背景:通常的无蜂窝(可能的UIP)的间质性肺炎(UIP)病例包括各种CT特征,通常难以诊断。
目的:本研究旨在利用聚类分析对可能存在UIP的病例进行CT特征分类,并评估参与者亚群的特征和预后的相关性。
方法:该研究纳入了2011年特发性肺纤维化(IPF)指南中85例可能患有UIP的患者,并进行放射学诊断。所有病例均接受了手术活检,并通过日本全国注册中心的多学科讨论(MDD)进行了诊断。读者评估了肺部混浊,结节,囊肿,和占主导地位的分布,在2018年被IPF指南重新分类。此外,根据CT检查结果,通过聚类分析将病例分为四组.评估IPF分类和聚类之间的生存差异。
结果:病例被诊断为IPF(n=55),NSIP(n=4),不可分类(n=23),和其他人(n=3)通过MDD。聚类分析显示CT特征有4个簇(分别为n=47、16、19和3)。第1组整体病变较少。集群2具有许多纯磨玻璃混浊物和带有网状的磨玻璃混浊物。簇3有许多网状混浊和结节,很少有较低的优势分布。集群4的特征是支气管血管周围巩固。集群1的平均生存时间(4518天)明显优于集群2、3和4(1843、2196和1814天,分别)(p=0.03)。
结论:结论:没有蜂窝的UIP包括各种CT模式和MDD诊断。在根据CT表现分类的簇之间观察到预后的显着差异。
BACKGROUND: Usual interstitial pneumonia (UIP) cases without honeycombing (possible UIP) included various CT features and was often difficult to diagnose.
OBJECTIVE: This study aimed to classify the cases with possible UIP on CT features using cluster analysis and evaluate the features of subsets of participants and the correlation of prognosis.
METHODS: The study included 85 patients with possible UIP in the 2011 idiopathic pulmonary fibrosis (IPF) guideline with radiological diagnosis. All cases underwent surgical biopsies and were diagnosed by multidisciplinary discussion (MDD) from the nationwide registry in Japan. The readers evaluated pulmonary opacity, nodules, cysts, and predominant distribution which were reclassified by IPF guidelines in 2018. Additionally, cases were classified into four groups by cluster analysis based on CT findings. The differences in survival among IPF classification and the clusters were evaluated.
RESULTS: Cases were diagnosed as IPF (n = 55), NSIP (n = 4), unclassifiable (n = 23), and others (n = 3) by MDD. Cluster analysis revealed 4 clusters by CT features (n = 47, 16, 19 and 3, respectively). Cluster 1 had fewer lesions overall. Cluster 2 have many pure ground-glass opacities and ground-glass opacities with reticulation. Cluster 3 had many reticular opacities and nodules with few lower predominant distributions. Cluster 4 was characterized by peribronchovascular consolidation.The mean survival time of cluster 1 (4518 days) was significantly better than cluster 2, 3, and 4 (1843, 2196, and 1814 days, respectively) (p = 0.03).
CONCLUSIONS: In conclusion, UIP without honeycombing included various CT patterns and MDD diagnoses. Significangly differences in prognosis were observed among clusters classified by CT findings.