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Asbestosis and Idiopathic Pulmonary Fibrosis: Comparison of Thin-Section CT Features¹

¹ From the Dept of Radiology, Hammersmith Hosp, London, England (S.J.C.); Dept of Radiology, King’s College Hosp, London, England (S.R.D.); Depts of Radiology (S.L.S.M., D.M.H., M.B.R.) and Pathology (A.G.N.), and Interstitial Lung Disease Unit (A.U.W., R.M.d.B.), Royal Brompton Hosp, Sydney St, London SW3 6NP, England; Depts of Radiology (R.I.T.) and Respiratory Medicine (A.W.M.), Sir Charles Gairdner Hosp, Perth, West Australia, Australia; Dept of Respiratory Medicine, Middlemore Hosp and Univ of Auckland, New Zealand (P.S.); and Dept of Laboratory Medicine/Pathology, Mayo Clinic, Scottsdale, Ariz (T.V.C.). Received Jun 4, 2002; revision requested Aug 8; final revision received Apr 30, 2003; accepted Jun 16. Address correspondence to D.M.H. (e-mail: d.hansell@rbh.nthames.nhs.uk).

PURPOSE: To identify differences, if any, in thin-section computed tomographic (CT) features between asbestosis and idiopathic pulmonary fibrosis (IPF) and to test the findings in a subset of histopathologically proved cases of usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP).

MATERIALS AND METHODS: Consecutive patients with a diagnosis of IPF (n = 212) or asbestosis (n = 74) were included. The relationships derived from the initial comparison were tested in a separate group of biopsy-proved UIP (n = 30) and NSIP (n = 23) cases. Two observers independently scored thin-section CT images for extent, distribution, and coarseness of fibrosis; proportion of ground-glass opacification; severity of traction bronchiectasis; and extent of emphysema.

RESULTS: After controlling for extent of fibrosis, patients with asbestosis had coarser fibrosis than those with IPF (odds ratio, 1.52; 95% CI: 1.25, 1.84; P < .001). Compared with the biopsy-proved cases, the asbestosis cases involved coarser fibrosis (after controlling for disease extent) than the NSIP cases (odds ratio, 2.48; 95% CI: 1.49, 4.11; P < .001) but fibrosis similar to that in the UIP cases. A basal and subpleural distribution of disease was usual in all subgroups but significantly more prevalent (P, <.01 to .001) with asbestosis than with UIP or NSIP.

CONCLUSION: The thin-section CT pattern of asbestosis closely resembles that of biopsy-proved UIP and differs markedly from that of biopsy-proved NSIP.

© RSNA, 2003

Index terms: Asbestos • Lung, CT, 60.12111, 60.12115, 60.12118 • Lung, diseases, 60.213, 60.6113, 60.773, 60.792, 60.795 • Lung, fibrosis, 60.6113, 60.792 • Pneumonia, interstitial with fibrosis, 60.213, 60.795

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