Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Curr Opin Pulm Med. 2012 Sep;18(5):530-4. doi: 10.1097/MCP.0b013e3283568026.
Of the idiopathic interstitial pneumonias, the differentiation between idiopathic pulmonary fibrosis (IPF) and nonspecific interstitial pneumonitis (NSIP) raises considerable diagnostic challenges, as their clinical presentations share many overlapping features. IPF is a fibrosing pneumonia of unknown cause, showing a histologic pattern of usual interstitial pneumonia (UIP), and has a poorer prognosis than does NSIP. This review examines whether the radiographic features of IFP and NSIP as assessed by high-resolution computed tomography (HRCT) can be used to distinguish between these two entities.
The diagnostic accuracy of HRCT for UIP and NSIP has been reported to be approximately 70% in various studies. Disagreement between the HRCT diagnosis and the histologic diagnosis occurs in approximately one-third of the cases. The predominant feature of honeycombing on HRCT yields a specificity of approximately 95% and sensitivity of approximately 40% for UIP. In contrast, a predominant feature of ground glass opacities (GGOs) gives a sensitivity of approximately 95% and specificity of approximately 40% for NSIP.
The finding of honeycombing as the predominant HRCT feature suggests the diagnosis of UIP and may exclude the need for biopsy. Predominant features of GGOs are not specific enough to distinguish between NSIP and UIP.
在特发性间质性肺炎中，特发性肺纤维化（IPF）和非特异性间质性肺炎（NSIP）的鉴别存在相当大的诊断挑战，因为它们的临床表现有许多重叠的特征。特发性肺纤维化是一种病因不明的纤维性肺炎，表现为普通间质性肺炎（UIP）的组织学模式，预后比非特异性间质性肺炎差。这篇综述探讨了高分辨率计算机断层扫描（HRCT）评估的特发性肺纤维化和非特异性间质性肺炎的放射学特征是否可用于区分这两种疾病。
在不同的研究中，HRCT 对 UIP 和 NSIP 的诊断准确性约为 70%。HRCT 诊断与组织学诊断之间存在约三分之一的不一致。HRCT 上蜂窝状改变为主的特征对 UIP 的特异性约为 95%，敏感性约为 40%。相比之下，磨玻璃影（GGO）为主的特征对 NSIP 的敏感性约为 95%，特异性约为 40%。
HRCT 上以蜂窝状改变为主的特征提示 UIP 的诊断，可能排除了进行活检的必要性。以 GGO 为主的特征特异性不够强，不足以区分 NSIP 和 UIP。
