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Tesi etd-03232012-122439


Thesis type
Tesi di specializzazione
Author
ROMEI, CHIARA
URN
etd-03232012-122439
Title
Idiopathic pulmonary fibrosis: evaluation of progression and prognosis after the ATS/ERS/JRS/ALAT statement 2011
Struttura
MEDICINA E CHIRURGIA
Corso di studi
RADIODIAGNOSTICA
Supervisors
relatore Bartolozzi, Carlo
Parole chiave
  • HRCT
  • idiopathic pulmonary fibrosis
Data inizio appello
13/04/2012;
Consultabilità
Completa
Riassunto analitico
Objectives
The prediction of usual interstitial pneumonia (UIP) progression and prognosis by the a application of HRCT criteria pattern recommended by ATS/ERS/JALAT guidelines 2011

Materials and methods
Two radiologists after assessing the baseline HRCT have distributed 70 patients affected by fibrotic idiopathic interstitial pneumonia (IIP) in three groups (UIP type= group 1, possible-UIP=group 2, inconsistence UIP=group 3) on the basis of 2011 guidelines. The different abnormalities (honeycombing, reticulation, ground-glass, bronchiectasis) were visually scored at baseline and during the follow-up (total HRCT 179). Overall CT score and fibrotic score (honeycombing plus reticulation) were calculated. The progression of the abnormalities and the correlation with mortality rate were assessed (Kaplan-Mayer survival estimates).

Results
The inter-observed agreement was substantial or almost perfect (k=0.73-0.85).
Forty-four patients were classified into group 1, 13 into group 2 and 13 into group 3.
After a mean follow-up of 1386 days (DS 915), the mortality rate was significantly greater in the group 1 (18 died) versus group 2 and 3 (1 died each). In the group 1 patients whom showed at baseline a honeycombing rate greater than 25%, fibrotic score greater than 30, overall CT score greater than 45 and bronchiectasis in more than 4 lobes obtained the better prognostic value and significantly predicted mortality risk.
A significant increment of fibrotic score and honeycombing rate was demonstrated in the group 1 and 3 but not in the group 2. Honeycombing progression was quantified in 3 points/year for UIP type.

Conclusion
In our study HRCT criteria for UIP pattern on the basis of 2011 guidelines showed high accuracy in the risk stratification of patients with idiopathic pulmonary fibrosis (IPF).
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