Related Experiment Video
Updated: May 24, 2025
Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
Published on: June 16, 2020
CT features of pathologically proven smoking-related interstitial fibrosis: compared with emphysema and usual
ChanU Jeong1, Taein An1,2, Myung Jin Chung1
1Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Objectives:
To differentiate smoking-related interstitial fibrosis (SRIF) from emphysema and usual interstitial pneumonia (UIP) using CT.
Materials And Methods:
From January 2016 to October 2023, a total of 123 patients who underwent lung surgery with pathologically proven SRIF (n = 23), emphysema (n = 50), and UIP (n = 50) were included. Three radiologists retrospectively reviewed preoperative chest CTs for imaging features of centrilobular/paraseptal emphysema, multiple thin-walled cysts (MTWC), honeycombing, traction bronchiectasis, subpleural ground-glass opacity (GGO)/reticulation, and presence of smoking-related disease (SRD) and compared the CT features by subgroup.
Results:
A total of 123 patients (23 SRIF, 50 emphysema, 50 UIP; mean age, 64.9 ± 8.96 years; 99 males) were involved. Centrilobular emphysema, paraseptal emphysema, MTWC, honeycombing, traction bronchiectasis, subpleural GGO/reticulation, and SRD were identified in SRIF (100%, 100%, 73.9%, 8.7%, 100%, 100%, 47.8%), emphysema (94%, 60%, 2%, 2%, 4%, 8%, 10%), and UIP (48%, 40%, 0%, 42%, 100%, 100%, 6%) cases, respectively. In the univariable analysis of SRIF and emphysema, MTWC, traction bronchiectasis, subpleural GGO/reticulation, and the presence of SRD were predictive features of SRIF (all p < 0.05). In the multivariable analysis of SRIF and emphysema, MTWC and subpleural GGO/reticulation were predictive of SRIF (all p < 0.05). In both univariable and multivariable analyses of SRIF and UIP, MTWC and the presence of SRD were predictive features of SRIF (all p < 0.05), whereas honeycombing was significant only in univariable analysis (p = 0.01).
Conclusion:
Imaging features of MTWC, subpleural GGO/reticulation, and the presence of SRD on CT may help differentiate SRIF from emphysema and UIP.
Key Points:
Question SRIF is recognized as a separate entity; however, insufficient radiological studies have been conducted. Findings CT imaging features of MTWC, subpleural GGO/reticulation, and the presence of SRD are predictive factors for SRIF. Clinical relevance SRIF, emphysema, and UIP have overlapping imaging/clinical features but different treatments and prognoses. As treatment for UIP slows the disease progression, accurate differentiation based on imaging findings is essential for improving prognosis.
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