Role of high resolution computed tomography in the clinico- radiological study of diffuse parenchymal lung diseases and in disease progression of tuberculosis

Authors

  • Sumit Sharma Department of Radiology, Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry, India
  • S. Shrinuvasan Department of Radiology, Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry, India
  • R. Chidambaram Department of Radiology, Sri Lakshmi Narayana Institute of Medical Sciences, Pondicherry, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20170643

Keywords:

Diffuse parenchymal lung disease, HRCT, Tuberculosis

Abstract

Background: This study was undertaken to detect and study the various HRCT patterns of DPLD, to assess disease progression of TB, also to evaluate disease prognosis and reversibility by quantification of data and compare it with clinical and functional impairment as evaluated by PFT; and to finally correlate it with a histopathological diagnosis wherever necessary.

Methods: This prospective study was conducted in the Department of Radiodiagnosis, SLIMS from December 2014 to November 2016. Patients of all age groups (3-86 years) presenting with dyspnea at rest/exertion, dry cough and known cases of DPLD were included; known lung anomalies were excluded. Clinical history with relevant lab investigations was followed by computerized radiography and HRCT. The extent of disease on HRCT scans, assessed by the mean attenuation value of the lung, was correlated with the severity of dyspnea and PFT results. HPE was done for diagnostic confirmation.

Results: IPF including chronic interstitial pneumonia comprised the most common group of diseases accounting for 28.3% cases followed by TB (25%). ‘Tree in bud’ appearance (71.4%), consolidation (42.8%) and scattered nodules (28.5%) are features of active disease while fibrosis (50%), honeycombing (50%), traction bronchiectasis (37.5%) and calcified granuloma (37.5%) are features of inactive disease. The histogram of the relative frequency of pulmonary attenuation values was depressed and skewed to the right in most cases. There was a statistically significant positive correlation between the mean lung density and severity of dyspnea and the extent of functional impairment as measured by the reduction in DLCO. Seven cases of active TB, three of sarcoidosis, three of PSS and two each of ABPA and HP among others were biopsy proven.

Conclusions: The present study concludes that HRCT is an invaluable tool in the detection, characterization, diagnosis, and evaluation of disease prognosis and reversibility of DPLDs especially in the study of disease progression of TB, in an appropriate clinical setting; while HPE is the gold standard for confirmation of the diagnosis.

References

Hamman L, Rich AR. Acute diffuse interstitial fibrosis of the lungs. Bull Johns Hopkins Hosp. 1944;74:177-212.

Coultas DB, Zumwalt RE, Black WC, Sobonya RE. The epidemiology of interstitial lung diseases. Am Resp Crit Care Med. 1994;150:967.

Todo G, Ito H, Nakano Y, Dodo Y, Maeda H, Murata K, et al. HRCT for the evaluation of pulmonary peripheral disorders. Jpn J Clin Rad. 1982;27:1319-26.

Mawson JB, Muller NL, Mathieson JR. Sarcoidosis- correlation of extent of disease at CT with clinical, functional and radiographic findings. Radiology. 1989;171:613-8.

Ryu JH, Colby TB, Hartman TE. Smoking related interstitial lung diseases: a review. Eur Respir J. 2001;17:122-32.

Epler GE, Carrington CB, Gaensler EA. Crackles (rales) in interstitial pulmonary diseases. Chest. 1978;73:333-9.

Turner-Warwick M, Burrows B, Johnson A. Cryptogenic fibrosing alveolitis: clinical features and their influence on survival. Thorax. 1980;35:171-80.

Staples CA, Muller NL, Vedal S. UIP – Correlation of CT with clinical functional and radiologic findings. Radiology. 1987;162:377-81.

Nishimura K; Kitaichi M, Izumi T. UIP – histologic correlation with high resolution computed tomography. Radiology. 1992;182:337-42.

Austin JH, Müller NL, Friedman PJ, Hansell DM, Naidich DP, Remy-Jardin M, et al: Glossary for terms for CT of lungs: Recommendations of Nomenclature Committee of Fleishner society. Radiology. 1996;200:327.

Remy-Jardin M, Remy J, Wallaert B, Bataille D, Hatron PY. Pulmonary involvement in progressive systemic sclerosis: sequential evaluation with CT, Pulmonary function tests and bronchioalveolar lavage. Radiology. 1993;188:499-506.

