Objectives To differentiate smoking-related interstitial fibrosis (SRIF) from emphysema and usual interstitial pneumonia (UIP) using CT. Materials and methods From January 2016 to October 2023, a total of 123 patients who underwent lung surgery with pathologically proven SRIF (n = 23), emphysema (n = 50), and UIP (n = 50) were included. Three radiologists retrospectively reviewed preoperative chest CTs for imaging features of centrilobular/paraseptal emphysema, multiple thin-walled cysts (MTWC), honeycombing, traction bronchiectasis, subpleural ground-glass opacity (GGO)/reticulation, and presence of smoking-related disease (SRD) and compared the CT features by subgroup. Results A total of 123 patients (23 SRIF, 50 emphysema, 50 UIP; mean age, 64.9 ± 8.96 years; 99 males) were involved. Centrilobular emphysema, paraseptal emphysema, MTWC, honeycombing, traction bronchiectasis, subpleural GGO/reticulation, and SRD were identified in SRIF (100%, 100%, 73.9%, 8.7%, 100%, 100%, 47.8%), emphysema (94%, 60%, 2%, 2%, 4%, 8%, 10%), and UIP (48%, 40%, 0%, 42%, 100%, 100%, 6%) cases, respectively. In the univariable analysis of SRIF and emphysema, MTWC, traction bronchiectasis, subpleural GGO/reticulation, and the presence of SRD were predictive features of SRIF (all p < 0.05). In the multivariable analysis of SRIF and emphysema, MTWC and subpleural GGO/reticulation were predictive of SRIF (all p < 0.05). In both univariable and multivariable analyses of SRIF and UIP, MTWC and the presence of SRD were predictive features of SRIF (all p < 0.05), whereas honeycombing was significant only in univariable analysis (p = 0.01). Conclusion Imaging features of MTWC, subpleural GGO/reticulation, and the presence of SRD on CT may help differentiate SRIF from emphysema and UIP. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> SRIF is recognized as a separate entity; however, insufficient radiological studies have been conducted. <Emphasis Type="BoldItalic">Findings</Emphasis> CT imaging features of MTWC, subpleural GGO/reticulation, and the presence of SRD are predictive factors for SRIF. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> SRIF, emphysema, and UIP have overlapping imaging/clinical features but different treatments and prognoses. As treatment for UIP slows the disease progression, accurate differentiation based on imaging findings is essential for improving prognosis.

CT features of pathologically proven smoking-related interstitial fibrosis: compared with emphysema and usual interstitial pneumonia

期刊论文
发表日期：

2025年3月6日

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ChanU Jeong,
Taein An,
Myung Jin Chung,
Joungho Han,
Hongseok Yoo,
Yoon Ki Cha

摘要

Objectives

To differentiate smoking-related interstitial fibrosis (SRIF) from emphysema and usual interstitial pneumonia (UIP) using CT.

Materials and methods

From January 2016 to October 2023, a total of 123 patients who underwent lung surgery with pathologically proven SRIF (n = 23), emphysema (n = 50), and UIP (n = 50) were included. Three radiologists retrospectively reviewed preoperative chest CTs for imaging features of centrilobular/paraseptal emphysema, multiple thin-walled cysts (MTWC), honeycombing, traction bronchiectasis, subpleural ground-glass opacity (GGO)/reticulation, and presence of smoking-related disease (SRD) and compared the CT features by subgroup.

Results

A total of 123 patients (23 SRIF, 50 emphysema, 50 UIP; mean age, 64.9 ± 8.96 years; 99 males) were involved. Centrilobular emphysema, paraseptal emphysema, MTWC, honeycombing, traction bronchiectasis, subpleural GGO/reticulation, and SRD were identified in SRIF (100%, 100%, 73.9%, 8.7%, 100%, 100%, 47.8%), emphysema (94%, 60%, 2%, 2%, 4%, 8%, 10%), and UIP (48%, 40%, 0%, 42%, 100%, 100%, 6%) cases, respectively. In the univariable analysis of SRIF and emphysema, MTWC, traction bronchiectasis, subpleural GGO/reticulation, and the presence of SRD were predictive features of SRIF (all p < 0.05). In the multivariable analysis of SRIF and emphysema, MTWC and subpleural GGO/reticulation were predictive of SRIF (all p < 0.05). In both univariable and multivariable analyses of SRIF and UIP, MTWC and the presence of SRD were predictive features of SRIF (all p < 0.05), whereas honeycombing was significant only in univariable analysis (p = 0.01).

Conclusion

Imaging features of MTWC, subpleural GGO/reticulation, and the presence of SRD on CT may help differentiate SRIF from emphysema and UIP.

Key Points

Question SRIF is recognized as a separate entity; however, insufficient radiological studies have been conducted.

Findings CT imaging features of MTWC, subpleural GGO/reticulation, and the presence of SRD are predictive factors for SRIF.

Clinical relevance SRIF, emphysema, and UIP have overlapping imaging/clinical features but different treatments and prognoses. As treatment for UIP slows the disease progression, accurate differentiation based on imaging findings is essential for improving prognosis.