Radiology : A Diagnosis process

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In the follow up routine of IPF patients chest x-rays are useful.

Plain chest x-rays are not diagnostic but may reveal decreased lung volumes typically with prominent reticular interstitial markings near the lung bases.

The radiological evaluation through HRCT is essential point in the diagnostic pathway in IPF.

HRCT is performed using a conventional computed axial tomographic scanner without injection of contrast agents.

Evaluation slices are very thin upto 1-2mm .

Typical HRCT of the chest of IPF demonstrates fibrotic changes in both lungs, with a predilection for the bases and periphery. According to the joint ATS/ETS/JRS/ALAT 2011 guidelines, HRCT is an essential component of the diagnostic pathway in IPF which can identify UIP by the presence of:

Reticular opacities often associated with traction bronchiectasis.

Honeycombing manifested as cluster cystic aisspaces, typically of comparable diameters (3-10mm) but occasionally large.

Usually sub-pleural and characterized by well defined walls and disposed in at least two lines.

Generally one line of cysts is not sufficient to define honeycombing.

Ground-glass opacities are common but less extensive than the reticulation.

Distribution characteristically basal and peripheral through often patchy.

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