Leung AN, Miller RR, Muller NL. Parenchymal opacities in chronic infiltrative lung diseases: CT-pathologic correlation. Radiology. 1993;188:209-14.

Hong SH, Im JG, Lee JS, Song JW, Lee HJ, Yeon KM. HRCT study of miliary tuberculosis Journal of Comput Assist Tomography. 1998;22:220-4.

Im JG, Itoh H, Shim YS, Lee JH, Ahn J, Han MC, et al. Pulmonary tuberculosis –CT findings – early disease and sequential change with anti-tubercular therapy. Radiology. 1993;186:653-60.

Grenier P, Valeyre D, Cluzel P, Brauner MW, Lenoir S, Chastang C. Chronic diffuse infiltrative lung disease: Diagnostic value of chest radiography and HRCT. Radiology. 1991;179;123-32.

Hansell DM, Moskovic E. HRCT in extrinsic allergic alveolitis. Clin Rad. 1991;43:8-12.

Schurawitzki H1, Stiglbauer R, Graninger W, Herold C, Pölzleitner D, Burghuber OC, et al. Interstitial lung disease in progressive systemic sclerosis: HRCT versus radiography. Radiology. 1990;176:755-9.

Grenier P, Chevret S, Beigelman C, Brauner MW, Chastang C, Valeyre D. Chronic diffuse infiltrative lung disease: Determination of diagnostic value of clinical data. Chest radiography and CT with Bayesian analysis. Radiology. 1994;191:383-90.

Kullnig P, Pangratz M, Kopp W. CT in the diagnosis of allergic bronchopulmonary aspergillosis. Radiology. 1989;29:228-31.

Murata K, Takahashi M, Mori M. Pulmonary metastatic nodules – CT pathologic correlation. Radiology. 1992;182:331-35.

Libshitz HI Shuman LS. Radiation induced pulmonary change- CT findings. J Comput Assist Tomo. 1984;8:15-9.

Ikezoe J, Takashima S, Morimoto S, Kadowaki K, Takeuchi N, Yamamoto T, et al: CT appearance of acute radiation induced injury to the lung. AJR. 1988;150:765-70.

Bouchardy LM, Kuhlman JE, Ball WC. CT findings in BOOP with clinical, radiographic and histological correlation. J Comput. Assist Tomo. 1993;17;352-7.

Muller NL, Staples CA, Miller RR: BOOP – CT features in 14 patients. AJR. 1990;154:983-87.

Muller NL, Gueny-Force ML, Staples CA. Differential diagnosis of UIP and BOOP: clinical, functional and radiological findings. Radiology. 1987;162:151-6.

Lee KS, Kullnig P, Hartman TE, Müller NL. Cryptogenic organizing pneumonia – CT findings in 43 patients. AJR. 1994;162:543-46.

Webb WR, Muller NL, Naidich DP. HRCT of the lung Ed 2 Philadelphia. Lipincott – Raven. 1996.

Primack SL, Hartman TE, Ikezoe. Acute interstitial pneumonia – radiological and CT findings in 9 patients. Radiology. 1993;188:817-20.

Goldin JG. Quantitative CT of the lung. RCNA. 2002;40(1):145-61.

Hartley PG, Galvim JR, Hunninghahn GW. HRCT derived measures of lung density are valid indexes of ILD. J Appl Physiology. 1994;76:271-7.

Remy-Jardin M, Giraud F, Remy J. Pulmonary sarcoidosis- role of CT in the evaluation of disease activity and functional impairment and in prognosis assessment. Radiology. 1994;191:675.

Kalender WA, Rienmüller R, Seissler W, Behr J, Welke M, Fichte H. Measurement of pulmonary parenchymal attenuation: use of spirometic gating with quantitative CT. Radiology. 1990;175:256-68.

Wall CP, Gaensler EA, Carrington CB, Hayes JA. comparison of transbronchial biopsy for chronic diffuse infiltrative lung disease. Am Rev Respir Dis. 1981;3:491-501.

Downloads

Published

2017-02-20

How to Cite

Sharma, S., Shrinuvasan, S., & Chidambaram, R. (2017). Role of high resolution computed tomography in the clinico- radiological study of diffuse parenchymal lung diseases and in disease progression of tuberculosis. International Journal of Research in Medical Sciences, 5(3), 956–964. https://doi.org/10.18203/2320-6012.ijrms20170643

Issue

Section

Original Research Articles