Pulmonary fibrosis and emphysema: Is the emphysema type associated with the pattern of fibrosis?

doi:10.4329/wjr.v7.i9.294

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World Journal of Radiology

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Observational Study

World J Radiol. Sep 28, 2015; 7(9): 294-305
Published online Sep 28, 2015. doi: 10.4329/wjr.v7.i9.294

Table 1 Predominant type of emphysema and pulmonary fibrosis according to the ratings on high resolution computed tomography of the two observers

		Observer 2
		Type of emphysema
Observer 1			CLE = PSE	Paraseptal	Centrilobular
	Type of emphysema¹	CLE = PSE	2	0	0	2
		Paraseptal	0	23	0	23
		Centrilobular	0	2	26	28
			2	25	26
		Type of pulmonary fibrosis
			Typical UIP	Possible UIP	NSIP
	Type of pulmonary fibrosis²	Typical UIP	19	0	0	19
		Possible UIP	5	4	1	10
		NSIP	0	1	23	24
			24	5	24

¹The interrater reliability for the 2 observers was found to be Kappa = 0.929 (P < 0.001), 95%CI (0.757-1.000);

²The interrater reliability for the observers was found to be Kappa = 0.785 (P < 0.001), 95%CI (0.646-0.924). CLE: Centrilobular emphysema; PSE: Paraseptal emphysema; UIP: Usual interstitial pneumonia; NSIP: Nonspecific interstitial pneumonia.

Table 2 Association of predominant type of emphysema with predominant type of fibrosis according to observer 1 and observer 2

	Predominant type ILD
		Typical UIP	Possible UIP	NSIP
Observer 1
Predominant emphysema type	CLE = PSE	0	2	0	2
	Paraseptal	19	4	0	23
	Centrilobular	0	4	24	28
		19	10	24
Observer 2
Predominant emphysema type	CLE = PSE	2	0	0	2
	Paraseptal	21	2	2	25
	Centrilobular	1	3	22	26
		24	5	24

CLE: Centrilobular emphysema; PSE: Paraseptal emphysema; UIP: Usual interstitial pneumonia; NSIP: Nonspecific interstitial pneumonia.

Table 3 Parameters of high resolution computed tomography scoring system and functional pulmonary parameters in the groups according to the predominant type of emphysema

Parameters	Group E1Paraseptal emphyseman = 23Mean (95%CI)	Group E2Centrilobular emphyseman = 28Mean (95%CI)	Independent samplest testP value
Emphysema	6.3 (2.9-9.7)	21.82 (14.93-28.85)	< 0.001
TotExtILD	53.34 (41.05-65.63)	29.82 (22.09-37.55)	0.002
RetNOS	17.56 (12.45-22.67)	10.75 (7.67-13.82)	0.023
ExtGGOBx	16.73 (11.52-21.89)	6.14 (1.65-10.62)	0.002
GGO	7.86 (3.49-12.23)	12.5 (8.06-16.93)	0.136
HC	11.21 (6.76-15.67)	0.42 (-0.31-1.17)	< 0.001
Coarseness	10.34 (9.36-11.32)	5.42 (4.61-6.24)	< 0.001
RetNOS prop	32.62 (28.57-36.67)	40.51 (34.03-46.99)	0.039
ExtGGOBx prop	30.83 (23.71-37.95)	15.62 (8.76-22.48)	0.003
GGO prop	12.97 (6.64-19.31)	41.70 (32.72-50.67)	< 0.001
HC prop	23.87 (14.80-32.94)	2.14 (-1.56-5.82)	< 0.001
FEV1	72.05	83.81	0.382
FEV1/FVC	81.82	75.79	0.109
PEF	89.47	76.17	0.436
MMEF 75%-25%	78.87	62.07	0.184
FVC	72.64	82.21	0.256
TLC	58.54	80.98	0.002
RV	53.3	88.54	0.022
RVTLC	89.92	108.3	0.276
DLCOsb	32.75	47.64	0.067
DLCOva	55.22	71.51	0.293
eSPAP (n = 12)	48.12	35.25	0.324

TotExtILD: Total extent of interstitial lung disease; RetNOS: Extent of reticular pattern not otherwise specified; ExtGGOBx: Extent of ground glass opacity with traction bronchiectasis; GGO: Extent of pure ground glass opacity; HC: Extent of honeycombing; Coarseness: Coarseness of fibrosis; FEV1: Forced expiratory volume in 1 s; FEV1/FVC: Ratio of forced expiratory volume in 1 s/forced vital capacity; PEF: Peak expiratory flow; MMEF: Maximum midexpiratory flow; FVC: Forced vital capacity; TLC: Total lung capacity; RV: Residual volume; DLCOsb: Single-breath diffusing capacity of the lungs for carbon monoxide; DLCOva: Diffusing capacity of the lungs for carbon monoxide corrected for alveolar volume.

