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. 2020 Jun;38(6):524-532.
doi: 10.1007/s11604-020-00932-6. Epub 2020 Feb 26.

High-resolution CT features distinguishing usual interstitial pneumonia pattern in chronic hypersensitivity pneumonitis from those with idiopathic pulmonary fibrosis

Tomoya Tateishi  1 , Takeshi Johkoh  2 , Fumikazu Sakai  3 , Yasunari Miyazaki  4 , Takashi Ogura  5 , Kazuya Ichikado  6 , Takafumi Suda  7 , Yoshio Taguchi  8 , Yoshikazu Inoue  9 , Tamiko Takemura  10 , Thomas V Colby  11 , Hiromitsu Sumikawa  12 , Kiminori Fujimoto  13 , Hiroaki Arakawa  14 , Suhail Raoof  15 , Naohiko Inase  4
Affiliations

High-resolution CT features distinguishing usual interstitial pneumonia pattern in chronic hypersensitivity pneumonitis from those with idiopathic pulmonary fibrosis

Tomoya Tateishi et al. Jpn J Radiol. 2020 Jun.

Abstract

Purpose: 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).

Materials and methods: 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.

Results: 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.

Conclusion: 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.

Keywords: High-resolution computed tomography (HRCT); Hypersensitivity pneumonitis; Profuse micronodules; Usual interstitial pneumonia (UIP).

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