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. 2015;88(1055):20150545.
doi: 10.1259/bjr.20150545. Epub 2015 Sep 21.

Visually stratified CT honeycombing as a survival predictor in combined pulmonary fibrosis and emphysema

Yong Seek Kim  1 , Gong Yong Jin  1 , Kum Ju Chae  1 , Young Min Han  1 , Su Bin Chon  1 , Young Sun Lee  1 , Keun Sang Kwon  2 , Hye Mi Choi  3
Affiliations

Visually stratified CT honeycombing as a survival predictor in combined pulmonary fibrosis and emphysema

Yong Seek Kim et al. Br J Radiol. 2015.

Abstract

Objective: To determine whether visually stratified CT findings and pulmonary function variables are helpful in predicting mortality in patients with combined pulmonary fibrosis and emphysema (CPFE).

Methods: We retrospectively identified 113 patients with CPFE who underwent high-resolution CT between January 2004 and December 2009. The extent of emphysema and fibrosis on CT was visually assessed using a 6- or 5-point scale, respectively. Univariate and multivariate Cox proportional regression analyses were performed to determine the prognostic value of visually stratified CT findings and pulmonary function variables in patients with CPFE. Differences in 5-year survival rates in patients with CPFE according to the extent of honeycombing were calculated using Kaplan-Meier analysis.

Results: An increase in the extent of visually stratified honeycombing on CT [hazard ratio (HR), 1.95; p = 0.018; 95% confidence interval (CI), 1.12-3.39] and reduced diffusing capacity of lung for carbon monoxide (DLCO) (HR, 0.97; p = 0.017; 95% CI, 0.94-0.99) were independently associated with increased mortality. In patients with CPFE, the 5-year survival rate was 78.5% for <5% honeycombing, 55.7% for 5-25% honeycombing, 32% for 26-50% honeycombing and 33.3% for >50% honeycombing on CT.

Conclusion: The >50% honeycombing on CT and reduced DLCO are important prognostic factors in CPFE.

Advances in knowledge: Visual estimation of honeycombing extent on CT can help in the prediction of prognosis in CPFE.

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Figures

Figure 1.
Figure 1.
Flow chart for selection of the study population. CPFE, combined pulmonary fibrosis and emphysema; HRCT, high-resolution CT.
Figure 2.
Figure 2.
Reference high-resolution CT images for visual assessment of emphysema and overall fibrosis. (a) The extent of emphysema was visually assessed using a 6-point scale in each lung lobe. (b) The extent of overall fibrosis was also assessed using a 5-point scale for whole lung.
Figure 3.
Figure 3.
Kaplan–Meier estimate of survival rate with respect to extent of honeycombing in patients with combined pulmonary fibrosis and emphysema. The 5-year survival rate was 78.5% in patients with honeycombing that was <5% in both lower lobes, 55.7% in patients with 5–25% honeycombing, 32% in patients with 26–50% honeycombing and 33.3% in patients with >50% honeycombing.
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