Abstract
PurposeTo conduct a meta-analysis to determine specific computed tomography (CT) patterns and clinical features that discriminate between nonspecific interstitial pneumonia (NSIP) and usual interstitial pneumonia (UIP).Materials and methodsThe PubMed/Medline and Embase databases were searched for studies describing the radiological patterns of UIP and NSIP in chest CT images. Only studies involving histologically confirmed diagnoses and a consensus diagnosis by an interstitial lung disease (ILD) board were included in this analysis. The radiological patterns and patient demographics were extracted from suitable articles. We used random-effects meta-analysis by DerSimonian & Laird and calculated pooled odds ratios for binary data and pooled mean differences for continuous data.ResultsOf the 794 search results, 33 articles describing 2,318 patients met the inclusion criteria. Twelve of these studies included both NSIP (338 patients) and UIP (447 patients). NSIP-patients were significantly younger (NSIP: median age 54.8 years, UIP: 59.7 years; mean difference (MD) -4.4; p = 0.001; 95% CI: -6.97 to -1.77), less often male (NSIP: median 52.8%, UIP: 73.6%; pooled odds ratio (OR) 0.32; p<0.001; 95% CI: 0.17 to 0.60), and less often smokers (NSIP: median 55.1%, UIP: 73.9%; OR 0.42; p = 0.005; 95% CI: 0.23 to 0.77) than patients with UIP. The CT findings from patients with NSIP revealed significantly lower levels of the honeycombing pattern (NSIP: median 28.9%, UIP: 73.4%; OR 0.07; p<0.001; 95% CI: 0.02 to 0.30) with less peripheral predominance (NSIP: median 41.8%, UIP: 83.3%; OR 0.21; p<0.001; 95% CI: 0.11 to 0.38) and more subpleural sparing (NSIP: median 40.7%, UIP: 4.3%; OR 16.3; p = 0.005; 95% CI: 2.28 to 117).ConclusionHoneycombing with a peripheral predominance was significantly associated with a diagnosis of UIP. The NSIP pattern showed more subpleural sparing. The UIP pattern was predominantly observed in elderly males with a history of smoking, whereas NSIP occurred in a younger patient population.
Highlights
Idiopathic pulmonary fibrosis (IPF) constitutes the most prevalent type of idiopathic interstitial pneumonia (IIP), accounting for 55% of IIP cases [1]
NSIPpatients were significantly younger (NSIP: median age 54.8 years, usual interstitial pneumonia (UIP): 59.7 years; mean difference (MD) -4.4; p = 0.001; 95% CI: -6.97 to -1.77), less often male (NSIP: median 52.8%, UIP: 73.6%; pooled odds ratio (OR) 0.32; p
Due to the small number of studies, we performed a sensitivity analysis using the method of Paule-Mandel to assess robustness of pooled estimates, which yielded very similar results
Summary
Idiopathic pulmonary fibrosis (IPF) constitutes the most prevalent type of idiopathic interstitial pneumonia (IIP), accounting for 55% of IIP cases [1]. The prevalence of IPF in the USA is reported to be 63 cases per 100,000 population and up to 23.4 cases per 100,000 population in Europe. The incidence of IPF in the USA ranges from 6.8 to 17.4 per 100,000 population and 0.22–7.4 per 100,000 population in Europe [4]. The median survival time reported in recent studies ranges from 2 to 5 years, starting at the time of diagnosis; this survival time is worse than in patients with many types of cancer [5]. IPF is associated with the radiographic and pathological patterns known as usual interstitial pneumonia (UIP). The UIP pattern can be associated with several other entities, such as rheumatoid arthritis, certain medications or chronic hypersensitivity pneumonitis
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