HRCT evaluation of patients with interstitial lung disease: comparison of the 2018 and 2011 diagnostic guidelines

Abstract

Background and aims: Chest high-resolution computed tomography (HRCT) is the central diagnostic tool in discerning idiopathic pulmonary fibrosis (IPF) from other interstitial lung disease (ILDs). In 2018, new guidelines were published and the nomenclature for HRCT interpretation was changed. We sought to evaluate how clinicians' interpretation would change based on reading HRCTs under the framework of the old versus new categorization.

Materials and methods: We collated HRCTs from 50 random cases evaluated in the Inova Fairfax ILD clinic. Six ILD experts were provided the deidentified HRCTs. They were all instructed to independently provide two reads of each HRCT, based on the old and the new guidelines.

Results: The kappa statistic for concordance for HRCT reads under old guidelines was 0.5, while for the new guidelines it was 0.38. Under the framework of the old guidelines, there were 22 HRCTs with unanimous consensus reads, while only 15 with the new guidelines. There were 12 HRCTs read unanimously as usual interstitial pneumonia (UIP) pattern based on both the old and the new guidelines. Ten HRCTs were read as a possible UIP pattern based on the old guidelines and were classified in nine cases as probable UIP and one indeterminate based on the new guidelines. Of the 28 inconsistent UIP HRCTs (old guidelines), 25 were read as alternative diagnosis suggested, two were read as indeterminate and one as probable UIP.

Conclusion: Implementation of the new guidelines to categorize HRCTs in ILD patients appears to be associated with greater inter-interpreter variability. How or whether new guidelines improve the care and management of ILD patients remains unclear.The reviews of this paper are available via the supplemental material section.

Keywords: high-resolution computed tomography; idiopathic pulmonary fibrosis; interstitial lung disease; usual interstitial pneumonia.

Conflict of interest statement

Conflict of interest statement: The following authors declare their conflict of interest: SDN is a consultant for Actelion, Bellerophon, Roche-Genentech, Boerhinger-Ingelheim, Pliant, Merck, United Therapeutics and Bayer Pharmaceuticals; he is also on the Speakers’ Bureau for Roche-Genentech, Boerhinger-Ingelheim, and Bayer Pharmaceuticals; JP has served as a consultant for Boerhinger-Ingelheim; CSK has served on an advisory board for Boerhinher-Ingelheim, Actelion and United Therapeutics; he is on the speakers’ bureau for Genentech; he has served as a consultant for the France Foundation. Other authors have no competing interest.

Figures

Figure 1.

Select baseline demographics, clinical characteristics, consensus computed tomography reads and final diagnoses of the 50 cases. AA, African-American; AIP, acute interstitial pneumonia; C, Caucasian; COP, cryptogenic organized pneumonia; CPFE, combined pulmonary fibrosis and emphysema; CTD, connective tissue disease; CTD-ILD, connective tissue disease related interstitial lung disease; DIP, desquamative interstitial pneumonia; HP, hypersensitivity pneumonitis; ILA, interstitial lung abnormalities; IPF, idiopathic pulmonary fibrosis; n, no; NSIP, non-specific interstitial pneumonia; RA-ILD, rheumatoid arthritis related interstitial lung disease; UIP, usual interstitial pneumonia; unk, unknown; VATS, video-assisted thoracoscopic surgery; y, yes.

Figure 2.

High resolution computed tomography interpretations of the six readers for each of the 50 cases under the guise of the old (a) and the new (b) guidelines. Each row of the two columns represents the same sequence of the 50 individual cases. UIP, usual interstitial pneumonia.

Figure 3.

Radiographic concordance heat maps of the individual high-resolution computed tomography features for each of the 50 cases. (a) Honeycombing, (b) traction bronchiectasis and (c) traction bronchiolectasis.