Imaging Of Interstitial Lung Disease Research Articles

Advances in the diagnosis of multiorgan involvement in systemic sclerosis: a focus on MRI.

Systemic sclerosis (SSc) is a rare chronic multisystem autoimmune disease characterized by endothelial dysfunction, tissue hypoxia, and diffuse organ fibrosis. MRI provides a radiation free approach to noninvasively assess the key manifestations of SSc in multiple organs. The purpose of this review is to summarize recent advances in MRI techniques to provide diagnostic and prognostic information in patients with SSc. MRI can probe processes that play a key role in the development of SSc-related complications, including neointima proliferation, fibrosis, and hypoxia. Feature tracking and parametric mapping MRI can detect cardiac involvement at the subclinical level. Contrast-free MRI angiography with Digital Artery Volume Index (DAVIX) assessment allow comprehensive assessment of hand involvement. T1 mapping and BOLD imaging can assess SSc effects on skeletal muscle, and lung MRI is becoming a key method for imaging of interstitial lung disease. As a new exciting application, the sodium content of the skin can be quantified by 23Na MRI reflective of glycosaminoglycan content. Recent advances in MRI provide a unique opportunity to study the key pathophysiologic processes and clinical manifestations of SSc in multiple organs noninvasively, which can pave the way for the development of effective therapies.

Ultra-high resolution CT imaging of interstitial lung disease: impact of photon-counting CT in 112 patients.

To compare lung parenchyma analysis on ultra-high resolution (UHR) images of a photon-counting CT (PCCT) scanner with that of high-resolution (HR) images of an energy-integrating detector CT (EID-CT). A total of 112 patients with stable interstitial lung disease (ILD) were investigated (a) at T0 with HRCT on a 3rd-generation dual-source CT scanner; (b) at T1 with UHR on a PCCT scanner; (c) with a comparison of 1-mm-thick lung images. Despite a higher level of objective noise at T1 (74.1 ± 14.1 UH vs 38.1 ± 8.7UH; p < 0.0001), higher qualitative scores were observed at T1 with (a) visualization of more distal bronchial divisions (median order; Q1-Q3) (T1: 10th division [9-10]; T0: 9th division [8-9]; p < 0.0001); (b) greater scores of sharpness of bronchial walls (p < 0.0001) and right major fissure (p < 0.0001). The scores of visualization of CT features of ILD were significantly superior at T1 (micronodules: p = 0.03; linear opacities, intralobular reticulation, bronchiectasis, bronchiolectasis, and honeycombing: p < 0.0001), leading to the reclassification of 4 patients with non-fibrotic ILD at T0, recognized with fibrotic ILD at T1. At T1, the mean (± SD) radiation dose (CTDI vol: 2.7 ± 0.5mGy; DLP: 88.5 ± 21mGy.cm) was significantly lower than that delivered at T0 (CTDI vol: 3.6 ± 0.9mGy; DLP: 129.8 ± 31.7mGy.cm) (p < 0.0001), corresponding to a mean reduction of 27% and 32% for the CTDIvol and DLP, respectively. The UHR scanning mode of PCCT allowed a more precise depiction of CT features of ILDs and reclassification of ILD patterns with significant radiation dose reduction. Evaluation of lung parenchymal structures with ultra-high-resolution makes subtle changes at the level of the secondary pulmonary lobules and lung microcirculation becoming visually accessible, opening new options for synergistic collaborations between highly-detailed morphology and artificial intelligence. • Photon-counting CT (PCCT) provides a more precise analysis of lung parenchymal structures and CT features of interstitial lung diseases (ILDs). • The UHR mode ensures a more precise delineation of fine fibrotic abnormalities with the potential of modifying the categorization of ILD patterns. • Better image quality at a lower radiation dose with PCCT opens new horizons for further dose reduction in noncontrast UHR examinations.

