Clinical Report: Imaging Guidelines for Fibrotic Lung Disorders by ESTI
Overview
High-resolution chest CT is the preferred imaging modality for diagnosing and monitoring fibrotic lung diseases (FLDs). Early detection and accurate pattern recognition on CT, combined with clinical data, enable non-invasive diagnosis and timely management, including antifibrotic therapy initiation.
Background
Fibrotic lung diseases (FLDs) encompass idiopathic and secondary interstitial lung diseases characterized by varying degrees of fibrosis and inflammation. Idiopathic pulmonary fibrosis (IPF) is the prototype with poor prognosis, but non-IPF FLDs may also progress and benefit from antifibrotic treatments. High-resolution CT (HRCT) plays a pivotal role in identifying fibrosis patterns, assessing progression, and guiding biopsy decisions. Radiologists must be aware of high-risk populations and apply standardized CT protocols to optimize diagnosis and follow-up.
Data Highlights
CT Technical Requirement
Specification
Slice Thickness
≤ 1.5 mm
Reconstruction Algorithm
High-resolution algorithm
Tube Voltage
Standard 120 kVp, adapted to BMI
Radiation Dose
Effective dose < 3 mSv recommended
Scan Position
Supine, arms above head, deep inspiration
Optional Scans
Expiratory scan for air-trapping; prone inspiratory scan if needed
Key Findings
High-resolution chest CT with ≤1.5 mm slice thickness is essential for detecting fibrotic patterns and disease extent.
Non-invasive diagnosis of FLDs is often possible by integrating CT patterns with clinical and laboratory data; biopsy is reserved for indeterminate cases or when treatment decisions depend on histology.
Early identification of fibrosis and monitoring progression are critical to initiate antifibrotic therapy, especially in IPF and progressive pulmonary fibrosis phenotypes.
Chest X-ray has limited sensitivity and specificity but remains a first-line screening tool; suspicious findings should prompt HRCT.
Expiratory CT scans are recommended selectively to detect small airway disease, common in hypersensitivity pneumonitis and connective tissue disease-related ILD.
Radiation dose optimization strategies and advanced reconstruction algorithms should be employed to maintain image quality while minimizing exposure.
Clinical Implications
Radiologists should employ standardized high-resolution CT protocols to accurately identify fibrotic lung disease patterns and assess progression. Early and precise imaging diagnosis facilitates timely antifibrotic treatment initiation, improving patient outcomes. Awareness of high-risk populations and appropriate use of expiratory scans can enhance detection of associated airway involvement.
Conclusion
High-resolution chest CT remains the cornerstone for diagnosing and managing fibrotic lung diseases. Adherence to recommended imaging protocols and integration with clinical data enable non-invasive diagnosis and guide therapeutic decisions effectively.
References
European Society of Thoracic Imaging Guidelines -- Key Insights on Imaging for Fibrotic Lung Disorders
by Anna Rita Larici, Juergen Biederer, Giuseppe Cicchetti, Tomas Franquet Casas, Nick Screaton, Martine Remy-Jardin, Anagha Parkar, Helmut Prosch, Cornelia Schaefer-Prokop, Thomas Frauenfelder, Benoit Ghaye, Nicola Sverzellati
