Idiopathic nonspecific interstitial pneumonia: changes in high-resolution computed tomography on long-term follow-up.
ABSTRACT This study aimed to assess the change in findings of nonspecific interstitial pneumonia (NSIP) from high-resolution computed tomography (HRCT) on long-term follow-up (median, 38 months).
A retrospective review of changes in HRCT in 68 patients with NSIP (fibrotic progression, 61) with follow-up HRCT of at least 1-year interval was conducted.
Follow-up HRCT findings showed a decreased extent of ground-glass opacity and consolidation, with increased honeycombing, traction bronchiectasis, and architectural distortion (all P < 0.05). Radiological improvement was seen in 36%, stability was seen in 23%, and fibrotic progression was seen with recurrence in 13% and without recurrence in 28%. In 3 patients (4.9%), HRCT converted to a definite usual interstitial pneumonia pattern. Honeycombing and reticulation were independent predictors for mortality in fibrotic NSIP (P < 0.01).
Although most of the follow-up HRCT scans showed improvement in the extent of ground-glass opacity and consolidation, approximately one third showed fibrotic progression or recurrence, with transition from NSIP to definite usual interstitial pneumonia pattern.
- SourceAvailable from: v1.apebble.com[show abstract] [hide abstract]
ABSTRACT: The syndrome resulting from combined pulmonary fibrosis and emphysema has not been comprehensively described. The current authors conducted a retrospective study of 61 patients with both emphysema of the upper zones and diffuse parenchymal lung disease with fibrosis of the lower zones of the lungs on chest computed tomography. Patients (all smokers) included 60 males and one female, with a mean age of 65 yrs. Dyspnoea on exertion was present in all patients. Basal crackles were found in 87% and finger clubbing in 43%. Pulmonary function tests were as follows (mean+/-sd): total lung capacity 88%+/-17, forced vital capacity (FVC) 88%+/-18, forced expiratory volume in one second (FEV1) 80%+/-21 (% predicted), FEV1/FVC 69%+/-13, carbon monoxide diffusion capacity of the lung 37%+/-16 (% predicted), carbon monoxide transfer coefficient 46%+/-19. Pulmonary hypertension was present in 47% of patients at diagnosis, and 55% during follow-up. Patients were followed for a mean of 2.1+/-2.8 yrs from diagnosis. Survival was 87.5% at 2 yrs and 54.6% at 5 yrs, with a median of 6.1 yrs. The presence of pulmonary hypertension at diagnosis was a critical determinant of prognosis. The authors hereby individualise the computer tomography-defined syndrome of combined pulmonary fibrosis and emphysema characterised by subnormal spirometry, severe impairment of gas exchange, high prevalence of pulmonary hypertension, and poor survival.European Respiratory Journal 11/2005; 26(4):586-93. · 6.36 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: Nonspecific interstitial pneumonia (NSIP) has been proposed as a histologic subtype of idiopathic interstitial pneumonia with lung biopsy findings that are inconsistent with those of other idiopathic interstitial pneumonias. NSIP has a broad spectrum of histologic findings and a variable prognosis. The aim of this study was to determine whether it would be preferable to subdivide NSIP into cellular and fibrosing patterns. The authors classified lung biopsies from 101 patients with idiopathic interstitial lung disease as having histologic patterns of desquamative interstitial pneumonia (DIP), usual interstitial pneumonia (UIP), or cellular or fibrosing NSIP. Survival analysis was performed using the Kaplan-Meier method. Due to histologic, clinical, and survival similarities, the patients with idiopathic NSIP with lung biopsies that showed fibrosing as well as fibrosing and cellular patterns were combined into a single group of NSIP, fibrosing pattern. Of the 101 patients, 16 patients (9 women, 7 men) had idiopathic DIP; 56 patients (17 women, 39 men) had idiopathic UIP; 22 patients (7 women, 15 men) had idiopathic NSIP, fibrosing pattern; and 7 patients (2 women, 5 men) had idiopathic NSIP, cellular pattern. The patients had a mean age of 42, 51, 50, and 39 years respectively. Patients with idiopathic NSIP, cellular pattern had a better 5- and 10-year survival than those with idiopathic NSIP, fibrosing pattern (100% vs 90% and 100% vs 35% respectively, p = 0.027). Survival of patients with idiopathic UIP was worse than that of patients with idiopathic NSIP, fibrosing pattern (p = 0.014). The difference, however, was more evident at 5 years (43% vs 90%) than at 10 years (15% vs 35%). The 5- and 10-year survival of patients with idiopathic NSIP, cellular pattern and DIP was 100%, which was significantly better than that of patients with idiopathic UIP (p <0.0001). Based on these data, NSIP should be separated into cellular and fibrosing patterns, because these histologic patterns are associated with different clinical characteristics and prognoses.American Journal of Surgical Pathology 02/2000; 24(1):19-33. · 4.87 Impact Factor
- [show abstract] [hide abstract]
ABSTRACT: To characterize thin-section computed tomographic (CT) findings of pathologic subgroups of nonspecific interstitial pneumonia (NIP) in a sizeable number of patients. The study included 55 cases of pathologically proven NIP. The 55 cases were categorized histologically into four grades: grade 1, interstitial inflammation without fibrosis (n = 6); grade 2, interstitial inflammation predominating over fibrosis (n = 16); grade 3, fibrosis predominating over inflammation (n = 5); and grade 4, fibrosis only (n = 28). Two independent observers evaluated the presence, extent, and distribution of various CT findings. Thin-section CT findings and histologic grades were compared by using the Spearman rank correlation coefficient. Observer agreement was assessed. Areas with ground-glass attenuation and architectural distortion were present in all 55 patients. Traction bronchiectasis and intralobular reticular opacities were seen in 52 and 48 patients, respectively. The extent of traction bronchiectasis (r = 0.68; P <.001) and intralobular reticular opacities (r = 0.35; P <.05) correlated with the histologic grade. Honeycombing was seen in 12 (43%) of 28 patients with grade 4 NIP and in three (11%) of the remaining 27 patients (chi(2) test, P <.001). There was good agreement between the observers for the presence (kappa = 0.7-1.0) and extent (Spearman rank correlation; r = 0.87-0.98; P <.001) of various abnormalities. The extent of traction bronchiectasis and intralobular reticulation at thin-section CT correlates with increased fibrosis in NIP. Honeycombing is seen almost exclusively in patients with fibrotic NIP.Radiology 11/2002; 225(1):199-204. · 6.34 Impact Factor