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Updated: Dec 3, 2025
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
HRCT evaluation of patients with interstitial lung disease: comparison of the 2018 and 2011 diagnostic guidelines
Steven D Nathan1, Jean Pastre2,3, Inga Ksovreli2
1Advanced Lung Disease Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA.
Insights
New guidelines for interpreting chest high-resolution computed tomography (HRCT) in interstitial lung disease (ILD) may increase variability among clinicians. Further research is needed to determine if these changes improve patient care for idiopathic pulmonary fibrosis (IPF).
Area of Science:
- Pulmonology
- Radiology
- Medical Diagnostics
Background:
- Chest high-resolution computed tomography (HRCT) is crucial for diagnosing idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs).
- Updated guidelines and HRCT interpretation nomenclature were introduced in 2018.
- The impact of these new guidelines on clinical interpretation requires evaluation.
Purpose of the Study:
- To assess how clinicians' interpretation of HRCT scans changes between old and new guideline frameworks.
- To evaluate inter-observer agreement in HRCT interpretation for ILD before and after guideline changes.
Main Methods:
- 50 deidentified HRCT scans from ILD patients were collected.
- Six ILD experts independently interpreted each HRCT using both old and new guidelines.
- Inter-interpreter concordance was measured using the kappa statistic.
Main Results:
- Concordance decreased from kappa 0.5 (old guidelines) to 0.38 (new guidelines).
- Unanimous consensus reads decreased from 22 to 15 cases with the new guidelines.
- The new guidelines showed increased inter-interpreter variability in classifying UIP patterns.
Conclusions:
- The implementation of new HRCT interpretation guidelines for ILD may lead to greater variability among clinicians.
- The clinical benefit and impact on patient management of these new guidelines remain uncertain.
- Further studies are needed to clarify the role of new guidelines in ILD patient care.
Background And Aims:
Chest high-resolution computed tomography (HRCT) is the central diagnostic tool in discerning idiopathic pulmonary fibrosis (IPF) from other interstitial lung disease (ILDs). In 2018, new guidelines were published and the nomenclature for HRCT interpretation was changed. We sought to evaluate how clinicians' interpretation would change based on reading HRCTs under the framework of the old versus new categorization.
Materials And Methods:
We collated HRCTs from 50 random cases evaluated in the Inova Fairfax ILD clinic. Six ILD experts were provided the deidentified HRCTs. They were all instructed to independently provide two reads of each HRCT, based on the old and the new guidelines.
Results:
The kappa statistic for concordance for HRCT reads under old guidelines was 0.5, while for the new guidelines it was 0.38. Under the framework of the old guidelines, there were 22 HRCTs with unanimous consensus reads, while only 15 with the new guidelines. There were 12 HRCTs read unanimously as usual interstitial pneumonia (UIP) pattern based on both the old and the new guidelines. Ten HRCTs were read as a possible UIP pattern based on the old guidelines and were classified in nine cases as probable UIP and one indeterminate based on the new guidelines. Of the 28 inconsistent UIP HRCTs (old guidelines), 25 were read as alternative diagnosis suggested, two were read as indeterminate and one as probable UIP.
Conclusion:
Implementation of the new guidelines to categorize HRCTs in ILD patients appears to be associated with greater inter-interpreter variability. How or whether new guidelines improve the care and management of ILD patients remains unclear.The reviews of this paper are available via the supplemental material section.
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