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Takeshi Johkoh - One of the best experts on this subject based on the ideXlab platform.

  • clinical course and changes in high resolution computed tomography findings in patients with idiopathic pulmonary fibrosis without Honeycombing
    PLOS ONE, 2016
    Co-Authors: Hiroyoshi Yamauchi, Takeshi Johkoh, Tomohisa Baba, Masashi Bando, Kensuke Kataoka, Yoshihito Yamada, Hiroshi Yamamoto, Atsushi Miyamoto, Soichiro Ikushima, Fumikazu Sakai
    Abstract:

    Some patients with idiopathic pulmonary fibrosis (IPF) do not have Honeycombing on high-resolution computed tomography (HRCT) at their initial evaluation. The clinical course and sequential changes in HRCT findings in these patients are not fully understood. We reviewed the cases of 43 patients with IPF without Honeycombing on initial HRCT from institutions throughout Japan. All patients were diagnosed with IPF based on a surgical lung biopsy. Multidisciplinary discussions were held five times between 2011 and 2014, to exclude alternative etiologies. We evaluated the sequential changes in HRCT findings in 30 patients with IPF. We classified these 30 patients into three groups based on their HRCT patterns and clarified the clinical characteristics and prognosis among the groups. The patterns of all 30 patients on initial HRCT corresponded to a possible usual interstitial pneumonia (UIP) pattern which was described in the 2011 International Statement. On long-term follow-up (71.0±38.7 standard deviation [SD] months), Honeycombing was seen in 16 patients (53%, the HoneyCo group); traction bronchiectasis or cysts without Honeycombing was observed in 12 patients (40%, the NoHoneyCo group), and two patients showed no interval change (7%, the NoChange group) on HRCT. The mean survival periods of the HoneyCo and NoHoneyCo groups were 67.1 and 61.2 months, respectively (p = 0.76). There are some patients with IPF whose conditions chronically progress without Honeycombing on HRCT. The appearance of Honeycombing on HRCT during the follow-up might not be related to prognosis.

  • Honeycombing on ct its definition pathologic correlation and future direction of its diagnosis
    European Journal of Radiology, 2014
    Co-Authors: Takeshi Johkoh, Fumikazu Sakai, Masanori Akira, Kiminori Fujimoto, Satoshi Noma, Takeyuki Watadani, Yukihiko Sugiyama
    Abstract:

    Honeycombing on CT is the clue for the diagnosis of usual interstitial pneumonia (UIP) and its hallmark. According to the ATS-ERS-JRS-ALAT 2010 guideline, the patients with Honeycombing on CT can be diagnosed as UIP without surgical biopsy. On CT scans, it is defined as clustered cystic airspaces, typically of comparable diameters of the order of 3-10mm, which are usually subpleural and have well-defined walls. Pathologically, Honeycombing consists of both collapsing of multiple fibrotic alveoli and dilation of alveolar duct and lumen Although the definition of Honeycombing seems to be strict, recognition of Honeycombing on CT is various among each observer Because typical Honeycombing is frequently observed in the patients with UIP, we should judge clustered cysts as Honeycombing when a diagnosis of UIP is suspected.

  • interobserver variability in the ct assessment of Honeycombing in the lungs
    Radiology, 2013
    Co-Authors: Takeyuki Watadani, Takeshi Johkoh, Fumikazu Sakai, Masanori Akira, Kiminori Fujimoto, Nestor L. Müller, Satoshi Noma, Alexander A Bankier, Kyung Soo Lee, Jae Woo Song
    Abstract:

    Even experienced radiologists may disagree on the identification of the presence of Honeycombing, and this disagreement is caused mainly by the misinterpretation of conditions that may mimic Honeycombing, such as traction bronchiectasis and emphysema.

  • acute interstitial pneumonia
    American Journal of Respiratory and Critical Care Medicine, 2012
    Co-Authors: Kazuya Ichikado, Naoki Mihara, Takeshi Johkoh, Masanori Akira, Moritaka Suga, Hiroyuki Taniguchi, Yasuhiro Kondoh, Nestor L. Müller, Hironobu Nakamura, Mutsumasa Takahashi
    Abstract:

    This study compared high-resolution computed tomography (CT) findings between 10 survivors and 21 nonsurvivors of acute interstitial pneumonia and evaluated whether the CT findings were predictive of patients' response to treatment. The survivor and nonsurvivor groups with pathologically or clinically diagnosed acute interstitial pneumonia were similar in age, sex, disease duration, and lung injury score. Retrospective, subjective evaluations of the CT scans were conducted by two independent observers without knowledge of patient outcomes. CT findings were graded on a one to six scale corresponding to consecutive pathologic phases as follows: areas of (1) normal attenuation, (2) ground-glass attenuation, (3) consolidation, (4) ground-glass attenuation associated with traction bronchiolectasis or bronchiectasis, (5) consolidation associated with traction bronchiolectasis or bronchiectasis, and (6) Honeycombing. An overall score was obtained by quantifying the extent of each abnormality in three lung zones ...

