Jonathan H Chung1,2,3,4, Steven M Montner1,2,3,4, Ayodeji Adegunsoye1,2,3,4, Cathryn Lee1,2,3,4, Justin M Oldham1,2,3,4, Aliya N Husain1,2,3,4, Heber MacMahon1,2,3,4, Imre Noth1,2,3,4, Rekha Vij1,2,3,4, Mary E Strek1,2,3,4. 1. 1 Department of Radiology, University of Chicago Medical Center, 5841 S Maryland Ave, Chicago, IL 60637. 2. 2 Section of Pulmonary/Critical Care, Department of Medicine, University of Chicago Medical Center, Chicago, IL. 3. 3 Section of Pulmonary/Critical Care, Department of Medicine, University of California at Davis, Sacramento, CA. 4. 4 Department of Pathology, University of Chicago Medical Center, Chicago, IL.
Abstract
OBJECTIVE: The objective of this study is to determine the CT findings and patterns of interstitial pneumonia with autoimmune features (IPAF) and to assess whether imaging can predict survival for patients with IPAF. MATERIALS AND METHODS: The study included 136 subjects who met the criteria for IPAF and had diagnostic-quality chest CT scans obtained from 2006 to 2015; a total of 74 of these subjects had pathologic samples available for review within 1 year of chest CT examination. CT findings and the presence of an usual interstitial pneumonitis (UIP) pattern of disease were assessed, as was the UIP pattern noted on pathologic analysis. Analysis of chest CT findings associated with survival was performed using standard univariate and multivariate Cox proportional hazards methods as well as the unadjusted log-rank test. Survival data were visually presented using the Kaplan-Meier survival curve estimator. RESULTS: Most subjects with IPAF (57.4%; 78/136) had a high-confidence diagnosis of a UIP pattern on CT. Substantially fewer subjects (28.7%; 39/136) had a pattern that was inconsistent with UIP noted on CT. The presence of a UIP pattern on CT was associated with smoking (p < 0.01), male sex (p < 0.01), and older age (p < 0.001). Approximately one-fourth of the subjects had a nonspecific interstitial pneumonitis pattern on CT. Of interest, nearly one-tenth of the subjects had a CT pattern that was most consistent with hypersensitivity pneumonitis rather than the customary CT patterns ascribed to lung disease resulting from connective tissue disease. Most subjects with a possible UIP pattern on CT (83.3%) had UIP diagnosed on the basis of pathologic findings. Focused multivariate analysis showed that honeycombing on CT (hazard ratio, 2.17; 95% CI, 1.05-4.47) and pulmonary artery enlargement on CT (hazard ratio, 2.08; 95% CI, 1.02-4.20) were independent predictors of survival. CONCLUSION: IPAF most often presents with a UIP pattern on CT and is associated with worse survival when concomitant honeycombing or pulmonary artery enlargement is present.
OBJECTIVE: The objective of this study is to determine the CT findings and patterns of interstitial pneumonia with autoimmune features (IPAF) and to assess whether imaging can predict survival for patients with IPAF. MATERIALS AND METHODS: The study included 136 subjects who met the criteria for IPAF and had diagnostic-quality chest CT scans obtained from 2006 to 2015; a total of 74 of these subjects had pathologic samples available for review within 1 year of chest CT examination. CT findings and the presence of an usual interstitial pneumonitis (UIP) pattern of disease were assessed, as was the UIP pattern noted on pathologic analysis. Analysis of chest CT findings associated with survival was performed using standard univariate and multivariate Cox proportional hazards methods as well as the unadjusted log-rank test. Survival data were visually presented using the Kaplan-Meier survival curve estimator. RESULTS: Most subjects with IPAF (57.4%; 78/136) had a high-confidence diagnosis of a UIP pattern on CT. Substantially fewer subjects (28.7%; 39/136) had a pattern that was inconsistent with UIP noted on CT. The presence of a UIP pattern on CT was associated with smoking (p < 0.01), male sex (p < 0.01), and older age (p < 0.001). Approximately one-fourth of the subjects had a nonspecific interstitial pneumonitis pattern on CT. Of interest, nearly one-tenth of the subjects had a CT pattern that was most consistent with hypersensitivitypneumonitis rather than the customary CT patterns ascribed to lung disease resulting from connective tissue disease. Most subjects with a possible UIP pattern on CT (83.3%) had UIP diagnosed on the basis of pathologic findings. Focused multivariate analysis showed that honeycombing on CT (hazard ratio, 2.17; 95% CI, 1.05-4.47) and pulmonary artery enlargement on CT (hazard ratio, 2.08; 95% CI, 1.02-4.20) were independent predictors of survival. CONCLUSION:IPAF most often presents with a UIP pattern on CT and is associated with worse survival when concomitant honeycombing or pulmonary artery enlargement is present.
Authors: Ayodeji Adegunsoye; Justin M Oldham; Jonathan H Chung; Steven M Montner; Cathryn Lee; Leah J Witt; Danielle Stahlbaum; Rene S Bermea; Lena W Chen; Scully Hsu; Aliya N Husain; Imre Noth; Rekha Vij; Mary E Strek; Matthew Churpek Journal: Chest Date: 2017-09-28 Impact factor: 9.410
Authors: Erin M Wilfong; Robert J Lentz; Adam Guttentag; James J Tolle; Joyce E Johnson; Jonathan A Kropski; Peggy L Kendall; Timothy S Blackwell; Leslie J Crofford Journal: Arthritis Rheumatol Date: 2018-10-27 Impact factor: 10.995
Authors: Giacomo Grasselli; Beatrice Vergnano; Maria Rosa Pozzi; Vittoria Sala; Gabriele D'Andrea; Vittorio Scaravilli; Marco Mantero; Alberto Pesci; Antonio Pesenti Journal: Ann Intensive Care Date: 2017-09-18 Impact factor: 6.925
Authors: Marlee S Crews; Brian J Bartholmai; Ayodeji Adegunsoye; Justin M Oldham; Steven M Montner; Ronald A Karwoski; Aliya N Husain; Rekha Vij; Imre Noth; Mary E Strek; Jonathan H Chung Journal: J Clin Med Date: 2020-11-23 Impact factor: 4.241