Abstract
Objectives:To describe the challenges inherent in diagnosing fibrosing lung diseases (FLD) on CT imaging and methodologies by which the diagnostic process may be simplified.Methods:Extensive searches in online scientific databases were performed to provide relevant and contemporary evidence that describe the current state of knowledge related to FLD diagnosis. This includes descriptions of the utility of a working diagnosis for an individual case discussed in a multidisciplinary team (MDT) setting and challenges associated with the lack of consensus guidelines for diagnosing chronic hypersensitivity pneumonitis.Results:As well as describing imaging features that indicate the presence of a fibrosing lung disease, those CT characteristics that nuance a diagnosis of the various FLDs are considered. The review also explains the essential information that a radiologist needs to convey to an MDT when reading a CT scan. Lastly, we provide some insights as to the future directions the field make take in the upcoming years.Conclusions:This review outlines the current state of FLD diagnosis and emphasizes areas where knowledge is limited, and more evidence is required. Fundamentally, however, it provides a guide for radiologists when tackling CT imaging in a patient with FLD.Advances in knowledge:This review encompasses advice from recent guideline statements and evidence from the latest studies in FLD to provide an up-to-date manual for radiologists to aid the diagnosis of FLD on CT imaging in an MDT setting.
Highlights
Interstitial lung diseases (ILD) comprise the spectrum of disorders that affect the connective tissue framework of the lungs, termed the pulmonary interstitium
Whilst there are many non-fibrotic ILDs, there are essentially eight FLDs which will be described in this review (Table 1)
A diagnosis of idiopathic pulmonary fibrosis (IPF) suggests a relentlessly progressive, aggressive disease where median survival might not extend beyond 5 years,[1] yet fibrosis in the context of sarcoidosis can be associated with a more benign disease course.[2]
Summary
To describe the challenges inherent in diagnosing fibrosing lung diseases (FLD) on CT imaging and methodologies by which the diagnostic process may be simplified. Methods: Extensive searches in online scientific databases were performed to provide relevant and contemporary evidence that describe the current state of knowledge related to FLD diagnosis. This includes descriptions of the utility of a working diagnosis for an individual case discussed in a multidisciplinary team (MDT) setting and challenges associated with the lack of consensus guidelines for diagnosing chronic hypersensitivity pneumonitis. Conclusions: This review outlines the current state of FLD diagnosis and emphasizes areas where knowledge is limited, and more evidence is required It provides a guide for radiologists when tackling CT imaging in a patient with FLD. Advances in knowledge: This review encompasses advice from recent guideline statements and evidence from the latest studies in FLD to provide an up-to-date manual for radiologists to aid the diagnosis of FLD on CT imaging in an MDT setting
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