Palmucci Stefano, Adorna Miriam, Rapisarda Angelica, Libra Alessandro, Fischetti Sefora, Sambataro Gianluca, Mauro Letizia Antonella, David Emanuele, Foti Pietro Valerio, Mattina Claudia, Spatola Corrado, Vancheri Carlo, Basile Antonio
Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia", University of Catania, 95123 Catania, Italy.
Pulmonary Imaging and Advanced Radiological Techniques Unit (UOSD IPTRA), 95123 Catania, Italy.
J Clin Med. 2025 Jun 12;14(12):4162. doi: 10.3390/jcm14124162.
: This study aims to distinguish radiological differences between primary idiopathic Usual Interstitial Pneumonia (UIP) and secondary UIP patterns : This retrospective study included patients with HRCT findings consistent with a UIP pattern. Final diagnoses were established via multidisciplinary discussion and classified as primary UIP/IPF or secondary UIP, following the 2022 ATS/ERS/JRS/ALAT guidelines. An expert thoracic radiologist (>10 years of experience), blinded to clinical data, reviewed the earliest available HRCT assessing key imaging features: honeycombing (micro-, macro- or exuberant), fibrosis distribution (symmetry, anterior-upper lobe sign, etc.), ground-glass opacities (GGO), dilatation of esophagus. Additionally, AI software AVIEW Build 1.1.46.28-win Coreline (©Coreline Soft Co., Ltd. All Rights Reserved). performed lung texture analysis, quantifying total lung volume and radiological patterns. Statistical analysis was performed to reveal results. : Among 53 cases, 31 were classified as IPF and 22 as secondary UIP cases. The expert radiologist achieved a diagnostic sensitivity of 82.9%, specificity of 889%, with a positive predictive value of 93.5%-in distinguishing between primary and secondary UIP. Primary UIP cases exhibited typical hallmark radiological features, including uniform honeycombing with cranio-caudal distribution (90.3%). Reticulations contributed significantly to the fibrotic texture, maintaining a consistent cranio-caudal gradient and axial symmetry (84.8%). Secondary UIP displayed more significant radiological heterogeneity, including patchy fibrosis with irregular GGO distribution (84.5% versus 53.33%); other findings-such as exuberant honeycombing, four corner sign and wedge-shaped fibrosis-were mainly observed in secondary pattern with respective percentages of 31.8%, 9% and 49%. : Experienced thoracic radiologists, leveraging hallmark imaging features, play a critical role in improving diagnostic accuracy between primary and secondary UIP patterns.
本研究旨在区分原发性特发性寻常型间质性肺炎（UIP）和继发性UIP模式之间的影像学差异：这项回顾性研究纳入了高分辨率计算机断层扫描（HRCT）表现符合UIP模式的患者。最终诊断通过多学科讨论确定，并根据2022年美国胸科学会（ATS）/欧洲呼吸学会（ERS）/日本呼吸学会（JRS）/拉丁美洲胸科协会（ALAT）指南分类为原发性UIP/特发性肺纤维化（IPF）或继发性UIP。一位对临床数据不知情的胸科放射学专家（经验超过10年）审查了最早可获得的HRCT，评估关键影像特征：蜂窝状改变（微蜂窝、大蜂窝或显著蜂窝）、纤维化分布（对称性、前上叶征等）、磨玻璃影（GGO）、食管扩张。此外，人工智能软件AVIEW Build 1.1.46.28-win Coreline（©Coreline Soft Co., Ltd.保留所有权利）进行了肺纹理分析，量化全肺容积和放射学模式。进行统计分析以揭示结果。：在53例病例中，31例被分类为IPF，22例为继发性UIP病例。专家放射科医生在区分原发性和继发性UIP方面的诊断敏感性为82.9%，特异性为88.9%，阳性预测值为93.5%。原发性UIP病例表现出典型的标志性放射学特征，包括头-尾分布的均匀蜂窝状改变（90.3%）。网状影对纤维化纹理有显著贡献，保持一致的头-尾梯度和轴向对称性（84.8%）。继发性UIP表现出更显著的放射学异质性，包括斑片状纤维化伴不规则GGO分布（84.5%对53.33%）；其他表现，如显著蜂窝状改变、四角征和楔形纤维化，主要在继发性模式中观察到，各自的百分比分别为31.8%、9%和49%。：经验丰富的胸科放射科医生利用标志性影像特征，在提高原发性和继发性UIP模式之间的诊断准确性方面发挥着关键作用。
