DIAGNOSTIC ACCURACY OF HIGH‑RESOLUTION CT IMAGING IN DETECTING EARLY INTERSTITIAL LUNG DISEASE

Abstract

The omnogenic diseases include interstitial lung diseases (ILDs) which are typified by inflammation and fibrosis of the lung parenchyma, and pose significant challenge in diagnosis and prognosis. The new standard of ILD has been high-resolution computed tomography (HRCT) but the relative merits of quantitative compared with the visual assessment have not been fully determined. To compare the diagnostic accuracy, prognostic utility and longitudinal performance of quantitative measurements of HRCT, including a novel Composite Interstitial Lung Disease Index (C-ILDI), in suspected ILD patients, including systemic sclerosis-associated ILD.It was an ex post cross-sectional study that involved 350 patients undergoing both standard and volumetric HRCT and standard chest radiography. The data of the HRCT of ground-glass opacities (percentage GGO) and fibrotic involvement (percentage FIB) were quantitatively measured and transformed to C-ILDI . Multidisciplinary consensus diagnosis was considered as a reference standard in order to measure the diagnostic performance measures. Logistic regression and Cox proportional hazards models were employed to find the predictors of disease progression and mortality at 24 months. HRCT showed a much better diagnostic accuracy than that of chest radiography, sensitivity (94.1) and specificity (92.8). The quantitative results demonstrated that percentage of FIB: UIP , NSIP , differed in the ILD subtypes. The C-ILDI emerged as the strongest predictor of disease progression and mortality, with patients in the high-risk tertile  demonstrating a hazard ratio of 14.32  for death at 24 months. Longitudinal indicated that the percentage of FIB, as a percentage of FIB (FIB) rose by 19.8 percent in 12 months  but the percentage of GGO did not change. The percentFIB and forced vital capacity and diffusing capacity  were found to have good correlations. The computer aided diagnosing software showed a high level of agreement to the expert visual assessment . The most-diagnostic tool is the C-ILDI composite index, and the high prognostic stratification, and objective longitudinal assessment in ILD. These data suggest incorporating automated quantitative HRCT measurement into clinical practice to allow tailoring management plans and better patient outcomes.