From the Departments of Medicine (D.A., T.E.K., H.R.C., J.S.L.) and Radiology (B.M.E., T.H.U.), University of California, San Francisco, Calif; Department of Laboratory Medicine and Pathology, Mayo Clinic, Phoenix, Ariz (T.V.C.); Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, 388-1 Pungnap-2dong, Songpa-gu, Seoul 138-736, Korea (B.H.K., D.S.K.); and Department of Medicine, Mayo Clinic, Rochester, Minn (J.H.R.).
Radiology. 2014 Feb;270(2):583-8. doi: 10.1148/radiol.13130187. Epub 2013 Oct 28.
To determine the accuracy of computed tomography (CT) in identifying the histopathologic usual interstitial pneumonia (UIP) pattern in rheumatoid arthritis-associated interstitial lung disease (RA-ILD).
All patients were enrolled into institutional review board-approved longitudinal cohorts at their respective institution, and informed consent was obtained at the time of enrollment. Images of patients with surgical lung biopsy-proved RA-ILD (n = 69) were collected from three tertiary care centers. Two experienced thoracic radiologists independently reviewed the CT scans. The CT pattern was categorized as definite UIP, possible UIP, or inconsistent with UIP in accordance with published criteria. Findings of biopsies were reviewed by an experienced lung pathologist. The sensitivity and specificity of definite CT UIP pattern to histopathologic UIP pattern were determined. The agreement between radiologists was assessed by calculating a κ score.
The histopathologic UIP pattern was present in 42 of 69 (61%) patients. Men were more likely than women to have a histopathologic UIP pattern (P = .02). Twenty patients (29%, 20 of 69) had a definite UIP pattern on CT scans. The specificity of CT UIP pattern was 96% (26 of 27; 95% confidence interval [CI]: 81%, 100%), with a negative predictive value of 53% (26 of 49). The sensitivity of CT UIP pattern was 45% (19 of 42; 95% CI: 30%, 61%), with a positive predictive value of 95% (19 of 20). The agreement between radiologists for definite UIP pattern versus not was 87% (κ = 0.67, P < .0001).
Definite UIP pattern on a CT scan in RA-ILD is highly specific and moderately sensitive for histopathologic UIP pattern. CT can therefore help accurately identify the UIP pattern in RA-ILD.
确定计算机断层扫描（CT）在识别类风湿关节炎相关间质性肺病（RA-ILD）中组织病理学普通间质性肺炎（UIP）模式的准确性。
所有患者均被纳入各自机构的机构审查委员会批准的纵向队列中，并在入组时获得了知情同意。从三个三级保健中心收集了经手术肺活检证实的 RA-ILD 患者（n = 69）的图像。两名经验丰富的胸部放射科医生独立审查了 CT 扫描。根据发表的标准，将 CT 模式分为明确 UIP、可能 UIP 或与 UIP 不一致。由一位经验丰富的肺病理学家审查活检结果。确定 CT 明确 UIP 模式对组织病理学 UIP 模式的敏感性和特异性。通过计算κ评分评估放射科医生之间的一致性。
69 例患者中有 42 例（61%）存在组织病理学 UIP 模式。男性比女性更有可能出现组织病理学 UIP 模式（P =.02）。20 例（29%，69 例中有 20 例）在 CT 扫描上有明确的 UIP 模式。CT UIP 模式的特异性为 96%（26/27；95%置信区间[CI]：81%，100%），阴性预测值为 53%（26/49）。CT UIP 模式的敏感性为 45%（26/42；95%CI：30%，61%），阳性预测值为 95%（20/20）。放射科医生对明确 UIP 模式与非明确 UIP 模式的一致性为 87%（κ = 0.67，P <.0001）。
RA-ILD 中 CT 扫描上明确的 UIP 模式对组织病理学 UIP 模式具有高度特异性和中等敏感性。因此，CT 可帮助准确识别 RA-ILD 中的 UIP 模式。
