Fast Five Quiz: Idiopathic Pulmonary Fibrosis Imaging

Ani Kapoor, MD; Zab Mosenifar, MD


February 17, 2023

HRCTs have been reported to show honeycombing in approximately 90% of patients with IPF. However, in the absence of honeycombing, probable UIP or traction bronchiectasis, extent of reticular ground glass opacities, and reticulations can predict a diagnosis of IPF. Approximately 83% of probable UIP patterns on HRCT show a histopathological UIP pattern on surgical lung biopsy. For this reason, the 2022 ATS/ERS/JRS/ALAT guidelines recommend against a histologic confirmation of UIP with surgical lung biopsy in patients with definitive UIP and probable UIP unless there is additional concern for an alternative diagnosis.

When evaluating a patient for suspected IPF, HRCT findings of > 30% ground-glass attenuation should prompt the consideration of other diagnoses, including desquamative interstitial pneumonitis, idiopathic bronchiolitis obliterans organizing pneumonia, respiratory bronchiolitis–associated interstitial lung disease, hypersensitivity pneumonitis, and nonspecific interstitial pneumonia.

Diagnostic accuracy of IPF is significantly increased with HRCT compared with chest radiography. When a trained observer performs an HRCT, the accuracy of the diagnosis is reported to be approximately 90%. A confident diagnosis of IPF is made in about two thirds of cases, whereas one third of cases are missed on HRCT.

Learn more about HRCT in IPF.


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