Nick J Screaton MD, Presenter: Nothing to Disclose

Fiona N. Miller MD, Abstract Co-Author: Nothing to Disclose

Bip Patel MD, Abstract Co-Author: Nothing to Disclose

Ashley Groves MD, Abstract Co-Author: Nothing to Disclose

Angela D. Tasker MD, Abstract Co-Author: Nothing to Disclose

David John Lomas MD, Abstract Co-Author: Nothing to Disclose

Most HRCT studies assess diagnostic performance. This study evaluates the diagnostic and therapeutic impact of HRCT.

Prospective observational study of all patients referred by respirologists for HRCT over 12 months. Respirologists completed questionnaires both before and following HRCT recording: differential diagnosis, level of confidence (0-10), and proposed investigation / management.The 5 most frequent first choice pre-HRCT diagnoses were bronchiectasis (n=99), emphysema (n=40), UIP (n=40), sarcoidosis (n=21), and hypersensitivity pneumonitis (n=12). Specific diagnoses were amalgamated into 8 diagnostic groups: airways, interstitial, mixed airways / interstitial, emphysema, infective, vascular, neoplastic and others. Patients were assigned diagnostic groups according to the maximum diagnostic confidence recorded. Treatments and investigations were assigned levels (0-3) according to their invasiveness. Changes in leading diagnosis, diagnostic group, diagnostic confidence, proposed investigations and management, before and after HRCT were assessed.

Complete data were available for 354 studies in 347 patients. Mean age 59 (range 17-70) years.Diagnostic Impact: Diagnostic confidence in the leading diagnosis increased following HRCT from 6.7 to 8.5 (pThe pre-HRCT diagnosis was retained post HRCT, or introduced as the first choice diagnosis post HRCT () respectively in: 39% (26%) bronchiectasis, 65% (46%) emphysema, 28% (42%)UIP, 90% (21%)sarcoidosis , and 42% (29%)hypersensitivity pneumonitis.Therapeutic impact:Following HRCT treatment plan changed in 90% and level of treatment changed in 49%, with a major change in treatment level in 16% of patients.

HRCT significantly increases diagnostic confidence, and commonly alters diagnosis and management in patients with suspected respiratory disease. The frequency of change in diagnosis following HRCT is incluenced by the initial leading diagnosis or diagnostic group.

Screaton, N, Miller, F, Patel, B, Groves, A, Tasker, A, Lomas, D, The Diagnostic and Therapeutic Impact of HRCT in Patients with Suspected Respiratory Disease.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4411620.html