Test Your Eyes: Reading HRCT Scans

Refine your skills by viewing HRCT scans of the lungs of patients with suspected IPF and identify specific features found in images that are consistent with a radiological diagnosis of definite usual interstitial pneumonia (UIP), possible/probable UIP, or those that are inconsistent with a UIP pattern.

Your Score

What you answered:

  • Question 1:
  • Question 2:
  • Question 3:
  • Question 4:

Total Score

%

HRCT Scan (1 of 4)

Test Your Eyes, HRCT Scan 1

Images courtesy of and used with permission from Jonathan Goldin, MD, PhD.

What radiographic features are present in the HRCT scans shown here?
Choose all that apply.

1. Honeycomb formation
2. Subpleural, basal predominance
3. Micronodules
4. Air trapping
5. Reticular abnormality
Submit

Correct!

Incorrect!

The answer is: honeycomb formation, subpleural, basal predominance and reticular abnormality. The radiographic features seen in these HRCT scans meet the criteria for definite UIP. Usual interstitial is spatially and temporally heterogeneous with variant areas of normal lung, interstitial inflammation, fibrosis, and honeycombing. In the left sagittal image, there is clear evidence of peripheral, lower lobe predominance of reticulation with honeycomb formation. In the TLC and RV scans on the right, there is honeycomb formation. Finally, the RV scan shows a uniform decrease in attenuation across functioning parenchyma, with no evidence of air trapping.

Next
Test Your Eyes, HRCT Scan 2

Images courtesy of and used with permission from Jonathan Goldin, MD, PhD.

The images shown in these HRCT scans are:

1. Indicative of a definite UIP pattern
2. Indicative of a possible/probable UIP pattern
3. Inconsistent with a UIP pattern
Submit

Correct!

Incorrect!

The answer is: inconsistent with a UIP pattern. The lower lobe predominance, peribronchovascular disease, extensive ground glass abnormality with peripheral reticulation and air trapping clearly shown in these HRCT scans are all features that are inconsistent with UIP.

Next
Test Your Eyes, HRCT Scan 3

Images courtesy of and used with permission from Jonathan Goldin, MD, PhD.

The presence of which of the following features would suggest a diagnosis of possible/probable UIP in this patient?
Choose all that apply.

1. Lower lobe, subpleural predominance
2. Honeycomb formation
3. Air trapping
4. Reticular abnormalities
5. Profuse micronodules
Submit

Correct!

Incorrect!

The answer is: lower lobe, subpleural predominance and reticular abnormalities. While there is clear lower lobe, subpleural predominance with reticular abnormalities in this patient’s HRCT scans, there is no evidence for true honeycomb cysts which would be suggestive of definite UIP. The TLC and RV scans show decreased attenuation and no significant evidence of air trapping. In addition, there is no evidence of micronodules which would suggest an alternative diagnosis to UIP. Taken together, this pattern is consistent with possible or probable UIP.

Next
Test Your Eyes, HRCT Scan 4

Images courtesy of and used with permission from Jonathan Goldin, MD, PhD.

The images shown in these HRCT scans are:

1. Indicative of a definite UIP pattern
2. Indicative of a possible/probable UIP pattern
3. Inconsistent with a UIP pattern
Submit

Correct!

Incorrect!

The answer is: indicative of a definite UIP pattern. These images show clear evidence of honeycomb formation, which is central to the diagnosis of UIP. In addition to honeycomb change, the TLC and RV scans show lower lobe predominance, based on the presence of the inferior pulmonary vein. In the RV scan, there is uniform decreased attenuation and no evidence of air trapping. Therefore, the radiological diagnosis for this patient is definite UIP.

Next

Editorial review was provided by Jonathan Goldin, MD, PhD.