Radiodiagnostic and Radiotherapy Unit, University Hospital Policlinico-Vittorio Emanuele, Via Santa Sofia 78, 95123, Catania, Italy,
Insights Imaging. 2014 Jun;5(3):347-64. doi: 10.1007/s13244-014-0335-3. Epub 2014 May 22.
To illustrate the clinical and radiological features of idiopathic interstitial pneumonias (IIPs), according to the American Thoracic Society (ATS)/European Respiratory Society (ERS) classification updated in 2013.
IIPs include a subset of diffuse and restrictive lung diseases, resulting from damage to the parenchyma characterised by inflammation and fibrosis of the interstitium. Classification into major and rare IIPs is based on the 2013 ATS/ERS committee.
The diagnosis of idiopathic pulmonary fibrosis (IPF) needs to exclude other well-known causes of interstitial lung diseases. According to the 2011 evidence-based guidelines, usual interstitial pneumonia (UIP) can be diagnosed by HRCT when all criteria are fulfilled. Non-specific interstitial pneumonia (NSIP) is characterised by patchy ground-glass opacities and irregular linear/reticular opacities. The imaging patterns of respiratory bronchiolitis associated-interstitial lung disease (RB-ILD) and desquamative interstitial pneumonia (DIP) show centrolobular nodules and ground-glass opacities. Cryptogenic organising pneumonia (COP) consists of patchy peripheral or peribronchial consolidations, while ground-glass opacities are typically associated with diffuse lung consolidation, evolving to fibrosis, in acute interstitial pneumonia (AIP). Rare IIPs include lymphoid interstitial pneumonia and idiopathic pleuro-parenchymal fibroelastosis (IPPFE).
The knowledge of IIP imaging features on HRCT images help radiologists in diagnosis. Moreover, the overlap of imaging features needs a multidisciplinary approach.
• UIP findings are reticulations, bronchiectasis, honeycombing and absence of inconsistent features. • Bilateral patchy ground-glass areas represent the most encountered features in NSIP. • Poorly defined centrilobular nodules are typical of RB-ILD, whereas a ground-glass appearance is typical of DIP. • HRCT features of COP include characteristic peripheral or peribronchial patchy consolidations. • Rare IIPs include idiopathic LIP and idiopathic pleuro-parenchymal fibroelastosis (PPFE).
根据 2013 年美国胸科学会（ATS）/欧洲呼吸学会（ERS）更新的分类，说明特发性间质性肺炎（IIP）的临床和影像学特征。
IIP 包括一组弥漫性和限制性肺疾病，是由于实质损伤导致的炎症和间质纤维化引起的。根据 2013 年 ATS/ERS 委员会的分类，将其分为主要和罕见的 IIP。
特发性肺纤维化（IPF）的诊断需要排除其他已知的间质性肺病的原因。根据 2011 年循证指南，当满足所有标准时，高分辨率 CT（HRCT）可以诊断为寻常型间质性肺炎（UIP）。非特异性间质性肺炎（NSIP）的特征是斑片状磨玻璃影和不规则的线性/网状影。呼吸性细支气管炎相关间质性肺病（RB-ILD）和脱屑性间质性肺炎（DIP）的影像学模式表现为小叶中心结节和磨玻璃影。隐源性机化性肺炎（COP）表现为斑片状外周或支气管周围实变，而弥漫性肺实变中通常伴有磨玻璃影，在急性间质性肺炎（AIP）中进展为纤维化。罕见的 IIP 包括淋巴性间质性肺炎和特发性胸膜肺弹力纤维增生症（IPPFE）。
HRCT 图像上 IIP 的影像学特征有助于放射科医生进行诊断。此外，影像学特征的重叠需要多学科的方法。
UIP 的发现是网状影、支气管扩张、蜂窝肺和不存在不一致的特征。
双侧斑片状磨玻璃区是 NSIP 最常见的特征。
边界不清的小叶中心结节是 RB-ILD 的典型表现，而磨玻璃影是 DIP 的典型表现。
COP 的 HRCT 特征包括特征性的外周或支气管周围斑片状实变。
罕见的 IIP 包括特发性 LIP 和特发性胸膜肺弹力纤维增生症（PPFE）。
