Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


High resolution computed tomography of the lungs

Topic Outline

GRAPHICS

INTRODUCTION

The initial imaging tool for the lung parenchyma remains the chest radiograph. It is unsurpassed in the amount of information it yields in relation to its cost, radiation dose, availability, and ease of performance. However, the chest radiograph has its limitations. It is normal in 10 to 15 percent of symptomatic patients with proven infiltrative lung disease, up to 30 percent of those with bronchiectasis, and close to 60 percent of patients with emphysema [1]. In several studies, the chest radiograph has been shown to have an overall sensitivity of 80 percent and a specificity of 82 percent for detection of diffuse lung disease [2]. Chest radiography could provide a confident diagnosis in only 23 percent of cases, and those confident diagnoses proved correct only in 77 percent of cases.

For these reasons, high resolution computed tomography (HRCT, also called thin-section CT scanning), is frequently used to help clarify specific problems. The clinical applications of HRCT will be reviewed here. The principles of CT imaging are discussed separately. (See "Principles of computed tomography of the chest".)

CLINICAL APPLICATION OF HRCT

HRCT, which has a sensitivity of 95 percent and a specificity approaching 100 percent [2-5], can often provide more information than either chest radiography or conventional CT scanning. A confident diagnosis is possible in roughly one-half of cases, and these are proven correct an estimated 93 percent of the time.

HRCT may be particularly useful in the following settings:

It can detect lung disease in symptomatic patients with a normal chest radiograph.

                                     

