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(Radiology. 2000;216:773-780.)
© RSNA, 2000

Thoracic Imaging

Eosinophilic Lung Diseases: Diagnostic Accuracy of Thin-Section CT in 111 Patients1

Takeshi Johkoh, MD, Nestor L. Müller, MD, PhD, Masanori Akira, MD, Kazuya Ichikado, MD, Moritaka Suga, MD, Masayuki Ando, MD, Takeshi Yoshinaga, MD, Teisou Kiyama, MD, Naoki Mihara, MD, Osamu Honda, MD, Noriyuki Tomiyama, MD and Hironobu Nakamura, MD

1 From the Dept of Radiology, Osaka Univ Medical School, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan (T.J., N.M., O.H., N.T., H.N.); the Dept of Radiology, Univ of British Columbia and Vancouver Hospital and Health Sciences Centre, Canada (N.L.M.); the Dept of Radiology, National Kinki Chuo Hospital for Chest Disease, Osaka, Japan, (M.Akira); the First Dept of Internal Medicine, Kumamoto University School of Medicine, Japan (K.I., M.S., M.Ando); and the Pulmonary Div, Kumamoto Chu-oh Hospital, Japan (T.Y., T.K.). Received Jun 14, 1999; revision requested Aug 3; final revision received Jan 19, 2000; accepted Feb 1. Address correspondence to T.J. (e-mail: johkoh@radiol.med.osaka-u.ac.jp).

PURPOSE: To determine whether various eosinophilic lung diseases can be differentiated by means of thin-section computed tomography (CT).

MATERIALS AND METHODS: Thin-section CT scans in 111 patients with eosinophilic lung diseases—40 with chronic eosinophilic pneumonia, 16 with Churg-Strauss syndrome, 16 with allergic bronchopulmonary aspergillosis (ABPA), 13 with acute eosinophilic pneumonia, 12 with simple pulmonary eosinophilia, 11 with drug-induced eosinophilic pneumonia, and three with hypereosinophilic syndrome—were assessed independently by two observers. The observers recorded the abnormalities, diagnosis, and degree of confidence in the diagnosis.

RESULTS: The two observers made a correct first-choice diagnosis on average in 61% of readings. The correct diagnosis was made in 78% of cases of chronic eosinophilic pneumonia; 81%, acute eosinophilic pneumonia; 44%, Churg-Strauss syndrome; 84%, ABPA; 17%, simple pulmonary eosinophilia; 27%, drug-induced eosinophilic pneumonia; and 33%, hypereosinophilic syndrome. The two observers made a correct diagnosis with a high degree of confidence in 36% of readings. There was moderate agreement between the observers for the correct diagnosis ({kappa}, 0.47) and for the correct diagnosis with a high degree of confidence ({kappa}, 0.59).

CONCLUSION: Although eosinophilic lung diseases often can be differentiated by means of thin-section CT, correlation between CT findings and careful clinical evaluation are required for a definitive diagnosis.

Index terms: Allergic bronchopulmonary aspergillosis (ABPA), 60.634 • Aspergillosis, 60.634 • Churg-Strauss syndrome, 60.623 • Computed tomography (CT), clinical effectiveness, 60.12118, 60.12119 • Computed tomography (CT), thin-section, 60.12118, 60.12119 • Lung, CT, 60.12118, 60.12119 • Lung, diseases, 60.632, 60.634, 60.64 • Lung, infection, 60.632, 60.634, 60.64 • Pneumonia, eosinophilic, 60.632 • Pneumonitis, hypersensitivity, 60.624




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