TWO TO TANGO: A MEDLEY OF HYPERSENSITIVITY PNEUMONITIS AND IDIOPATHIC PULMONARY FIBROSIS

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Interstitial Lung Disease (ILD) is a broad group of heterogeneous disorders that share certain pathologic features. Categorization of ILD always necessitates a thorough history, but diagnosis also relies on serologic testing, high-resolution CT, and sometimes bronchoalveolar lavage. When etiology of disease remains unclear, lung biopsy can provide clarity. CASE PRESENTATION: An 81-year-old male presented to the ED with one-year history of dyspnea and productive cough. He had history of large B-cell lymphoma treated with chemotherapy in remission and persistent atrial fibrillation status post cardioversion and intermittent amiodarone use in the last year. The patient noted a steady decline in functional status over several months, but reported to the ED after noting an oxygen saturation at home of 75%. He denied fevers, chills, night sweats, but did endorse recent weight loss. He denied use of tobacco, alcohol, drugs, or recent travel. He denied pet, dander, smoke, asbestos, or other trigger exposure. Vital signs were normal except for an oxygen requirement of 3.5 liters by nasal canula. Exam revealed bibasilar rales on inspiration sans wheeze in an elderly Caucasian male appearing younger than stated age. No abnormalities noted on CBC. Patient had prior RF > 1000 and ANA 1:640 but repeat testing included negative ANA, anti-CCP, scleroderma, myeloperoxidase, anti-SSA, anti-SSB, and anti-Smith antibodies. Echocardiogram was unremarkable. Chest CT showed multifocal pulmonary opacities and septal thickening, reticular opacities in lower lungs, and enlarged mediastinal lymph nodes, likely reactive. PFTs showed a mild restriction pattern with a diffusion capacity 41% of predicted. Hypersensitivity panel was unremarkable. Lung biopsy showed hypersensitivity pneumonia with usual interstitial pneumonia (UIP)-like fibrosis. Discussion across specialists yielded a diagnosis of acute hypersensitivity pneumonitis secondary to amiodarone toxicity with underlying fibrosis which may represent Idiopathic pulmonary fibrosis (IPF). DISCUSSION: While this patient's initial presentation was concerning for a rheumatologic-associated ILD from non-specific interstitial pneumonia, repeat serology and pathology led to amiodarone-induced hypersensitivity pneumonitis. This case is unique because pathology revealed well-formed granulomas in the peribronchiolar interstitium with a background of UIP-like fibrosis. These findings led to a conclusion of a primary acute hypersensitivity pneumonitis superimposed upon more chronic fibrosis. While this patient is currently responding well to steroids, long-term he is likely to experience a progressive clinical course typical of IPF patients. CONCLUSIONS: Classifying interstitial lung diseases is challenging and relies on detailed history, serologies, imaging, and often pathology. Multispecialty input should be pursued to obtain the most accurate diagnosis and treatment plan. Reference #1: Bradley B, Branley HM, Egan JJ, et al. Interstitial lung disease guideline: the British Thoracic Society in collaboration with the Thoracic Society of Australia and New Zealand and the Irish Thoracic Society. Thorax 2008; 63 Suppl 5:v1. Reference #2: Pipavath S, Godwin JD. Imaging of interstitial lung disease. Clin Chest Med 2004; 25:455. DISCLOSURES: No relevant relationships by Katherine Axon, source=Web Response No relevant relationships by Allison Palmer, source=Web Response No relevant relationships by Siva Parcha, source=Web Response No relevant relationships by Adam Smalley, source=Web Response

Clinico radiological series: Imaging of interstitial lung disease

Clinico radiological series: Imaging of interstitial lung disease

Interstitial lung disease related to smoking: imaging considerations.

To discuss the imaging of interstitial lung disease believed to be caused by smoking. It is increasingly clear that smoking is associated with a variety of patterns of interstitial lung disease. The radiologic features of interstitial lung disease caused by smoking cigarettes are variable and may be nonspecific. It is now accepted that cigarette smoking can cause lung diseases other than lung cancer, chronic bronchitis and emphysema. Indeed, the hypothesis that tobacco smoke can cause interstitial lung disease - and, specifically, pulmonary fibrosis - dates back to the 1960s. The list of interstitial lung disease, in which smoking is believed to have an etiologic role, includes Langerhans' cell histiocytosis, respiratory bronchiolitis/respiratory bronchiolitis-interstitial lung disease and desquamative interstitial pneumonia. More recently, there is emerging evidence which suggests that smoking may be associated with other patterns of pulmonary fibrosis (e.g. nonspecific interstitial pneumonia and smoking-related interstitial fibrosis). In the present review we discuss the imaging of the interstitial lung disease known to be caused by smoking; the typical appearances and some of the diagnostic difficulties are discussed.

Imaging of interstitial lung disease in systemic sclerosis: computed tomography versus ultrasound

Interstitial lung disease related to systemic sclerosis (SSc-ILD) is a main prognostic determinant of the disease. High-resolution computed tomography is the reference tool to detect SSc-ILD in the clinical arena. It enables the diagnosis, quantification and monitoring of lung involvement, providing robust information for the management of the disease; yet its cost and especially radiological burden can make it unappealing to SSc patients, who are often young women in their reproductive age, who require serial testing to assess the natural history of the disease. Recently, lung ultrasound has been proposed as a nonionizing technique to detect and semiquantifiy SSc-ILD. This new application of ultrasound seems interesting, as it is fast, inexpensive and can easily be performed at the patient’s bedside with a handheld device. Magnetic resonance is the current gold standard for noninvasive virtual histological discrimination of different tissues. Despite still being underused for the evaluation of the lungs,...

Imaging of Childhood Interstitial Lung Disease

The aphorism that children are not little adults certainly applies for the imaging of interstitial lung disease. Acquiring motion-free images of fine pulmonary structures at desired lung volumes is much more difficult in children than in adults. Several forms of interstitial lung disease are unique to children, and some forms of interstitial lung disease encountered in adults rarely, if ever, occur in children. Meticulous attention to imaging technique and specialized knowledge are required to properly perform and interpret chest imaging studies obtained for the evaluation of childhood interstitial lung disease (chILD). This review will address technique recommendations for imaging chILD, the salient imaging findings in various forms of chILD, and the efficacy of imaging in the diagnosis and management of chILD.

Imaging of Interstitial Lung Disease

Imaging of Interstitial Lung Disease