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Diagnostic Accuracy of HRCT for Differentiation of NSIP, UIP and Chronic Hypersensitivity Pneumonitis

AUTHORS

Mehrdad Bakhshayesh Karam 1 , Shahram Kahkouee 1 , Makhtoum Shahnazi 2 , Leila Sourtji 1 , Mohammad Ali Karimi 3 , *

AUTHORS INFORMATION

1 Department of Radiology, Masih-e-Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

2 Department of Radiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

3 Department of Radiology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

ARTICLE INFORMATION

Iranian Journal of Radiology: 11 (30th Iranian Congress of Radiology); e21269
Published Online: February 28, 2014
Article Type: Research Article
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Abstract

Background: Diagnosis of chronic pulmonary fibrosing diseases is dependent on biopsy which is an invasive procedure that cannot be done in some patients. A noninvasive accurate diagnostic tool such as HRCT can obviate the need for biopsy.

Objectives: The aim of this study was to assess the diagnostic accuracy of HRCT for nonspecific intrestitial pneumonitis (NSIP), usual intrestitial pneumonitis (UIP) and chronic hypersensitivity pneumonitis (HP).

Patients and Methods: HRCT images of 57 patients (22 NSIPs, 21UIPs, and 14 chronic HPs) were reviewed by two pulmonary radiologists in a blinded way. The radiologic diagnosis was compared with pathologically proven diagnosis, and sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy as well as reliability were determined.

Results: Confident diagnosis by HRCT was made in 66% of patients. The diagnosis in 93.1% of cases which were confidently diagnosed by both radiologists was consistent with histopathology. The overall agreement between two radiologists in all three diseases was fair. However, in the cases with confident diagnosis by both radiologists the agreement was excellent, especially for NSIP (Kappa = 0.86). The diagnostic accuracy of HRCT for NSIP, UIP and chronic HP was 82%, 73% and 87.5%, respectively. Sensitivity, specificity, PPV, and NPV for all of these diseases were almost acceptable (71-100%).

Conclusions: HRCT is a highly accurate method for diagnosis of NSIP, UIP, and chronic HP. Biopsy could be avoided in case of confident agreement between two radiologists in their HRCT based diagnosis of NSIP.

Keywords

© 2014, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
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