  • usual interstitial pneumonia and chronic idiopathic interstitial pneumonia analysis of ct appearance in 92 patients
    Radiology, 2006
    Co-Authors: Hiromitsu Sumikawa, Kazuya Ichikado, Tetsuo Hiramatsu, Atsuo Inoue, Ukihide Tateishi, Takeshi Johkoh, Hiroyuki Taniguchi, Kiminori Fujimoto, Yasuhiro Kondoh, Javzandulam Natsag
    Abstract:

    PURPOSE: To retrospectively analyze computed tomographic (CT) findings of chronic idiopathic interstitial pneumonia (IIP) and to determine which findings are most helpful for distinguishing IIP from usual interstitial pneumonia (UIP) with univariate and multivariate analyses. MATERIALS AND METHODS: Institutional review board approval and informed consent were not required for this retrospective review of patient records and images. Two observers working independently and without knowledge of the diagnosis evaluated the extent and distribution of various thin-section CT findings (ground-glass opacity, consolidation, reticulation, and Honeycombing) in 92 patients (51 men, 41 women; mean age, 56 years; age range, 29-81 years) with a histologic diagnosis of UIP (n = 20), cellular nonspecific interstitial pneumonia (NSIP) (n = 16), fibrotic NSIP (n = 16), respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) (n = 11), desquamative interstitial pneumonia (DIP) (n = 15), or lymphoid interstitial pneumonia (LIP) (n = 14). Observers used univariate and multivariate statistical analyses to compare their findings with the extent and distribution of UIP. RESULTS: Observers made the correct diagnosis in 145 (79%) of 184 readings. Multivariate logistic regression analysis showed that the independent findings that distinguished UIP from cellular NSIP were the extent of Honeycombing and the most proximal bronchus with traction bronchiectasis (odds ratio, 5.16 and 0.37, respectively); the finding that distinguished UIP from fibrotic NSIP was the extent of Honeycombing (odds ratio, 2.10). CT features that distinguished UIP from RB-ILD and DIP included extent of ground-glass opacity (odds ratio, 0.76), thickening of bronchovascular bundles (odds ratio, 1.58), the most proximal bronchus with traction bronchiectasis (odds ratio, 0.22), and the number of segments with traction bronchiectasis (odds ratio, 3.64). CONCLUSION: UIP has a characteristic appearance that usually facilitates distinction from other types of chronic IIPs at thin-section CT. The most useful finding when differentiating UIP from NSIP was the extent of Honeycombing.

Nestor L. Müller - One of the best experts on this subject based on the ideXlab platform.

  • interobserver variability in the ct assessment of Honeycombing in the lungs
    Radiology, 2013
    Co-Authors: Takeyuki Watadani, Takeshi Johkoh, Fumikazu Sakai, Masanori Akira, Kiminori Fujimoto, Nestor L. Müller, Satoshi Noma, Alexander A Bankier, Kyung Soo Lee, Jae Woo Song
    Abstract:

    Even experienced radiologists may disagree on the identification of the presence of Honeycombing, and this disagreement is caused mainly by the misinterpretation of conditions that may mimic Honeycombing, such as traction bronchiectasis and emphysema.

  • acute interstitial pneumonia
    American Journal of Respiratory and Critical Care Medicine, 2012
    Co-Authors: Kazuya Ichikado, Naoki Mihara, Takeshi Johkoh, Masanori Akira, Moritaka Suga, Hiroyuki Taniguchi, Yasuhiro Kondoh, Nestor L. Müller, Hironobu Nakamura, Mutsumasa Takahashi
    Abstract:

    This study compared high-resolution computed tomography (CT) findings between 10 survivors and 21 nonsurvivors of acute interstitial pneumonia and evaluated whether the CT findings were predictive of patients' response to treatment. The survivor and nonsurvivor groups with pathologically or clinically diagnosed acute interstitial pneumonia were similar in age, sex, disease duration, and lung injury score. Retrospective, subjective evaluations of the CT scans were conducted by two independent observers without knowledge of patient outcomes. CT findings were graded on a one to six scale corresponding to consecutive pathologic phases as follows: areas of (1) normal attenuation, (2) ground-glass attenuation, (3) consolidation, (4) ground-glass attenuation associated with traction bronchiolectasis or bronchiectasis, (5) consolidation associated with traction bronchiolectasis or bronchiectasis, and (6) Honeycombing. An overall score was obtained by quantifying the extent of each abnormality in three lung zones ...

  • nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis changes in pattern and distribution of disease over time
    Radiology, 2008
    Co-Authors: Isabela C S Silva, Nestor L. Müller, David M Hansell, Kyung Soo Lee, Andrew G Nicholson, Athol U Wells
    Abstract:

    Purpose: To retrospectively assess the change in disease pattern of nonspecific interstitial pneumonia (NSIP) and idiopathic pulmonary fibrosis (IPF) findings seen at thin-section computed tomography (CT) at long-term follow-up and to compare the same with initial findings at CT. Materials and Methods: The study included 48 patients (28 men, 20 women; mean age, 57.5 years) with biopsy-proved NSIP (n = 23) or IPF (n = 25) who underwent CT at initial diagnosis and at follow-up 34–155 months later. The CT scans were randomized and reviewed by two independent thoracic radiologists for pattern and distribution of ground-glass opacity (GGO), reticulation, traction bronchiectasis and bronchiolectasis, and Honeycombing. Statistical analysis was performed by using nonparametric methods and univariate logistic regression. Results: Follow-up CT in patients with NSIP showed marked decrease in the extent of GGO, increase in reticulation, and a greater likelihood of peripheral distribution (all P < .05). At presentatio...

  • usual interstitial pneumonia and non specific interstitial pneumonia serial thin section ct findings correlated with pulmonary function
    Korean Journal of Radiology, 2005
    Co-Authors: Thomas V Colby, Nestor L. Müller, Man Pyo Chung, Kyung Soo Lee, Yeon Joo Jeong, Joungho Han, Myung Jin Chung, Seonwoo Kim
    Abstract:

    OBJECTIVE We wanted to demonstrate and compare the serial high-resolution CTs (HRCT) and the pulmonary function test (PFT) findings of the usual interstitial pneumonia (UIP) and the non-specific interstitial pneumonia (NSIP). MATERIALS AND METHODS The serial HRCT scans and the PFT results were retrospectively analysed and compared for 35 patients having UIP without significant Honeycombing (UIP-w/o hc, or = 5% of Honeycombing), and 25 patients with NSIP. The mortality rates were also compared. Follow-up CT scans were available in 75 patients (29 UIP-w/o hc patients, 22 UIP-w/i hc patients and 24 NSIP patients) and the follow-up periods ranged from 150 to 2,370 days. The initial and follow-up PFT data were available for 71 patients. RESULTS On the initial CT, significant differences were present between the UIP-w/i hc patients and both the UIP-w/o hc patients and the NSIP patients in the overall extent, ground-glass opacity (GGO) away from the reticulation, reticulation and Honeycombing (all p < 0.05). Improvement was noticed in five (17%) of 29 UIP-w/o hc patients, none of 22 UIP-w/i hc patients, and 9 (37%) of 24 NSIP patients; deterioration was noted in six (21%) UIP-w/o hc patients, two (9%) UIPw/i hc patients and three (13%) NSIP patients (p = 0.044 between UIP-w/o and UIP-w/i hc; p = 0.637 between UIP-w/o hc and NSIP; p = 0.007 between UIP-w/i hc and NSIP). The serial changes of the pulmonary function in the NSIP patients were different from those noted for the UIP-w/i hc and UIP-w/o hc patients (p = 0.440 between UIP-w/o and UIP-w/i hc; p = 0.022 between UIP-w/o hc and NSIP; p = 0.003 between UIP-w/i hc and NSIP). Five (14%) of the 35 patients with UIPw/o hc, 16 (46%) of the 35 patients with UIP-w/i hc and three (12%) of the 25 patients with NSIP died (p = 0.002, comparison for the three groups). CONCLUSION On CT, NSIP and UIP-w/o hc patients have similar patterns of parenchymal abnormalities and a similar likelihood of change in the extent of disease on follow-up. Patients with UIP-w/i hc have distinctive features and a worst prognosis.

  • radiologic findings are strongly associated with a pathologic diagnosis of usual interstitial pneumonia
    Chest, 2003
    Co-Authors: Gary W Hunninghake, Barry H. Gross, David A Schwartz, David A Lynch, Nestor L. Müller, Jeffrey R Galvin, Talmadge E King, Joseph P Lynch, Richard G Hegele, James A Waldron
    Abstract:

    Purpose To determine which clinical and radiologic findings are independently associated with a pathologic diagnosis of usual interstitial pneumonia (UIP). Methods We recently reported, using a prospective, multicenter study of patients suspected of having idiopathic interstitial pneumonia (IIP), that a confident diagnosis of UIP made by experienced radiologists was correct in 95% of cases. In the current article, we further analyzed data from this study. Ninety-one patients were entered into the study. Clinical, physiologic, chest radiographic, and CT features were prospectively recorded, and analyzed using univariate and multivariate logistic regression analysis to compare the patients with a histologic diagnosis of UIP with those who received other pathologic diagnoses. Results Fifty-four of 91 patients (59%) received a pathologic diagnosis of UIP. The following features recorded at the referring clinical centers were associated with a pathologic diagnosis of UIP on multivariate analysis: lower-lobe Honeycombing on high-resolution CT (HRCT) [odds ratio, 11.45], radiographic findings consistent with UIP (odds ratio, 5.73), elevated ratio of FEV 1 to FVC (odds ratio, 4.8), and absence of smoking history (odds ratio, 0.19). On multivariate analysis of specific HRCT features recorded by four experienced chest radiologists, lower-lung Honeycombing (odds ratio, 5.36) and upper-lung irregular lines (odds ratio, 6.28) were the only independent predictors of UIP. Using only these two factors, a diagnosis of UIP could be established with a sensitivity of 74%, a specificity of 81%, and a positive predictive value of 85%. Conclusion In patients presenting with a clinical syndrome suggestive of IIP, CT findings of lower-lung Honeycombing and upper-lung irregular lines are most closely associated with a pathologic diagnosis of UIP.

