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Updated: May 24, 2025

Imaging Features of Systemic Sclerosis-Associated Interstitial Lung Disease
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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.

European Radiology
|March 6, 2025
PubMed
Summary

Computed tomography (CT) imaging features like multiple thin-walled cysts (MTWC), subpleural ground-glass opacity/reticulation, and smoking-related disease (SRD) can help differentiate smoking-related interstitial fibrosis (SRIF) from emphysema and usual interstitial pneumonia (UIP). Accurate differentiation is crucial for appropriate treatment and improved prognosis.

Keywords:
Computed tomographyEmphysemaSmoking-related interstitial fibrosisUsual interstitial pneumonia

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Area of Science:

  • Radiology and Pulmonary Medicine
  • Medical Imaging Analysis
  • Disease Differentiation

Background:

  • Smoking-related interstitial fibrosis (SRIF) is a distinct entity, yet radiological studies are limited.
  • SRIF, emphysema, and usual interstitial pneumonia (UIP) share overlapping clinical and imaging features, complicating diagnosis.
  • Accurate differentiation is critical due to differing treatments and prognoses, especially as UIP treatment can slow disease progression.

Purpose of the Study:

  • To identify and evaluate specific CT imaging features that differentiate SRIF from emphysema and UIP.
  • To establish reliable radiological markers for diagnosing SRIF.

Main Methods:

  • Retrospective review of preoperative chest CT scans from 123 patients (23 SRIF, 50 emphysema, 50 UIP) with pathologically proven diagnoses.
  • Radiologists assessed CT features including emphysema types, multiple thin-walled cysts (MTWC), honeycombing, traction bronchiectasis, subpleural ground-glass opacity (GGO)/reticulation, and smoking-related disease (SRD).
  • Statistical analysis (univariable and multivariable) was performed to identify predictive features for SRIF.

Main Results:

  • SRIF cases frequently exhibited MTWC (73.9%), subpleural GGO/reticulation (100%), and SRD (47.8%).
  • In comparisons with emphysema, MTWC, traction bronchiectasis, subpleural GGO/reticulation, and SRD were significant predictors of SRIF.
  • When compared with UIP, MTWC and SRD were significant predictors of SRIF in both univariable and multivariable analyses.

Conclusions:

  • CT findings of MTWC, subpleural GGO/reticulation, and the presence of SRD are valuable in differentiating SRIF from emphysema and UIP.
  • These imaging features provide crucial information for accurate diagnosis and management planning.
  • The study highlights the importance of recognizing specific CT patterns for improved patient outcomes.