US Chest One small study has shown that measurements obtained from US imaging of the extrathoracic trachea correlate well with MRI [46]; however, a transthoracic US technique is limited by its inability to evaluate the entire tracheobronchial tree. Chronic Dyspnea-Noncardiovascular Origin Variant 4: Chronic dyspnea. Suspected interstitial lung disease. Initial imaging. Radiography Chest The chest radiograph may be abnormal in diffuse ILD; however, studies documenting the sensitivity of chest radiographs predate the widespread use of CT [47]. A normal chest radiograph in the setting of suspected ILD does not exclude the possibility of clinically important ILD. In subjects with diseases that predispose them to ILD (eg, connective tissue disease), it is reasonable to consider CT rather than radiography as the primary screening modality. CT Chest CT is currently the preferred imaging method for evaluating ILD [48]. CT protocols should be tailored to the clinical setting and may include expiratory or prone imaging. Good correlation has been reported between extent of disease on CT and severity of dyspnea [49-53]. CT findings are often sufficient to permit either a limited differential or confident diagnosis; the latter occurs particularly in the diagnosis of usual interstitial pneumonia [54-57], although the diagnostic yield improves with multidisciplinary discussion [58,59]. There is moderate agreement across individuals in the rating of honeycomb change [60]. The presence and extent of honeycomb change and other imaging features of ILD may serve as important prognostic variables [61,62]. MRI Chest MRI does not currently have an established clinical role in the evaluation of ILD, although small studies have shown good concordance with CT [63-65]. In general, MRI does not yet display the same level of parenchymal detail that is available with CT.
Chronic Dyspnea Noncardiovascular Origin. US Chest One small study has shown that measurements obtained from US imaging of the extrathoracic trachea correlate well with MRI [46]; however, a transthoracic US technique is limited by its inability to evaluate the entire tracheobronchial tree. Chronic Dyspnea-Noncardiovascular Origin Variant 4: Chronic dyspnea. Suspected interstitial lung disease. Initial imaging. Radiography Chest The chest radiograph may be abnormal in diffuse ILD; however, studies documenting the sensitivity of chest radiographs predate the widespread use of CT [47]. A normal chest radiograph in the setting of suspected ILD does not exclude the possibility of clinically important ILD. In subjects with diseases that predispose them to ILD (eg, connective tissue disease), it is reasonable to consider CT rather than radiography as the primary screening modality. CT Chest CT is currently the preferred imaging method for evaluating ILD [48]. CT protocols should be tailored to the clinical setting and may include expiratory or prone imaging. Good correlation has been reported between extent of disease on CT and severity of dyspnea [49-53]. CT findings are often sufficient to permit either a limited differential or confident diagnosis; the latter occurs particularly in the diagnosis of usual interstitial pneumonia [54-57], although the diagnostic yield improves with multidisciplinary discussion [58,59]. There is moderate agreement across individuals in the rating of honeycomb change [60]. The presence and extent of honeycomb change and other imaging features of ILD may serve as important prognostic variables [61,62]. MRI Chest MRI does not currently have an established clinical role in the evaluation of ILD, although small studies have shown good concordance with CT [63-65]. In general, MRI does not yet display the same level of parenchymal detail that is available with CT.