Athol U Wells - One of the best experts on this subject based on the ideXlab platform.

  • idiopathic pulmonary fibrosis prognostic impact of histologic Honeycombing in transbronchial lung cryobiopsy
    Multidisciplinary Respiratory Medicine, 2019
    Co-Authors: Claudia Ravaglia, Athol U Wells, Sara Piciucchi, Christian Gurioli, Alessandra Dubini, Marcello Bosi, Carlo Gurioli, Silvia Puglisi, Susanna Mascetti, Antonella Arcadu
    Abstract:

    Prognostic evaluation in idiopathic pulmonary fibrosis (IPF) may be important as it can guide management decisions, but the potential role of honeycomb changes in providing information about outcome and survival of patients with IPF, particularly if diagnosed using cryobiopsy, has not been evaluated. Aim of this study was to determinate whether a relationship exists between Honeycombing on cryobiopsy and clinical/radiological picture and outcome in patients with IPF and to assess whether the same pathologic criteria that have been used to define the UIP pattern (usual interstitial pneumonia) for surgical biopsy can also be applied to cryobiopsy. Sixty-three subjects with a multidisciplinary diagnosis of IPF and a UIP pattern on cryobiopsy were evaluated. Patients were classified into two sub-groups depending on the presence of Honeycombing on histology. The presence of Honeycombing on cryobiopsy did not identify a specific phenotype of patients as it did not correlate with radiological and clinical picture and it was not associated neither with the risk of death (p = 0.1192) or with the event-free survival (p = 0.827); a higher number of samples and the presence of pleura on biopsy were instead associated with an increase in the finding of Honeycombing. The same pathologic criteria that have been used to define the UIP pattern in surgical biopsies (with Honeycombing changes considered as non-mandatory for the definition of the pattern itself) can be applied to cryobiopsy samples, as the presence of these changes do not define different clinical or radiological phenotypes of patients with IPF.

  • Idiopathic pulmonary fibrosis: prognostic impact of histologic Honeycombing in transbronchial lung cryobiopsy
    BMC, 2019
    Co-Authors: Claudia Ravaglia, Athol U Wells, Sara Piciucchi, Christian Gurioli, Alessandra Dubini, Marcello Bosi, Carlo Gurioli, Silvia Puglisi, Susanna Mascetti, Antonella Arcadu
    Abstract:

    Abstract Background Prognostic evaluation in idiopathic pulmonary fibrosis (IPF) may be important as it can guide management decisions, but the potential role of honeycomb changes in providing information about outcome and survival of patients with IPF, particularly if diagnosed using cryobiopsy, has not been evaluated. Aim of this study was to determinate whether a relationship exists between Honeycombing on cryobiopsy and clinical/radiological picture and outcome in patients with IPF and to assess whether the same pathologic criteria that have been used to define the UIP pattern (usual interstitial pneumonia) for surgical biopsy can also be applied to cryobiopsy. Methods Sixty-three subjects with a multidisciplinary diagnosis of IPF and a UIP pattern on cryobiopsy were evaluated. Patients were classified into two sub-groups depending on the presence of Honeycombing on histology. Results The presence of Honeycombing on cryobiopsy did not identify a specific phenotype of patients as it did not correlate with radiological and clinical picture and it was not associated neither with the risk of death (p = 0.1192) or with the event-free survival (p = 0.827); a higher number of samples and the presence of pleura on biopsy were instead associated with an increase in the finding of Honeycombing. Conclusions The same pathologic criteria that have been used to define the UIP pattern in surgical biopsies (with Honeycombing changes considered as non-mandatory for the definition of the pattern itself) can be applied to cryobiopsy samples, as the presence of these changes do not define different clinical or radiological phenotypes of patients with IPF

  • chronic hypersensitivity pneumonitis identification of key prognostic determinants using automated ct analysis
    BMC Pulmonary Medicine, 2017
    Co-Authors: Joseph Jacob, David M Hansell, Brian J Bartholmai, Ryoko Egashira, Anne Laure Brun, Srinivasan Rajagopalan, Ronald A Karwoski, Maria Kokosi, Athol U Wells
    Abstract:

