Hakan Sahin, Presenter: Nothing to Disclose

David Augustine Lynch MD, Abstract Co-Author: Nothing to Disclose

Kevin K Brown MD, Abstract Co-Author: Nothing to Disclose

Jason Vourlekis, Abstract Co-Author: Nothing to Disclose

Valerie A.E. Hale MD, Abstract Co-Author: Nothing to Disclose

Carlyne D Cool MD, Abstract Co-Author: Nothing to Disclose

Douglas Curran-Everett, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

The presence of histologic lung fibrosis in patients with chronic hypersensitivity pneumonitis (HP) is an important predictor of survival. The purpose of this study was to evaluate the correlation between CT features suggestive of fibrosis on HRCT and pathologic evidence of fibrosis on surgical lung biopsy, and to investigate the predictive value of a UIP pattern of HRCT on survival.

Twenty-six patients with a diagnosis of chronic HP by clinical criteria and surgical lung biopsy had their biopsies reviewed by a pulmonary pathologist for presence of fibrosis. Two radiologists systematically reviewed their HRCT scans. The combination of subpleural reticular abnormality and lower zone predominance was considered a typical usual interstitial pneumonia (UIP) pattern. HRCT features were correlated with the presence of fibrosis on biopsy, physiologic parameters and symptoms. The impact of a UIP pattern on survival was investigated using Kaplan-Meier analysis.

Fifteen patients had fibrotic HP (FHP) on biopsy, while 11 had non-fibrotic HP (NFHP). Patients with FHP had more extensive reticular abnormality on CT, and were more likely to have traction bronchiectasis and honeycombing than those with NFHP (p<0.001). Six cases (all with FHP) had a UIP pattern by HRCT (p=0.024). Median survival in patients with a UIP pattern on HRCT was 4.9 years, compared with 10.5 years for those without UIP. (p= 0.0014).

HRCT findings of extensive reticular abnormality, traction bronchiectasis, and honeycombing are excellent predictors of histologic fibrosis in chronic HP. A UIP pattern on HRCT is a predictor of shortened survival.

Sahin, H, Lynch, D, Brown, K, Vourlekis, J, Hale, V, Cool, C, Curran-Everett, D, et al, , Chronic Hypersensitivity Pneumonitis: Value of CT in Predicting Histology and Outcome.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4411660.html