DIAGNOSTIC ACCURACY OF CHEST RADIOGRAPH IN INTERSTITIAL LUNG DISEASE AS CONFIRMED BY HIGH-RESOLUTION COMPUTED TOMOGRAPHY (HRCT) CHEST

Authors

  • Faiza Akram Radiology Department Ayub Medical College Abbottabad
  • Shahid Hussain MO, DHQ Dir
  • Azmat Ali Radiology, ATH
  • Hamza Javed Abbottabad International Medical College, Abbottabad
  • Muhammad Fayyaz Prosthodontic Department, Dentistry Section AMC
  • Khalil Ahmed Free lancer

DOI:

https://doi.org/10.55519/JAMC-04-S4-11183

Keywords:

Interstitial Lung Diseases, Chest radiographs, HRCT chest, Validity Parameters, Validation Study

Abstract

Background: Interstitial Lung Disease (ILD) - an umbrella term encompassing about 100 different pathophysiological entities are usually defined as an irreversible, progressive fibrotic changes in the lung parenchyma that leads to difficult breathing and reduced gaseous exchange at the alveolar level. We aimed to quantify the validity of CXR for the diagnosis of ILD taking HRCT as gold standard in the population of Hazara division. Methods: This validation study was conducted during 11 June till 12 Dec 2019 in the radiology department of Ayub Teaching Hospital, Abbottabad on 60 adult patients aged 30–60 years who presented with progressive exertional dyspnoea. The patients were enrolled into the study via non-probability, consecutive sampling technique. All the data was recorded on a self-developed structured questionnaire. Data was analyzed using SPSS version 20. Results: The mean age of study participants was 47.18±6.90 years SD with a range of 36–60years. The mean of time duration of symptoms was 9.66±1.7 years with a range of 7–12 years. There were 40 (66.7%) males and 20 (33.3%) females with a male to female ratio of 2:1. The sensitivity, specificity, PPV, NPV and Diagnostic Accuracy of CXR for the diagnosis of ILD as compared to HRCT was calculated to be 65.5%, 20%, 90%, 5% and 61.66% respectively. A chi square test of significance yielded a value of 0.51 for the diagnostic accuracy of CXR for ILD as compared to HRCT. Diagnostic ODDs ratio and Youden’s Index yielded values of 47.37% and 0.145 respectively. All these parameters’ points towards a lower utility of CXR for the diagnostic purpose in patients suspected with ILD. Conclusion: Chest x-ray is simple, non-invasive, economical and readily available alternative to HRCT but its specificity and diagnostic accuracy are questionable. CXR is a recommendable first line investigation for chest pathology workup but for a definitive diagnosis, one should not depend on CXR as it can miss the diagnosis.

References

Antoine M, Mlika M. Interstitial Lung Disease. 2021 Aug 3. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. [cited 2022 June 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK541084/

Interstitial Lung Disease. [Internet]. Lung.org. 2022. [cited 2022 June 26]. Available from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/interstitial-lung-disease

Interstitial Lung Disease: Pulmonary Fibrosis. [Internet]. Hopkinsmedicine.org. 2022. [cited 2022 June 26]. Available from: https://www.hopkinsmedicine.org/health/conditions-and-diseases/interstitial-lung-disease-pulmonary-fibrosis

Hodler J, Kubik-Huch RA, von Schulthess GK. Diseases of the Chest, Breast, Heart and Vessels 2019-2022: Diagnostic and Interventional Imaging. [Internet]. Cham (CH): Springer; 2019. [cited 2022 June 26]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553871/

Kumar A, Cherian SV, Vassallo R, Eunhee SY, Ryu JH. Current concepts in pathogenesis, diagnosis, and management of smoking-related interstitial lung diseases. Chest 2018;154(2):394–408.

Riario Sforza GG, Marinou A. Hypersensitivity pneumonitis: a complex lung disease. Clin Mol Allergy 2017;15(1):1–8.

Hu Y, Wang LS, Wei YR, Du SS, Du YK, He X, et al. Clinical characteristics of connective tissue disease-associated interstitial lung disease in 1,044 Chinese patients. Chest 2016;149(1):201–8.

Ryerson CJ, Corte TJ, Lee JS, Richeldi L, Walsh SL, Myers JL, et al. A standardized diagnostic ontology for fibrotic interstitial lung disease. An international working group perspective. Am J Respir Crit Care Med 2017;196(10):1249–54.

Sharif R, Zouk A, Kulkarni T, Acosta P, Duncan S, Luckhardt T, et al. Cost of hospitalization among patients with idiopathic pulmonary fibrosis: patterns and predictors. Chest 2016;150(4):469A.

Agrawal MK, Kumar A, Agrawal R, Rana R. To study the significance of HRCT over Chest x-ray in the diagnosis of interstitial lung diseases. J Evol Med Dent Sci 2019;8(2):94–8.

Senger KP, Singh A. High-resolution computed tomography as a non-invasive imaging biomarker for interstitial lung diseases: a tertiary center study. Int J Adv Med 2021;8(2):207.

Walsh SL, Devaraj A, Enghelmayer JI, Kishi K, Silva RS, Patel N, et al. Role of imaging in progressive-fibrosing interstitial lung diseases. Eur Respir Rev 2018;27(150):180073.

Dhagat PK, Singh S, Jain M, Singh SN, Sharma RK. Thoracic sarcoidosis: imaging with high resolution computed tomography. Journal of clinical and diagnostic research. J Clin Diagn Res 2017;11(2):TC15–8.

Baskey S, Mohan C, Toppo SK. High Resolution Computed Tomographic Evaluation Of Patients Suspected Of Having Diffuse Interstitial Lung Diseases With Radiographic Correlation. J Dent Med Sci 2018;17(4):21–33.

Jeny F, Brillet PY, Kim YW, Freynet O, Nunes H, Valeyre D. The place of high-resolution computed tomography imaging in the investigation of interstitial lung disease. Expert Rev Respir Med 2019;13(1):79–94.

Purohit S, Dutt N, Saini L, Panwar R, Kumar S. High resolution computed tomography in chronic obstructive pulmonary disease patients: Do not forget radiation hazard. Lung India 2016;33(5):582–3.

Zhang Y, Du SS, Zhao MM, Li QH, Zhou Y, Song JC, et al. Chest high-resolution computed tomography can make higher accurate stages for thoracic sarcoidosis than X-Ray. BMC Pulm Med 2022;22(1):146.

Afzal F, Raza S, Shafique M. Diagnostic accuracy of x-ray chest in interstitial lung disease as confirmed by high resolution computed tomography (HRCT) chest. PAFMJ 2017;67(4):593–98.

Patel T, Ilangovan G, Balganesan H. Comparative Study of X-ray and High Resolution Computed Tomography in the Diagnosis of Interstitial Lung Disease. Int J Contemp Med Surg Radiol 2020;5(1):A263–7.

Coutinho GF, Pancas R, Magalhaes E, Bernardo JE, Eugenio L, Antunes MJ. Diagnostic value of surgical lung biopsy: comparison with clinical and radiological diagnosis. Eur J Cardiothorac Surg 2008;33(5):781–85.

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Published

2022-10-11

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