    Chronic hypersensitivity pneumonitis (CHP) has a variable disease course. Computer analysis of CT features was used to identify a subset of CHP patients with an outcome similar to patients with idiopathic pulmonary fibrosis (IPF). Consecutive patients with a multi-disciplinary team diagnosis of CHP (n = 116) had pulmonary function tests (FEV1, FVC, DLco, Kco, and a composite physiologic index [CPI]) and CT variables predictive of mortality evaluated by analysing visual and computer-based (CALIPER) parenchymal features: total interstitial lung disease (ILD) extent, Honeycombing, reticular pattern, ground glass opacities, pulmonary vessel volume (PVV), emphysema, and traction bronchiectasis. Mean survival was compared between both CHP and IPF patients (n = 185). In CHP, visual/CALIPER measures of reticular pattern, Honeycombing, visual traction bronchiectasis, and CALIPER ILD extent were predictive of mortality (p  6 · 5% of the lung had a mean survival (35 · 3 ± 6 · 1 months; n = 20/116 [17%]) and rate of disease progression that closely matched IPF patients (38 · 4 ± 2 · 2 months; n = 185). Pulmonary vessel volume can identify CHP patients at risk of aggressive disease and a poor IPF-like prognosis.

  • effect of nintedanib in subgroups of idiopathic pulmonary fibrosis by diagnostic criteria
    American Journal of Respiratory and Critical Care Medicine, 2017
    Co-Authors: Ganesh Raghu, Kevin R Flaherty, Athol U Wells, Andrew G Nicholson, Luca Richeldi, Florence Le Maulf, Susanne Stowasser, Rozsa Schlenkerherceg, David M Hansell
    Abstract:

    Rationale: In the absence of a surgical lung biopsy, patients diagnosed with idiopathic pulmonary fibrosis (IPF) in clinical practice could participate in the INPULSIS trials of nintedanib if they had Honeycombing and/or traction bronchiectasis plus reticulation, without atypical features of usual interstitial pneumonia (UIP), on high-resolution computed tomography (HRCT). Thus, the patients in these trials represented patients with definite UIP and a large subgroup of patients with possible UIP.Objectives: To investigate the potential impact of diagnostic subgroups on the progression of IPF and the effect of nintedanib.Methods: We conducted a post hoc subgroup analysis of patients with Honeycombing on HRCT and/or confirmation of UIP by biopsy versus patients without either, using pooled data from the INPULSIS trials.Measurements and Main Results: Seven hundred twenty-three (68.1%) patients had Honeycombing and/or biopsy, and 338 (31.9%) patients had no Honeycombing or biopsy. In these subgroups, respecti...

  • interobserver agreement for the ats ers jrs alat criteria for a uip pattern on ct
    Thorax, 2016
    Co-Authors: Simon L F Walsh, Athol U Wells, Nicola Sverzellati, Lucio Calandriello, David M Hansell
    Abstract:

    Objectives To establish the level of observer variation for the current ATS/ERS/JRS/ALAT criteria for a diagnosis of usual interstitial pneumonia (UIP) on CT among a large group of thoracic radiologists of varying levels of experience. Materials and methods 112 observers (96 of whom were thoracic radiologists) categorised CTs of 150 consecutive patients with fibrotic lung disease using the ATS/ERS/JRS/ALAT CT criteria for a UIP pattern (3 categories—UIP, possibly UIP and inconsistent with UIP). The presence of Honeycombing, traction bronchiectasis and emphysema was also scored using a 3-point scale (definitely present, possibly present, absent). Observer agreement for the UIP categorisation and for the 3 CT patterns in the entire observer group and in subgroups stratified by observer experience, were evaluated. Results Interobserver agreement across the diagnosis category scores among the 112 observers was moderate, ranging from 0.48 (IQR 0.18) for general radiologists to 0.52 (IQR 0.20) for thoracic radiologists of 10–20 years’ experience. A binary score for UIP versus possible or inconsistent with UIP was examined. Observer agreement for this binary score was only moderate. No significant differences in agreement levels were identified when the CTs were stratified according to multidisciplinary team (MDT) diagnosis or patient age or when observers were categorised according to experience. Observer agreement for each of Honeycombing, traction bronchiectasis and emphysema were 0.59±0.12, 0.42±0.15 and 0.43±0.18, respectively. Conclusions Interobserver agreement for the current ATS/ERS/JRS/ALAT CT criteria for UIP is only moderate among thoracic radiologists, irrespective of their experience, and did not vary with patient age or the MDT diagnosis.

Thomas V Colby - One of the best experts on this subject based on the ideXlab platform.

