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Published online before print December 12, 2005, 10.1148/radiol.2381041823
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Interstitial Lung Disease: Effects of Thin-Section CT on Clinical Decision Making1

Zelena A. Aziz, MD, Athol U. Wells, MD, Eric D. Bateman, MD, Susan J. Copley, MD, Sujal R. Desai, MD, Jan C. Grutters, MD, David G. Milne, MD, Gerrard D. Phillips, MD, David Smallwood, MD, John Wiggins, MD, Margaret L. Wilsher, MD and David M. Hansell, MD

1 From the Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England. Received October 24, 2004; revision requested December 23; revision received February 1, 2005; accepted February 24; final version accepted April 27. Address correspondence to D.M.H. (e-mail: d.hansell{at}rbh.nthames.nhs.uk).


Figure 1
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  		Figure 1: Chart shows categories of disease that were used for statistical analysis. IPF = idiopathic pulmonary fibrosis.

 

Figure 2
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  		Figure 2: Transverse thin-section CT image obtained at the level of the right main pulmonary artery shows linear opacities and extensive ground-glass opacification. Several low-attenuation focal areas are evident, which suggests air trapping (arrows). The first-choice diagnosis of radiologists was hypersensitivity pneumonitis. The first-choice diagnosis of pulmonologists before CT was either IPF or nonspecific interstitial pneumonia. After CT, all pulmonologists altered their diagnosis to hypersensitivity pneumonitis.

 

Figure 3
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  		Figure 3: Transverse thin-section CT image at the level of the right hemidiaphragm. Ground-glass opacification in association with traction bronchiectasis and a fine reticular pattern are demonstrated. In this case, six different first-choice diagnoses were offered by the pulmonologists. The first-choice diagnosis of radiologists was nonspecific interstitial pneumonia. CT findings resulted in all pulmonologists changing their original diagnosis to nonspecific interstitial pneumonia.

 

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  		Figure A1: Clinical data sheets, which were completed for each patient, included both general and detailed information.

 

Figure 2
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  		Figure A2: Pro forma completed by pulmonologists before and after CT. ATS = American Thoracic Society, CXR = chest radiography, ERS = European Respiratory Society.

 

Figure 3
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  		Figure A3: An example of the format in which the radiology report was conveyed to the pulmonologists. HRCT = thin-section CT.

 




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