Related Experiment Video
Updated: Nov 9, 2025
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
Vessel-related structures predict UIP pathology in those with a non-IPF pattern on CT
Jonathan H Chung1, Ayodeji Adegunsoye2, Justin M Oldham3
1Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA. jonherochung@uchicago.edu.
Insights
Quantitative imaging of vessel-related structures (VRS) can help identify usual interstitial pneumonia (UIP) in patients with interstitial lung disease. Higher VRS on CT scans may predict UIP pathology, potentially reducing the need for invasive biopsies.
Area of Science:
- Radiology
- Pulmonary Medicine
- Pathology
Background:
- Interstitial lung diseases (ILDs) encompass a heterogeneous group of disorders.
- Distinguishing usual interstitial pneumonia (UIP) from other ILDs is crucial for prognosis and treatment.
- Current diagnostic methods rely on a combination of imaging and histopathology, which can have limitations.
Purpose of the Study:
- To evaluate if quantitative imaging of vessel-related structures (VRS) can identify patients with a non-IPF diagnosis CT pattern who are likely to have UIP histologically.
- To assess the diagnostic performance of VRS compared to standard qualitative CT assessment for pathological UIP.
Main Methods:
- Retrospective analysis of chest CT scans from patients with ILD and multidisciplinary diagnosis.
- Utilized the Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER) program for quantitative analysis of CT patterns.
- Correlated quantitative data (reticulation, honeycombing, VRS) with pathological diagnosis and qualitative CT patterns.
Main Results:
- Quantitative VRS, reticulation, and honeycombing volumes were associated with UIP on univariate analysis.
- Only VRS remained significantly associated with UIP pathology on multivariable analysis (p = 0.013).
- A VRS cut-off of 173 cm³ demonstrated sensitivity (55.9%) and specificity (80.4%) for pathological UIP, comparable to qualitative CT assessment.
Conclusions:
- Volume of vessel-related structures (VRS) is associated with UIP pathology.
- VRS effectively differentiates UIP in patients with a non-IPF diagnosis CT pattern.
- High VRS values may obviate the need for invasive pathology in suspected UIP cases, serving as an adjunct to CT imaging.
Objectives:
To determine if a quantitative imaging variable (vessel-related structures [VRS]) could identify subjects with a non-IPF diagnosis CT pattern who were highly likely to have UIP histologically.
Methods:
Subjects with a multidisciplinary diagnosis of interstitial lung disease including surgical lung biopsy and chest CT within 1 year of each other were included in the study. Non-contrast CT scans were analyzed using the Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER) program, which quantifies the amount of various abnormal CT patterns on chest CT. Quantitative data were analyzed relative to pathological diagnosis as well as the qualitative CT pattern.
Results:
CALIPER-derived volumes of reticulation (p = 0.012), honeycombing (p = 0.017), and VRS (p < 0.001) were associated with a UIP pattern on pathology on univariate analysis but only VRS was associated with a UIP pathology on multivariable analysis (p = 0.013). Using a VRS cut-off of 173 cm3, the sensitivity and specificity for pathological UIP were similar to those for standard qualitative CT assessment (55.9% and 80.4% compared to 60.6% and 80.4%, respectively). VRS differentiated pathological UIP cases in those with a non-IPF diagnosis CT category (p < 0.001) but not in other qualitative CT patterns (typical UIP, probable UIP, and indeterminate for UIP). The rate of pathological UIP in those with VRS greater than 173 cm3 (84.2%) was nearly identical to those who had a qualitative CT pattern of probable UIP (88.9%).
Conclusions:
VRS may be an adjunct to CT in predicting pathology in patients with interstitial lung disease.
Key Points:
• Volume of vessel-related structures (VRS) was associated with usual interstitial pneumonia (UIP) on pathology. • This differentiation arose from those with CT scans with a non-IPF diagnosis imaging pattern. • Higher VRS has similar diagnostic ramifications for UIP as probable UIP, transitively suggesting in patients with high VRS, pathology may be obviated.