  • from traction bronchiectasis to Honeycombing in idiopathic pulmonary fibrosis a spectrum of bronchiolar remodeling also in radiology
    BMC Pulmonary Medicine, 2016
    Co-Authors: Sara Piciucchi, Thomas V Colby, Sara Tomassetti, Claudia Ravaglia, Christian Gurioli, Alessandra Dubini, Angelo Carloni, Marco Chilosi, Venerino Poletti
    Abstract:

    The diagnostic and prognostic impact of traction bronchiectasis on high resolution CT scan (HRCT) in patients suspected to have idiopathic pulmonary fibrosis (IPF) is increasing significantly. Recent data demonstrated that cysts in Honeycombing areas are covered by epithelium expressing bronchiolar markers. In IPF bronchiolization is the final consequence of a variety of pathogenic events starting from alveolar stem cell exhaustion, and ending in a abnormal/dysplastic proliferation of bronchiolar epithelium. CT scan features of traction bronchiectasis and Honeycombing should be interpreted under the light of these new pathogenetic and morphologic considerations. We suggest that in IPF subjects traction bronchiectasis and Honeycombing -now defined as distinct entities on HRCT scan- are actually diverse aspects of a continuous spectrum of lung remodeling.

  • uip diagnosed at surgical lung biopsy 2000 2009 hrct patterns and proposed classification system
    American Journal of Roentgenology, 2013
    Co-Authors: James F Gruden, Kevin O Leslie, Prasad M Panse, Henry D Tazelaar, Thomas V Colby
    Abstract:

    OBJECTIVE. High resolution CT (HRCT) is diagnostic of usual interstitial pneumonia (UIP) if Honeycombing is present. However, biopsy-proven UIP also occurs in patients without Honeycombing. Identification of specific HRCT patterns may enable specific diagnosis and allow more patients to enter clinical trials. Pattern may also predict prognosis. We sought to identify specific HRCT patterns in patients with biopsy-proven UIP (2000–2009) and to assess outcomes and serial change in pattern. MATERIALS AND METHODS. We reviewed the HRCT findings in 44 patients with biopsy-proven UIP and identified four distinct patterns: classic UIP (cUIP) with Honeycombing, fibrosis without Honeycombing (FnoH), minimal fibrosis (Fmin), and ground-glass present (GGOp). We reviewed electronic medical records for outcome information and serial HRCT examinations when available. RESULTS. The extent of fibrosis varied between patterns; findings were always heterogeneous in the cUIP and FnoH patterns. Some Fmin patients had a more hom...

  • desquamative interstitial pneumonia may progress to lung fibrosis as characterized radiologically
    Respirology, 2012
    Co-Authors: Yoshinori Kawabata, Tetsu Kanauchi, Fumikazu Sakai, Akira Hebisawa, Yutaka Sugita, Sonoko Nagai, Takashi Ogura, Tamiko Takemura, Thomas V Colby
    Abstract:

    Background and objective:  In some patients, desquamative interstitial pneumonia may progress to lung fibrosis. The aim of this study was to assess the long-term radiological follow-up results in patients with desquamative interstitial pneumonia. Methods:  Among 75 patients suspected of having desquamative interstitial pneumonia, 31 who fulfilled the criteria were included in this study. Clinical characteristics at presentation, responses to treatment and long-term follow-up were evaluated. Results:  The 31 patients were predominantly males (94%), and the mean age was 55 years; 93% (28/30) had a history of smoking. The clinical findings included high serum levels of lactate dehydrogenase and immunoglobulin G. Bronchoalveolar lavage (26 patients, 84% of cases) frequently showed an increased percentage of eosinophils (mean 17%). Computed tomography (CT) or high resolution (HR) CT at presentation showed ground glass opacities and/or consolidation in all patients, with one third of patients also showing thin-walled cysts within the ground glass opacities. There was no Honeycombing on CT or HRCT scans at presentation. Corticosteroid therapy was effective early in the course of the disease; long-term follow-up (mean 99 months) of 31 patients showed only one death due to progression of the disease, but long-term follow-up of 14 patients (mean 125 months) by HRCT showed the development of new thin-walled cysts and Honeycombing in five and lung cancer in four patients, respectively. Conclusions:  In a proportion of patients, desquamative interstitial pneumonia may progress to lung fibrosis with Honeycombing on HRCT, despite therapy.

  • usual interstitial pneumonia and non specific interstitial pneumonia serial thin section ct findings correlated with pulmonary function
    Korean Journal of Radiology, 2005
    Co-Authors: Thomas V Colby, Nestor L. Müller, Man Pyo Chung, Kyung Soo Lee, Yeon Joo Jeong, Joungho Han, Myung Jin Chung, Seonwoo Kim
    Abstract:

