Radiology Rounds

A Closer Look at Interstitial Lung Disease

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Role of HRCT in Diagnosing Interstitial Lung Disease

Updated International Guidelines for IPF Diagnosis: A Radiology Perspective

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Quiz: Differentiating Between Chronic HP, NSIP, and UIP

Question 1:

Inspiratory (TLC)

Axial Inspiratory (TLC) on HRCT

Expiratory (RV)

Axial Expiratory (RV) on HRCT

Inspiratory (TLC)

Coronal Inspiratory (TLC) on HRCT

Expiratory (RV)

Coronal Expiratory (RV) on HRCT

RV, residual volume; TLC, total lung capacity.
Images courtesy of and used with permission from Jonathan Goldin, MD, PhD.

Which of the following features are present in the above axial and coronal HRCT scans?

A Honeycombing

B Reticulation

C Ground glass opacity

D Traction bronchiectasis

E Air trapping

F All of the above

Correct! All of these features are present in the above CT scans. Note the importance of obtaining expiratory scans to evaluate the presence of air trapping.

Incorrect! All of these features are present in the above CT scans. Note the importance of obtaining expiratory scans to evaluate the presence of air trapping.

Question 2:

Inspiratory (TLC)

Axial Inspiratory (TLC) on HRCT

Expiratory (RV)

Axial Expiratory (RV) on HRCT

Inspiratory (TLC)

Coronal Inspiratory (TLC) on HRCT

Expiratory (RV)

Coronal Expiratory (RV) on HRCT

Images courtesy of and used with permission from Jonathan Goldin, MD, PhD.

What is the most likely diagnosis for this patient?

A UIP/IPF

B NSIP

C Chronic hypersensitivity pneumonitis

Correct! While this HRCT has several features which are consistent with UIP, air trapping excludes a definite diagnosis of UIP. The predominant abnormalities and their distribution are consistent with a diagnosis of chronic hypersensitivity pneumonitis.

Incorrect! While this HRCT has several features which are consistent with UIP, air trapping excludes a definite diagnosis of UIP. The predominant abnormalities and their distribution are consistent with a diagnosis of chronic hypersensitivity pneumonitis.

Question 3:

Typical Features of UIP on HRCT

Typical Features of NSIP on HRCT

Reprinted with permission from Mueller-Mang C et al. RadioGraphics. 2007;27(3):595-615.

Correctly identify the above images.

A Left, UIP; Right, NSIP

B Left, NSIP; Right, UIP

Correct! The image to the left is characterized by subpleural honeycombing, reticulation, and traction bronchiectasis typical of UIP. The image to the right demonstrates ground glass opacity, subpleural linear opacities, and micronodules, typical of NSIP.

Incorrect! The image to the left is characterized by subpleural honeycombing, reticulation, and traction bronchiectasis typical of UIP. The image to the right demonstrates ground glass opacity, subpleural linear opacities, and micronodules, typical of NSIP.

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