Hiroaki Arakawa1, Takumi Kishimoto2, Kazuto Ashizawa3, Katsuya Kato4, Kenzo Okamoto5, Koichi Honma6, Seiji Hayashi7, Masanori Akira8. 1. Department of Radiology, Dokkyo Medical University, 880, Kita-Kobayashi, Mibu, Tochigi, 321-0293, Japan. arakawa@dokkyomed.ac.jp. 2. Asbestos Research Center, Okayama Rosai Hospital, 1-10-25 Chikkomidorimachi Ninamiku, Okayama, 702-8055, Japan. 3. Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. 4. Department of Diagnostic Radiology 2, Kawasaki Medical School, 2-1-80, Nakasange, Kita-ku, Okayama, 701-0114, Japan. 5. Department of Pathology, Hokkaido Chuo Hospital, 4 Joh Higashi 16, Iwamizawa, Hokkaido, 068-0004, Japan. 6. Department of Pathology, Dokkyo Medical University, 880, Kita-Kobayashi, Mibu, Tochigi, 321-0293, Japan. 7. National Hospital Organization Kinki-Chuo Chest Medical Center, 1180 Nagasone-cho, Kita-ku, Sakai-city, Osaka, 591-8555, Japan. 8. Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
Abstract
OBJECTIVE: The purpose was to identify distinguishing CT features of pathologically diagnosed asbestosis, and correlate diagnostic confidence with asbestos body burden. METHODS: Thirty-three workers (mean age at CT: 73 years) with clinical diagnoses of asbestosis, who were autopsied (n = 30) or underwent lobectomy (n = 3), were collected. Two radiologists independently scored high-resolution CT images for various CT findings and the likelihood of asbestosis was scored. Two pathologists reviewed the pathology specimens and scored the confidence of their diagnoses. Asbestos body count was correlated with CT and pathology scores. RESULTS: Pathologically, 15 cases were diagnosed as asbestosis and 18 cases with various lung fibroses other than asbestosis. On CT, only the score of the subpleural curvilinear lines was significantly higher in asbestosis (p = 0.03). Accuracy of CT diagnosis of asbestosis with a high confidence ranged from 0.73 to 0.79. Asbestos body count positively correlated with CT likelihood of asbestosis (r = 0.503, p = 0.003), and with the confidence level of pathological diagnosis (r = 0.637, p < 0.001). CONCLUSIONS: Subpleural curvilinear lines were the only clue for the diagnosis of asbestosis. However, this was complicated by other lung fibrosis, especially at low asbestos body burden. KEY POINTS: • Various patterns of pulmonary fibrosis occurred in asbestos-exposed workers. • The fibre burden in lungs paralleled confident CT diagnosis of asbestosis. • The fibre burden in lungs paralleled confident pathological diagnosis of asbestosis. • Subpleural curvilinear lines were an important CT finding favouring asbestosis.
OBJECTIVE: The purpose was to identify distinguishing CT features of pathologically diagnosed asbestosis, and correlate diagnostic confidence with asbestos body burden. METHODS: Thirty-three workers (mean age at CT: 73 years) with clinical diagnoses of asbestosis, who were autopsied (n = 30) or underwent lobectomy (n = 3), were collected. Two radiologists independently scored high-resolution CT images for various CT findings and the likelihood of asbestosis was scored. Two pathologists reviewed the pathology specimens and scored the confidence of their diagnoses. Asbestos body count was correlated with CT and pathology scores. RESULTS: Pathologically, 15 cases were diagnosed as asbestosis and 18 cases with various lung fibroses other than asbestosis. On CT, only the score of the subpleural curvilinear lines was significantly higher in asbestosis (p = 0.03). Accuracy of CT diagnosis of asbestosis with a high confidence ranged from 0.73 to 0.79. Asbestos body count positively correlated with CT likelihood of asbestosis (r = 0.503, p = 0.003), and with the confidence level of pathological diagnosis (r = 0.637, p < 0.001). CONCLUSIONS: Subpleural curvilinear lines were the only clue for the diagnosis of asbestosis. However, this was complicated by other lung fibrosis, especially at low asbestos body burden. KEY POINTS: • Various patterns of pulmonary fibrosis occurred in asbestos-exposed workers. • The fibre burden in lungs paralleled confident CT diagnosis of asbestosis. • The fibre burden in lungs paralleled confident pathological diagnosis of asbestosis. • Subpleural curvilinear lines were an important CT finding favouring asbestosis.
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