The clinical impact of high resolution computed tomography in patients with respiratory disease.

ABSTRACT

OBJECTIVE: High resolution computed tomography is widely used to investigate patients with suspected diffuse lung disease. Numerous studies have assessed the diagnostic performance of this investigation, but the diagnostic and therapeutic impacts have received little attention. METHODS: The diagnostic and therapeutic impacts of high resolution computed tomography in routine clinical practice were evaluated prospectively. All 507 referrals for high-resolution computed tomography over 12 months in two centres were included. Requesting clinicians completed questionnaires before and after the investigation detailing clinical indications, working diagnoses, confidence level in each diagnosis, planned investigations and treatments. RESULTS: Three hundred and fifty-four studies on 347 patients had complete data and were available for analysis. Following high-resolution computed tomography, a new leading diagnosis (the diagnosis with the highest confidence level) emerged in 204 (58%) studies; in 166 (47%) studies the new leading diagnosis was not in the original differential diagnosis. Mean confidence in the leading diagnosis increased from 6.7 to 8.5 out of 10 (p < 0.001). The invasiveness of planned investigations increased in 23 (7%) studies and decreased in 124 (35%) studies. The treatment plan was modified after 319 (90%) studies. CONCLUSIONS: Thoracic high-resolution computed tomography alters leading diagnosis, increases diagnostic confidence, and frequently changes investigation and management plans.