    OBJECTIVE We wanted to demonstrate and compare the serial high-resolution CTs (HRCT) and the pulmonary function test (PFT) findings of the usual interstitial pneumonia (UIP) and the non-specific interstitial pneumonia (NSIP). MATERIALS AND METHODS The serial HRCT scans and the PFT results were retrospectively analysed and compared for 35 patients having UIP without significant Honeycombing (UIP-w/o hc, or = 5% of Honeycombing), and 25 patients with NSIP. The mortality rates were also compared. Follow-up CT scans were available in 75 patients (29 UIP-w/o hc patients, 22 UIP-w/i hc patients and 24 NSIP patients) and the follow-up periods ranged from 150 to 2,370 days. The initial and follow-up PFT data were available for 71 patients. RESULTS On the initial CT, significant differences were present between the UIP-w/i hc patients and both the UIP-w/o hc patients and the NSIP patients in the overall extent, ground-glass opacity (GGO) away from the reticulation, reticulation and Honeycombing (all p < 0.05). Improvement was noticed in five (17%) of 29 UIP-w/o hc patients, none of 22 UIP-w/i hc patients, and 9 (37%) of 24 NSIP patients; deterioration was noted in six (21%) UIP-w/o hc patients, two (9%) UIPw/i hc patients and three (13%) NSIP patients (p = 0.044 between UIP-w/o and UIP-w/i hc; p = 0.637 between UIP-w/o hc and NSIP; p = 0.007 between UIP-w/i hc and NSIP). The serial changes of the pulmonary function in the NSIP patients were different from those noted for the UIP-w/i hc and UIP-w/o hc patients (p = 0.440 between UIP-w/o and UIP-w/i hc; p = 0.022 between UIP-w/o hc and NSIP; p = 0.003 between UIP-w/i hc and NSIP). Five (14%) of the 35 patients with UIPw/o hc, 16 (46%) of the 35 patients with UIP-w/i hc and three (12%) of the 25 patients with NSIP died (p = 0.002, comparison for the three groups). CONCLUSION On CT, NSIP and UIP-w/o hc patients have similar patterns of parenchymal abnormalities and a similar likelihood of change in the extent of disease on follow-up. Patients with UIP-w/i hc have distinctive features and a worst prognosis.

  • clinical significance of histological classification of idiopathic interstitial pneumonia
    European Respiratory Journal, 2002
    Co-Authors: Kevin R Flaherty, Robert L Strawderman, Arvind Jain, Barry H. Gross, Robert Paine, Ella A Kazerooni, Galen B Toews, William D Travis, Thomas V Colby, Andrew Flint
    Abstract:

    Patients with idiopathic interstitial pneumonias (IIPs) can be subdivided into groups based on the histological appearance of lung tissue obtained by surgical biopsy. The quantitative impact of histological diagnosis, baseline factors and response to therapy on survival has not been evaluated. Surgical lung biopsy specimens from 168 patients with suspected IIP were reviewed according to the latest diagnostic criteria. The impact of baseline clinical, physiological, radiographic and histological features on survival was evaluated using Cox regression analysis. The predictive value of Honeycombing on high-resolution computed tomography (HRCT) as a surrogate marker for usual interstitial pneumonia (UIP) was examined. The response to therapy and survival of 39 patients treated prospectively with high-dose prednisone was evaluated. The presence of UIP was the most important factor influencing mortality. The risk ratio of mortality when UIP was present was 28.46 (95% confidence interval (CI) 5.5-148.0; p=0.0001) after controlling for patient age, duration of symptoms, radiographic appearance, pulmonary physiology, smoking history and sex. Honeycombing on HRCT indicated the presence of UIP with a sensitivity of 90% and specificity of 86%. Patients with nonspecific interstitial pneumonia were more likely to respond or remain stable (9 of 10) compared to patients with UIP (14 of 29) after treatment with prednisone. Patients remaining stable had the best prognosis. The risk ratio of mortality for stable patients compared to nonresponders was 0.32 (95% CI 0.11-0.93; p=0.04) in all patients and 0.33 (95% CI 0.12-0.96; p=0.04) in patients with UIP. The histological diagnosis of usual interstitial pneumonia is the most important factor determining survival in patients with suspected idiopathic interstitial pneumonia. The presence of Honeycombing on high-resolution computed tomography is a good surrogate for usual interstitial pneumonia and could be utilized in patients unable to undergo surgical lung biopsy. Patients with nonspecific interstitial pneumonia are more likely to respond or remain stable following a course of prednisone. Patients remaining stable following prednisone therapy have the best prognosis.

Masanori Akira - One of the best experts on this subject based on the ideXlab platform.

  • Honeycombing on ct its definition pathologic correlation and future direction of its diagnosis
    European Journal of Radiology, 2014
    Co-Authors: Takeshi Johkoh, Fumikazu Sakai, Masanori Akira, Kiminori Fujimoto, Satoshi Noma, Takeyuki Watadani, Yukihiko Sugiyama
    Abstract:

    Honeycombing on CT is the clue for the diagnosis of usual interstitial pneumonia (UIP) and its hallmark. According to the ATS-ERS-JRS-ALAT 2010 guideline, the patients with Honeycombing on CT can be diagnosed as UIP without surgical biopsy. On CT scans, it is defined as clustered cystic airspaces, typically of comparable diameters of the order of 3-10mm, which are usually subpleural and have well-defined walls. Pathologically, Honeycombing consists of both collapsing of multiple fibrotic alveoli and dilation of alveolar duct and lumen Although the definition of Honeycombing seems to be strict, recognition of Honeycombing on CT is various among each observer Because typical Honeycombing is frequently observed in the patients with UIP, we should judge clustered cysts as Honeycombing when a diagnosis of UIP is suspected.

