Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung Disease
Purpose Usual interstitial pneumonia (UIP) pattern of interstitial lung disease (ILD) can have varied etiology, with connective tissue disease (CTD) being a common known cause. The anterior upper lobe (AUL) sign, exuberant honeycombing (EHC), and straight edge (SE) sign are recently described comput...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Thieme Medical and Scientific Publishers Pvt. Ltd.
2023-01-01
|
| Series: | Indian Journal of Radiology and Imaging |
| Subjects: | |
| Online Access: | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758876 |
| _version_ | 1797894376498659328 |
|---|---|
| author | Antony Augustine Leena Robinson Vimala Aparna Irodi John Mathew Mini Pakkal |
| author_facet | Antony Augustine Leena Robinson Vimala Aparna Irodi John Mathew Mini Pakkal |
| author_sort | Antony Augustine |
| collection | DOAJ |
| description | Purpose Usual interstitial pneumonia (UIP) pattern of interstitial lung disease (ILD) can have varied etiology, with connective tissue disease (CTD) being a common known cause. The anterior upper lobe (AUL) sign, exuberant honeycombing (EHC), and straight edge (SE) sign are recently described computed tomography (CT) signs in CTD-related UIP. We test the diagnostic value of these CT signs for CTD in patients with UIP and compare the incidence of these signs between CTD-related UIP and non–CTD-related UIP. We also evaluated the interobserver agreement in detection of these CT signs.
Methods Retrospective study of all patients who had UIP pattern of ILD on CT thorax done from January 1, 2016 to January 31, 2019, was grouped into two: non–CTD-related UIP or CTD-related UIP. CT thorax was reviewed for the presence of these signs—AUL, SE, and EHC. The diagnostic values of these signs in diagnosing CTD-related UIP was assessed. For assessment of interobserver agreement, another radiologist reviewed a subset of 30 randomly selected cases and looked for the presence of these signs.
Results Of the 156 patients included, 76 had CTD. The incidence of CT signs were significantly higher in CTD-related UIP. The specificities of AUL, EHC, and SE were 82.5, 75, and 85%, respectively. The EHC sign had highest sensitivity of 48.7%. Inclusion of more than one sign increased the specificity of diagnosis of CTD-related UIP; however, the sensitivity decreases. There was excellent interobserver agreement (0.81–0.87) for each of these signs.
Conclusion The presence of SE, AUL, and EHC signs in cases with UIP pattern are specific imaging markers to diagnose underlying CTD; however, due to its low sensitivity, the absence of these signs cannot exclude the same. Because of its excellent interobserver agreement, these signs are reliable in the evaluation of CTD-related ILD. |
| first_indexed | 2024-04-10T07:09:06Z |
| format | Article |
| id | doaj.art-1725c5a1088a463f94cd0c25d145cb6a |
| institution | Directory Open Access Journal |
| issn | 0971-3026 1998-3808 |
| language | English |
| last_indexed | 2024-04-10T07:09:06Z |
| publishDate | 2023-01-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
| record_format | Article |
| series | Indian Journal of Radiology and Imaging |
| spelling | doaj.art-1725c5a1088a463f94cd0c25d145cb6a2023-02-26T23:48:15ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Radiology and Imaging0971-30261998-38082023-01-01330107007510.1055/s-0042-1758876Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung DiseaseAntony Augustine0Leena Robinson Vimala1Aparna Irodi2John Mathew3Mini Pakkal4Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, IndiaDepartment of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, IndiaDepartment of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, IndiaDepartment of Clinical Immunology and Rheumatology, Christian Medical College and Hospital, Vellore, Tamil Nadu, IndiaJoint Department of Medical Imaging, Toronto General Hospital, Toronto, Ontario, CanadaPurpose Usual interstitial pneumonia (UIP) pattern of interstitial lung disease (ILD) can have varied etiology, with connective tissue disease (CTD) being a common known cause. The anterior upper lobe (AUL) sign, exuberant honeycombing (EHC), and straight edge (SE) sign are recently described computed tomography (CT) signs in CTD-related UIP. We test the diagnostic value of these CT signs for CTD in patients with UIP and compare the incidence of these signs between CTD-related UIP and non–CTD-related UIP. We also evaluated the interobserver agreement in detection of these CT signs. Methods Retrospective study of all patients who had UIP pattern of ILD on CT thorax done from January 1, 2016 to January 31, 2019, was grouped into two: non–CTD-related UIP or CTD-related UIP. CT thorax was reviewed for the presence of these signs—AUL, SE, and EHC. The diagnostic values of these signs in diagnosing CTD-related UIP was assessed. For assessment of interobserver agreement, another radiologist reviewed a subset of 30 randomly selected cases and looked for the presence of these signs. Results Of the 156 patients included, 76 had CTD. The incidence of CT signs were significantly higher in CTD-related UIP. The specificities of AUL, EHC, and SE were 82.5, 75, and 85%, respectively. The EHC sign had highest sensitivity of 48.7%. Inclusion of more than one sign increased the specificity of diagnosis of CTD-related UIP; however, the sensitivity decreases. There was excellent interobserver agreement (0.81–0.87) for each of these signs. Conclusion The presence of SE, AUL, and EHC signs in cases with UIP pattern are specific imaging markers to diagnose underlying CTD; however, due to its low sensitivity, the absence of these signs cannot exclude the same. Because of its excellent interobserver agreement, these signs are reliable in the evaluation of CTD-related ILD.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758876usual interstitial pneumoniaconnective tissue diseasecomputed tomography |
| spellingShingle | Antony Augustine Leena Robinson Vimala Aparna Irodi John Mathew Mini Pakkal Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung Disease Indian Journal of Radiology and Imaging usual interstitial pneumonia connective tissue disease computed tomography |
| title | Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung Disease |
| title_full | Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung Disease |
| title_fullStr | Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung Disease |
| title_full_unstemmed | Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung Disease |
| title_short | Diagnostic Value of Connective Tissue Disease Related CT Signs in Usual Interstitial Pneumonia Pattern of Interstitial Lung Disease |
| title_sort | diagnostic value of connective tissue disease related ct signs in usual interstitial pneumonia pattern of interstitial lung disease |
| topic | usual interstitial pneumonia connective tissue disease computed tomography |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0042-1758876 |
| work_keys_str_mv | AT antonyaugustine diagnosticvalueofconnectivetissuediseaserelatedctsignsinusualinterstitialpneumoniapatternofinterstitiallungdisease AT leenarobinsonvimala diagnosticvalueofconnectivetissuediseaserelatedctsignsinusualinterstitialpneumoniapatternofinterstitiallungdisease AT aparnairodi diagnosticvalueofconnectivetissuediseaserelatedctsignsinusualinterstitialpneumoniapatternofinterstitiallungdisease AT johnmathew diagnosticvalueofconnectivetissuediseaserelatedctsignsinusualinterstitialpneumoniapatternofinterstitiallungdisease AT minipakkal diagnosticvalueofconnectivetissuediseaserelatedctsignsinusualinterstitialpneumoniapatternofinterstitiallungdisease |