Tateishi Tomoya, Johkoh Takeshi, Sakai Fumikazu, Miyazaki Yasunari, Ogura Takashi, Ichikado Kazuya, Suda Takafumi, Taguchi Yoshio, Inoue Yoshikazu, Takemura Tamiko, Colby Thomas V, Sumikawa Hiromitsu, Fujimoto Kiminori, Arakawa Hiroaki, Raoof Suhail, Inase Naohiko
Department of Respiratory Medicine, Tokyo Medical and Dental University, 5-45 Yushima 1-chome, Bunkyo-ku, Tokyo, 113-8519, Japan.
Department of Radiology, Kansai Rosai Hospital, Hyogo, Japan.
Jpn J Radiol. 2020 Jun;38(6):524-532. doi: 10.1007/s11604-020-00932-6. Epub 2020 Feb 26.
Radiologic diagnosis of chronic hypersensitivity pneumonitis (CHP) presenting a usual interstitial pneumonia (UIP) pattern is challenging. The aim of this study was to identify the high-resolution CT (HRCT) findings which are useful to discriminate CHP-UIP from idiopathic pulmonary fibrosis (IPF).
This study included 49 patients with well-established bird-related CHP-UIP, histologically confirmed, and 49 patients with IPF. Two groups of observers independently assessed HRCT, evaluated the extent of each abnormal HRCT finding. When their radiological diagnosis was CHP-UIP, they noted the HRCT findings inconsistent with IPF.
Correct CT diagnoses were made in 79% of CHP-UIP and 53% of IPF. Although no apparent difference was seen in the extent of each HRCT finding, upper or mid-lung predominance, extensive ground-glass abnormality, and profuse micronodules were more frequently pointed out as inconsistent findings in CHP-UIP than IPF (p = 0.007, 0.010, 0.001, respectively). On regression analysis, profuse micronodules [OR 13.34 (2.85-62.37); p = 0.001] and upper or mid-lung predominance of findings [OR 2.86 (1.16-7.01); p = 0.022] remained as variables in the equation.
In this cohort, some IPF cases were misdiagnosed as CHP-UIP. Profuse micronodules and upper or mid-lung predominance are important clues for the differentiation of CHP-UIP from IPF.
对呈现普通型间质性肺炎（UIP）模式的慢性过敏性肺炎（CHP）进行放射学诊断具有挑战性。本研究的目的是确定有助于鉴别CHP-UIP与特发性肺纤维化（IPF）的高分辨率CT（HRCT）表现。
本研究纳入49例经组织学证实的确诊为与鸟类相关的CHP-UIP患者和49例IPF患者。两组观察者独立评估HRCT，评估每项HRCT异常表现的范围。当他们的放射学诊断为CHP-UIP时，记录与IPF不一致的HRCT表现。
CHP-UIP组的CT正确诊断率为79%，IPF组为53%。虽然每项HRCT表现的范围没有明显差异，但与IPF相比，CHP-UIP中更常指出上肺或中肺为主、广泛的磨玻璃样异常和大量微结节为不一致表现（分别为p = 0.007、0.010、0.001）。回归分析显示，大量微结节[比值比13.34（2.85 - 62.37）；p = 0.001]和上肺或中肺为主的表现[比值比2.86（1.16 - 7.01）；p = 0.022]仍为方程中的变量。
在该队列中，一些IPF病例被误诊为CHP-UIP。大量微结节以及上肺或中肺为主是鉴别CHP-UIP与IPF的重要线索。
