Imaging Patterns are Associated with Interstitial Lung Abnormality Progression and Mortality


Putman RK, Gudmundsson G, Axelsson GT, Hida T, Honda O, Araki T, Yanagawa M, Nishino M, Miller ER, Eiriksdottir G, Gudmundsson EF, Tomiyama N, Honda H, Rosas IO, Washko GR, Cho MH, Schwartz DA, Gudnason V, Hatabu H, Hunninghake GM. Imaging Patterns are Associated with Interstitial Lung Abnormality Progression and Mortality. Am J Respir Crit Care Med 2019;

Date Published:

2019 Jan 23


Rationale Interstitial lung abnormalities (ILA) are radiologic abnormalities on chest CT scans that have been associated with an early or mild form of pulmonary fibrosis. While ILA have been associated with radiologic progression, it is not known if specific imaging patterns are associated with progression or risk of mortality. Objectives To determine the role of imaging patterns on the risk of death and ILA progression. Methods ILA (and imaging pattern) were assessed in 5320 participants from the AGES-Reykjavik Study, ILA progression was assessed in 3167 participants. Multivariable logistic regression was used to assess factors associated with ILA progression, Cox-proportional hazards models were used to assess time to mortality. Measurements and Main Results Over five years, 327 (10%) had ILA on at least one CT, 1435 (45%) did not have ILA on either CT. Of those with ILA, 238 (73%) had imaging progression, while 89 (27%) had stable to improved imaging; increasing age and copies of MUC5B genotype were associated with imaging progression. The Definite Fibrosis pattern was associated with the highest risk of progression (OR=8.4, 95% CI 2.7-25, P=0.0003). Specific imaging patterns were also associated with an increased risk of death. After adjustment, both a probable UIP and UIP pattern were associated with an increased risk of death when compared to those indeterminate for UIP, (HR=1.7, 95% CI 1.2-2.4, P=0.001) (HR=3.9, 95% CI 2.3-6.8, P<0.0001) respectively. Conclusions In those with ILA, imaging patterns can be used to help predict who is at the greatest risk of progression and early death.