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Mar 2014. | This topic last updated: Mar 21, 2014.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Epler GR, McLoud TC, Gaensler EA, et al. Normal chest roentgenograms in chronic diffuse infiltrative lung disease. N Engl J Med 1978; 298:934.
  2. Mathieson JR, Mayo JR, Staples CA, Müller NL. Chronic diffuse infiltrative lung disease: comparison of diagnostic accuracy of CT and chest radiography. Radiology 1989; 171:111.
  3. Müller NL, Miller RR. Computed tomography of chronic diffuse infiltrative lung disease. Part 1. Am Rev Respir Dis 1990; 142:1206.
  4. Müller NL, Miller RR. Computed tomography of chronic diffuse infiltrative lung disease. Part 2. Am Rev Respir Dis 1990; 142:1440.
  5. Müller NL. Clinical value of high-resolution CT in chronic diffuse lung disease. AJR Am J Roentgenol 1991; 157:1163.
  6. Swensen SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement at CT: multicenter study. Radiology 2000; 214:73.
  7. Webb WR. Thin-section CT of the secondary pulmonary lobule: anatomy and the image--the 2004 Fleischner lecture. Radiology 2006; 239:322.
  8. Remy-Jardin M, Remy J, Giraud F, et al. Computed tomography assessment of ground-glass opacity: semiology and significance. J Thorac Imaging 1993; 8:249.
  9. Collins J, Stern EJ. Ground-glass opacity at CT: the ABCs. AJR Am J Roentgenol 1997; 169:355.
  10. Miller WT Jr, Shah RM. Isolated diffuse ground-glass opacity in thoracic CT: causes and clinical presentations. AJR Am J Roentgenol 2005; 184:613.
  11. Hansell DM. Thin-section CT of the lungs: the Hinterland of normal. Radiology 2010; 256:695.
  12. Leung AN, Miller RR, Müller NL. Parenchymal opacification in chronic infiltrative lung diseases: CT-pathologic correlation. Radiology 1993; 188:209.
  13. Rossi SE, Erasmus JJ, Volpacchio M, et al. "Crazy-paving" pattern at thin-section CT of the lungs: radiologic-pathologic overview. Radiographics 2003; 23:1509.
  14. Lee CH. The crazy-paving sign. Radiology 2007; 243:905.
  15. Gattinoni L, Caironi P, Pelosi P, Goodman LR. What has computed tomography taught us about the acute respiratory distress syndrome? Am J Respir Crit Care Med 2001; 164:1701.
  16. Eber CD, Stark P, Bertozzi P. Bronchiolitis obliterans on high-resolution CT: a pattern of mosaic oligemia. J Comput Assist Tomogr 1993; 17:853.
  17. Worthy SA, Müller NL, Hartman TE, et al. Mosaic attenuation pattern on thin-section CT scans of the lung: differentiation among infiltrative lung, airway, and vascular diseases as a cause. Radiology 1997; 205:465.
  18. Newell JD Jr. Quantitative computed tomography of lung parenchyma in chronic obstructive pulmonary disease: an overview. Proc Am Thorac Soc 2008; 5:915.
  19. Agarwal PP, Gross BH, Holloway BJ, et al. Thoracic CT findings in Birt-Hogg-Dube syndrome. AJR Am J Roentgenol 2011; 196:349.
  20. Copley SJ, Wells AU, Hawtin KE, et al. Lung morphology in the elderly: comparative CT study of subjects over 75 years old versus those under 55 years old. Radiology 2009; 251:566.
  21. Bergin CJ, Müller NL, Miller RR. CT in the qualitative assessment of emphysema. J Thorac Imaging 1986; 1:94.
  22. Bonelli FS, Hartman TE, Swensen SJ, Sherrick A. Accuracy of high-resolution CT in diagnosing lung diseases. AJR Am J Roentgenol 1998; 170:1507.
  23. Washko GR, Hunninghake GM, Fernandez IE, et al. Lung volumes and emphysema in smokers with interstitial lung abnormalities. N Engl J Med 2011; 364:897.
  24. Panchal, NJ, Stark, P. Bullous Lung disease. A review CDR. Contemporary Diagnostic Radiology 2006; 29:1.
  25. Hackx M, Bankier AA, Gevenois PA. Chronic obstructive pulmonary disease: CT quantification of airways disease. Radiology 2012; 265:34.
  26. Grenier P, Maurice F, Musset D, et al. Bronchiectasis: assessment by thin-section CT. Radiology 1986; 161:95.
  27. Kang EY, Miller RR, Müller NL. Bronchiectasis: comparison of preoperative thin-section CT and pathologic findings in resected specimens. Radiology 1995; 195:649.
  28. Worthy SA, Müller NL. Small airway diseases. Radiol Clin North Am 1998; 36:163.
  29. Jensen SP, Lynch DA, Brown KK, et al. High-resolution CT features of severe asthma and bronchiolitis obliterans. Clin Radiol 2002; 57:1078.
  30. Howling SJ, Hansell DM, Wells AU, et al. Follicular bronchiolitis: thin-section CT and histologic findings. Radiology 1999; 212:637.
  31. Stein MG, Mayo J, Müller N, et al. Pulmonary lymphangitic spread of carcinoma: appearance on CT scans. Radiology 1987; 162:371.
  32. Aikins A, Kanne JP, Chung JH. Galaxy sign. J Thorac Imaging 2012; 27:W164.
  33. Müller NL, Kullnig P, Miller RR. The CT findings of pulmonary sarcoidosis: analysis of 25 patients. AJR Am J Roentgenol 1989; 152:1179.
  34. Criado E, Sánchez M, Ramírez J, et al. Pulmonary sarcoidosis: typical and atypical manifestations at high-resolution CT with pathologic correlation. Radiographics 2010; 30:1567.
