A specific advantage of MRI may exist when a single examination is desired for the evaluation of both ILD and its effect on the cardiovascular system [66]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT may have a secondary role in ILD evaluation. It can be used as a marker of disease extent and severity in sarcoidosis [67], reveal inflammatory activity before morphological changes are demonstrated on CT [68], and assist in follow-up and the monitoring of treatment response [10]. Some studies show that the degree of FDG activity correlates with severity and prognosis in ILD [69-71]. US Chest US has been evaluated as a potential ILD screening tool in high-risk populations. In scleroderma, US was concordant with CT in 83% of patients and demonstrated high sensitivity [72]. It is being used in some centers to detect chronic ILD [73,74] and is emerging as a monitoring tool [75]. Variant 5: Chronic dyspnea. Suspected disease of the pleura or chest wall. Initial imaging. Radiography Chest Pleural effusion is often diagnosed by a chest radiograph, and volume can reasonably be estimated [76]. A radiograph is somewhat limited in its ability to determine the exact location of an abnormality, whether parenchymal, pleural, or extrapleural. A chest radiograph may reveal structural abnormalities of the sternum, ribs, and thoracic spine that may predispose toward dyspnea. CT Chest CT is superior to radiographs in detecting and characterizing pleural disease, differentiating it from parenchymal and chest wall disease, and determining the extent of involvement [77]. CT is somewhat limited in its ability to differentiate causes of pleural effusion, although the presence of pleural thickening or enhancement may help document complex exudative and malignant effusions [78,79]. MRI Chest MRI may provide improved characterization and assessment of the extent of pleural and chest wall abnormalities compared to CT.
Chronic Dyspnea Noncardiovascular Origin. A specific advantage of MRI may exist when a single examination is desired for the evaluation of both ILD and its effect on the cardiovascular system [66]. FDG-PET/CT Skull Base to Mid-Thigh FDG-PET/CT may have a secondary role in ILD evaluation. It can be used as a marker of disease extent and severity in sarcoidosis [67], reveal inflammatory activity before morphological changes are demonstrated on CT [68], and assist in follow-up and the monitoring of treatment response [10]. Some studies show that the degree of FDG activity correlates with severity and prognosis in ILD [69-71]. US Chest US has been evaluated as a potential ILD screening tool in high-risk populations. In scleroderma, US was concordant with CT in 83% of patients and demonstrated high sensitivity [72]. It is being used in some centers to detect chronic ILD [73,74] and is emerging as a monitoring tool [75]. Variant 5: Chronic dyspnea. Suspected disease of the pleura or chest wall. Initial imaging. Radiography Chest Pleural effusion is often diagnosed by a chest radiograph, and volume can reasonably be estimated [76]. A radiograph is somewhat limited in its ability to determine the exact location of an abnormality, whether parenchymal, pleural, or extrapleural. A chest radiograph may reveal structural abnormalities of the sternum, ribs, and thoracic spine that may predispose toward dyspnea. CT Chest CT is superior to radiographs in detecting and characterizing pleural disease, differentiating it from parenchymal and chest wall disease, and determining the extent of involvement [77]. CT is somewhat limited in its ability to differentiate causes of pleural effusion, although the presence of pleural thickening or enhancement may help document complex exudative and malignant effusions [78,79]. MRI Chest MRI may provide improved characterization and assessment of the extent of pleural and chest wall abnormalities compared to CT.