Interstitial lung abnormalities: prognostic stratification of subtle radiological findings

Area of Science:

• Radiology
• Pulmonology
• Pathology

Background:

• Interstitial lung abnormalities (ILA) are increasingly reported on high-resolution computed tomography (HRCT).
• Interpretation of subtle ILA features can be challenging due to interobserver variability.
• ILA share morphological similarities with histopathological patterns like fibrosis and atypical adenomatous hyperplasia.

Purpose of the Study:

• To provide a radiological description of interstitial lung abnormalities (ILA) on HRCT.
• To discuss the prospective interpretation of ILA.
• To highlight the clinical significance and prognostic implications of ILA.

Main Methods:

• Review of radiological findings of ILA on HRCT.
• Discussion of quantitative analysis for standardized ILA description.
• Exploration of extraradiological predictors and prognostic factors associated with ILA.

Main Results:

• ILA present with specific elementary findings on HRCT, requiring careful interpretation.
• Quantitative analysis aids in standardized and reproducible ILA description.
• Fibrotic ILA morphology is associated with disease progression, respiratory mortality, and all-cause mortality.
• ILA are linked to an increased risk of lung cancer and impact survival.
• Risk predictors include age, smoking, biomarkers, and genetic sequencing.

Conclusions:

• ILA are significant findings on HRCT that warrant reporting by radiologists.
• Optimal management of ILA requires consideration of their clinic-functional context.
• ILA exhibit semiological characteristics indicative of fibrotic or nonfibrotic disease with prognostic implications.