  35. Staples CA, Müller NL, Vedal S, et al. Usual interstitial pneumonia: correlation of CT with clinical, functional, and radiologic findings. Radiology 1987; 162:377.
  36. Müller NL, Staples CA, Miller RR, et al. Disease activity in idiopathic pulmonary fibrosis: CT and pathologic correlation. Radiology 1987; 165:731.
  37. Wells A. Clinical usefulness of high resolution computed tomography in cryptogenic fibrosing alveolitis. Thorax 1998; 53:1080.
  38. Thomeer M, Demedts M, Behr J, et al. Multidisciplinary interobserver agreement in the diagnosis of idiopathic pulmonary fibrosis. Eur Respir J 2008; 31:585.
  39. Assayag D, Elicker BM, Urbania TH, et al. Rheumatoid arthritis-associated interstitial lung disease: radiologic identification of usual interstitial pneumonia pattern. Radiology 2014; 270:583.
  40. Watadani T, Sakai F, Johkoh T, et al. Interobserver variability in the CT assessment of honeycombing in the lungs. Radiology 2013; 266:936.
  41. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011; 183:788.
  42. Egashira R, Kondo T, Hirai T, et al. CT findings of thoracic manifestations of primary Sjögren syndrome: radiologic-pathologic correlation. Radiographics 2013; 33:1933.
  43. Sverzellati N, Wells AU, Tomassetti S, et al. Biopsy-proved idiopathic pulmonary fibrosis: spectrum of nondiagnostic thin-section CT diagnoses. Radiology 2010; 254:957.
  44. Müller NL, Guerry-Force ML, Staples CA, et al. Differential diagnosis of bronchiolitis obliterans with organizing pneumonia and usual interstitial pneumonia: clinical, functional, and radiologic findings. Radiology 1987; 162:151.
  45. King TE Jr. Smoking and subclinical interstitial lung disease. N Engl J Med 2011; 364:968.
  46. Ryerson CJ, Hartman T, Elicker BM, et al. Clinical features and outcomes in combined pulmonary fibrosis and emphysema in idiopathic pulmonary fibrosis. Chest 2013; 144:234.
  47. Lynch DA. Nonspecific interstitial pneumonia: evolving concepts. Radiology 2001; 221:583.
  48. Kligerman SJ, Groshong S, Brown KK, Lynch DA. Nonspecific interstitial pneumonia: radiologic, clinical, and pathologic considerations. Radiographics 2009; 29:73.
  49. MacDonald SL, Rubens MB, Hansell DM, et al. Nonspecific interstitial pneumonia and usual interstitial pneumonia: comparative appearances at and diagnostic accuracy of thin-section CT. Radiology 2001; 221:600.
  50. Silva CI, Müller NL, Hansell DM, et al. Nonspecific interstitial pneumonia and idiopathic pulmonary fibrosis: changes in pattern and distribution of disease over time. Radiology 2008; 247:251.
  51. Heyneman LE, Ward S, Lynch DA, et al. Respiratory bronchiolitis, respiratory bronchiolitis-associated interstitial lung disease, and desquamative interstitial pneumonia: different entities or part of the spectrum of the same disease process? AJR Am J Roentgenol 1999; 173:1617.
  52. Johkoh T, Müller NL, Taniguchi H, et al. Acute interstitial pneumonia: thin-section CT findings in 36 patients. Radiology 1999; 211:859.
  53. Kligerman SJ, Franks TJ, Galvin JR. From the radiologic pathology archives: organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. Radiographics 2013; 33:1951.
  54. Kim SJ, Lee KS, Ryu YH, et al. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol 2003; 180:1251.
  55. Gamsu G, Salmon CJ, Warnock ML, Blanc PD. CT quantification of interstitial fibrosis in patients with asbestosis: a comparison of two methods. AJR Am J Roentgenol 1995; 164:63.
  56. Brauner MW, Grenier P, Mouelhi MM, et al. Pulmonary histiocytosis X: evaluation with high-resolution CT. Radiology 1989; 172:255.
  57. Müller NL, Chiles C, Kullnig P. Pulmonary lymphangiomyomatosis: correlation of CT with radiographic and functional findings. Radiology 1990; 175:335.
  58. Frazier AA, Franks TJ, Cooke EO, et al. From the archives of the AFIP: pulmonary alveolar proteinosis. Radiographics 2008; 28:883.
  59. Bergin CJ, Wirth RL, Berry GJ, Castellino RA. Pneumocystis carinii pneumonia: CT and HRCT observations. J Comput Assist Tomogr 1990; 14:756.
  60. Silver SF, Müller NL, Miller RR, Lefcoe MS. Hypersensitivity pneumonitis: evaluation with CT. Radiology 1989; 173:441.
  61. Yoshizawa Y, Ohtani Y, Hayakawa H, et al. Chronic hypersensitivity pneumonitis in Japan: a nationwide epidemiologic survey. J Allergy Clin Immunol 1999; 103:315.
  62. Kang EY, Grenier P, Laurent F, Müller NL. Interlobular septal thickening: patterns at high-resolution computed tomography. J Thorac Imaging 1996; 11:260.
  63. Ferreira Francisco FA, Pereira e Silva JL, Hochhegger B, et al. Pulmonary alveolar microlithiasis. State-of-the-art review. Respir Med 2013; 107:1.
  64. Hsu A, Stark P, Friedman P. Focal organizing pneumonia with reversed halo sign. Applied Radiology 2007; 36:45.
  65. Jin GY, Lynch D, Chawla A, et al. Interstitial lung abnormalities in a CT lung cancer screening population: prevalence and progression rate. Radiology 2013; 268:563.