Table 4 Comparison of parameters of high resolution computed tomography scoring system and functional parameters within the 3 groups according to the predominant type of fibrosis

Parameters	Group F1Typical UIPn = 19Mean (95%CI)	Group F2Possible UIPn = 10Mean (95%CI)	Group F3NSIPn = 24Mean (95%CI)
Emphysema	7.05 (2.96-11.14)^c	9.6 (3.33-15.86)^e	23.08 (15.1-31.06)
TotExtILD	56.84 (43.18-70.49)^d	39.6 (19.83-59.36)	28.16 (20.94-35.38)
RetNOS	18.68 (12.78-24.58)^c	9.9 (5.51-14.28)	11.04 (7.48-14.6)
ExtGGOBx	18.05 (12.02-24.08)^c	17.9 (2.84-32.95)^e	3.66 (1.84-5.48)
GGO	7.36 (2.34-12.39)	8 (2.98-13.01)	13.45 (8.45-18.45)
HC	12.78 (7.65-17.92)^d^a	3.8 (1.25-6.34)	-
Coarseness	10.73 (9.67-11.80)^d^a	8.5 (7.22-9.77)^f	4.87 (4.24-5.50)
RetNOS prop	32.44 (27.51-37.36)	30.08 (21.35-38.80)	42.63 (35.51- 49.76)
ExtGGOBx prop	30.86 (22.36-39.35)^d	36.98 (21.53-52.42)^f	11.24 (5.63-16.85)
ExtGGO prop	10.44 (4.07-16.81)^d	19.97 (10.11-29.82)^f	46.10 (36.95- 55.25)
HC prop	26.63 (16.13-37.13)^d	12.95 (2.16-23.74)	-
FEV1	66.51 (41.27-91.75)	76.82 (27.32-126.32)	87.39 (70.19-104.58)
FEV1/FVC	81.04 (75.47-86.61)	84.83 (74.00-95.66)	74.98 (68.95-81.00)
PEF	82.80 (44.11-121.50)	85.86 (-55.76-227.49)	80.53 (61.05-100.01)
MMEF 75%-25%	73.90 (47.97-99.84)	75.76 (43.89-107.64)	65.02 (47.55- 82.50)
FVC	69.16 (55.02- 83.30)	74.38 (51.03-97.73)	85.66 (73.70-97.62)
TLC	54.77 (41.67-67.87)^d	67.3 (52.53-82.06)	84.09 (75.99-92.18)
RV	54.69 (17.24-92.13)	71.3 (36.58-106.01)	87.80 (68.45-107.15)
RVTLC	89.92 (47.00-132.84)	97.89 (-64.43- 260.21)	101.06 (88.98-113.14)
DLCOsb	27.35 (19.85-34.85)^c^a	54.44 (27.51- 81.36)	47.73 (34.24-61.22)
SPAP (n = 12)	48.12 (32.49-63.75)	-	27.33 (10.42-44.24)

One - way ANOVA: Typical UIP vs possible UIP;

^aP≤ 0.05, ^bP≤ 0.001; Typical UIP vs NSIP;

^cP≤ 0.05,

^dP≤ 0.001; possible UIP vs NSIP;

^eP≤ 0.05,

^fP≤ 0.001. TotExtILD: Total extent of interstitial lung disease; RetNOS: Extent of reticular pattern not otherwise specified; ExtGGOBx: Extent of ground glass opacity with traction bronchiectasis; GGO: Extent of pure ground glass opacity; HC: Extent of honeycombing; Coarseness: Coarseness of fibrosis; FEV1: Forced expiratory volume in 1 s; FEV1/FVC: Ratio of forced expiratory volume in 1 s/forced vital capacity; PEF: Peak expiratory flow; MMEF: Maximum midexpiratory flow; FVC: Forced vital capacity; TLC: Total lung capacity; RV: Residual volume; DLCOsb: Single-breath diffusing capacity of the lungs for carbon monoxide; DLCOva: Diffusing capacity of the lungs for carbon monoxide corrected for alveolar volume.

Table 5 High resolution computed tomography - pathology correlation according to the pattern of fibrosis

	Patient (no)	Histology	HRCT - observer 1	HRCT - observer 2
1	7	Possible UIP	NSIP	NSIP
2	10	Possible UIP	Possible UIP	Typical UIP
3	11	NSIP	NSIP	NSIP
4	14	Possible UIP	Typical UIP	Typical UIP
5	15	Definite UIP	Typical UIP	Typical UIP
6	17	Possible UIP	Typical UIP	Typical UIP
7	19	NSIP	NSIP	NSIP
8	23	Definite UIP	Typical UIP	Typical UIP
9	25	Definite UIP	Typical UIP	Typical UIP
10	26	Definite UIP	Possible UIP	Possible UIP
11	31	Definite UIP	Typical UIP	Typical UIP
12	33	Definite UIP	Typical UIP	Typical UIP
13	34	Definite UIP	Typical UIP	Typical UIP
14	35	Possible UIP	NSIP	NSIP
15	41	Definite UIP	Possible UIP	Possible UIP
16	45	Definite UIP	Typical UIP	Typical UIP
17	46	Definite UIP	Possible UIP	Typical UIP
18	51	Definite UIP	Typical UIP	Typical UIP
19	53	Definite UIP	Typical UIP	Typical UIP

HRCT: High resolution computed tomography; UIP: Usual interstitial pneumonia; NSIP: Nonspecific interstitial pneumonia.

Citation: Oikonomou A, Mintzopoulou P, Tzouvelekis A, Zezos P, Zacharis G, Koutsopoulos A, Bouros D, Prassopoulos P. Pulmonary fibrosis and emphysema: Is the emphysema type associated with the pattern of fibrosis? World J Radiol 2015; 7(9): 294-305
URL: https://www.wjgnet.com/1949-8470/full/v7/i9/294.htm
DOI: https://dx.doi.org/10.4329/wjr.v7.i9.294