  • interobserver variability in the ct assessment of Honeycombing in the lungs
    Radiology, 2013
    Co-Authors: Takeyuki Watadani, Takeshi Johkoh, Fumikazu Sakai, Masanori Akira, Kiminori Fujimoto, Nestor L. Müller, Satoshi Noma, Alexander A Bankier, Kyung Soo Lee, Jae Woo Song
    Abstract:

    Even experienced radiologists may disagree on the identification of the presence of Honeycombing, and this disagreement is caused mainly by the misinterpretation of conditions that may mimic Honeycombing, such as traction bronchiectasis and emphysema.

  • acute interstitial pneumonia
    American Journal of Respiratory and Critical Care Medicine, 2012
    Co-Authors: Kazuya Ichikado, Naoki Mihara, Takeshi Johkoh, Masanori Akira, Moritaka Suga, Hiroyuki Taniguchi, Yasuhiro Kondoh, Nestor L. Müller, Hironobu Nakamura, Mutsumasa Takahashi
    Abstract:

    This study compared high-resolution computed tomography (CT) findings between 10 survivors and 21 nonsurvivors of acute interstitial pneumonia and evaluated whether the CT findings were predictive of patients' response to treatment. The survivor and nonsurvivor groups with pathologically or clinically diagnosed acute interstitial pneumonia were similar in age, sex, disease duration, and lung injury score. Retrospective, subjective evaluations of the CT scans were conducted by two independent observers without knowledge of patient outcomes. CT findings were graded on a one to six scale corresponding to consecutive pathologic phases as follows: areas of (1) normal attenuation, (2) ground-glass attenuation, (3) consolidation, (4) ground-glass attenuation associated with traction bronchiolectasis or bronchiectasis, (5) consolidation associated with traction bronchiolectasis or bronchiectasis, and (6) Honeycombing. An overall score was obtained by quantifying the extent of each abnormality in three lung zones ...

  • high resolution ct of asbestosis and idiopathic pulmonary fibrosis
    American Journal of Roentgenology, 2003
    Co-Authors: Masanori Akira, Yoshikazu Inoue, Satoru Yamamoto, Mitsunori Sakatani
    Abstract:

    OBJECTIVE. We studied high-resolution CT of asbestosis and idiopathic pulmonary fibrosis to determine whether differences—other than the frequency of associated pleural changes—could be discerned between the two diseases.MATERIALS AND METHODS. High-resolution CT scans of 80 patients with asbestosis and 80 patients with idiopathic pulmonary fibrosis were retrospectively reviewed. Two chest radiologists assessed the type and distribution of parenchymal and pleural abnormalities on high-resolution CT.RESULTS. Subpleural dotlike or branching opacities (65/80), subpleural curvilinear lines (55/80), mosaic perfusion (39/80), and parenchymal bands (38/80) were more common in patients with asbestosis (p < 0.0001). Visible intralobular bronchioles (62/80), bronchiolectasis within fibrotic consolidations (47/80), and Honeycombing (61/80) were more common in patients with idiopathic pulmonary fibrosis (p < 0.0001). The frequencies of interlobular septal thickening, ground-glass opacities, fibrotic consolidation, and...

  • lymphocytic interstitial pneumonia thin section ct findings in 22 patients
    Radiology, 1999
    Co-Authors: Takeshi Johkoh, Kazuya Ichikado, Heather A Pickford, Thomas E Hartman, Masanori Akira, Osamu Honda, Nestor L. Müller, Hironobu Nakamura
    Abstract:

    PURPOSE: To assess the thin-section computed tomographic (CT) findings of lymphocytic interstitial pneumonia. MATERIALS AND METHODS: The study included 22 patients (five men, 17 women; age range, 24–83 years; mean age, 50 years) with biopsy-proved lymphocytic interstitial pneumonia. The CT scans were obtained by using 1–3-mm collimation and reconstructed by using a high-spatial-frequency algorithm. RESULTS: The predominant abnormalities consisted of areas of ground-glass attenuation and poorly defined centrilobular nodules present in all 22 patients and subpleural small nodules seen in 19 patients. Other common findings included thickening of bronchovascular bundles (n = 19), interlobular septal thickening (n = 18), cystic airspaces (n = 15), and lymph node enlargement (n = 15). Less common findings included large nodules, emphysema, airspace consolidation, bronchiectasis, architectural distortion, Honeycombing, and pleural thickening. CONCLUSION: Lymphocytic interstitial pneumonia is characterized by the...