例经活检证实的 IPF 患者（核心组）。在核心组中，如果至少 2 位观察者诊断 IPF 的低度可能性（<30%），则认为 IPF 患者为非典型 IPF 病例，并进一步分析其他替代诊断。
55 例经活检证实的 IPF 病例中有 34 例（62%）被认为是其他诊断。在这些非典型 IPF 病例中，首选诊断为高度可能的非特异性间质性肺炎（NSIP，34 例中的 18 例[53%]）、慢性过敏性肺炎（HP，34 例中的 4 例[12%]）、结节病（34 例中的 3 例[9%]）和机化性肺炎（34 例中的 1 例[3%]）；在 34 例中有 8 例（23%）没有一位观察者首选单一诊断。尽管并非总是首选诊断，但常见的鉴别诊断包括 NSIP（n=29）、慢性 HP（n=23）和结节病（n=9）。
在正确的临床环境下，特发性肺纤维化的 CT 表现更倾向于非特异性间质性肺炎、慢性过敏性肺炎或结节病时，并不排除该诊断。（c）RSNA，2010。
