Nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis: Changes in pattern and distribution of disease over time

Purpose: To retrospectively assess the change in disease pattern of nonspecific interstitial pneumonia ( NSIP) and idiopathic pulmonary fibrosis ( IPF) findings seen at thin-section computed tomography ( CT) at long-term follow-up and to compare the same with initial findings at CT. Materials and Methods: The study included 48 patients ( 28 men, 20 women; mean age, 57.5 years) with biopsy-proved NSIP ( n = 23) or IPF ( n = 25) who underwent CT at initial diagnosis and at follow-up 34 - 155 months later. The CT scans were randomized and reviewed by two independent thoracic radiologists for pattern and distribution of ground-glass opacity ( GGO), reticulation, traction bronchiectasis and bronchiolectasis, and honeycombing. Statistical analysis was performed by using nonparametric methods and univariate logistic regression. Results: Follow-up CT in patients with NSIP showed marked decrease in the extent of GGO, increase in reticulation, and a greater likelihood of peripheral distribution ( all P <.05). At presentation, the CT findings were interpreted as suggestive of NSIP in 18 of 23 patients with NSIP and indeterminate or suggestive of IPF in five. In five ( 28%) of 18 patients with initial findings suggestive of NSIP, the follow-up CT scans were interpreted as more suggestive of IPF. No CT features seen at presentation allowed distinction between patients with NSIP that maintained an NSIP pattern at follow-up and those that progressed to an IPF pattern. Conclusion: At follow-up CT, 28% of patients with initial CT findings suggestive of NSIP progressed to findings suggestive of IPF. Similar initial CT findings for NSIP may have different imaging outcomes. (C) RSNA, 2008.