Development and validation of a radiological diagnosis model for hypersensitivity pneumonitis.

High-resolution computed tomography (HRCT) may be useful for diagnosing hypersensitivity pneumonitis. Here, we develop and validate a radiological diagnosis model and model-based points score.Patients with interstitial lung disease seen at the University of Michigan Health System (derivation cohort) or enrolling in the Lung Tissue Research Consortium (validation cohort) were included. A thin-section, inspiratory HRCT scan was required. Thoracic radiologists documented radiological features.The derivation cohort comprised 356 subjects (33.9% hypersensitivity pneumonitis) and the validation cohort comprised 424 subjects (15.5% hypersensitivity pneumonitis). An age-, sex- and smoking status-adjusted logistic regression model identified extent of mosaic attenuation or air trapping greater than that of reticulation ("MA-AT>Reticulation"; OR 6.20, 95% CI 3.53-10.90; p<0.0001) and diffuse axial disease distribution (OR 2.33, 95% CI 1.31-4.16; p=0.004) as hypersensitivity pneumonitis predictors (area under the receiver operating characteristic curve 0.814). A model-based score >2 (1 point for axial distribution, 2 points for "MA-AT>Reticulation") has specificity 90% and positive predictive value (PPV) 74% in the derivation cohort and specificity 96% and PPV 44% in the validation cohort. Similar model performance is seen with population restriction to those reporting no exposure (score >2: specificity 91%).When radiological mosaic attenuation or air trapping are more extensive than reticulation and disease has diffuse axial distribution, hypersensitivity pneumonitis specificity is high and false diagnosis risk low (<10%), but PPV is diminished in a low-prevalence setting.

Application of a broadly tunable SG-DBR QCL for multi-species trace gas spectroscopy.

Feasibility of using a mid-Infrared tunable sampled-grating distributed Bragg reflectors quantum cascade laser for high resolution multicomponent trace gas spectroscopy is demonstrated. By controlling the driving currents to the front and back sections of the laser, we were able to tune a pulsed 4.55 µm laser over a frequency range a of 30 cm(-1) with high resolution, accuracy and repeatability. The laser was applied to absorption spectroscopy of ambient and reduced pressure (150 Torr) air in a 205 meters multi-pass Herriott cell, and by using standard LSQ fitting to a spectral database of these trace gases (HITRAN), the concentrations of nitrous oxide, carbon monoxide, and water vapor were retrieved.

Increased epicardial fat is independently associated with the presence and chronicity of atrial fibrillation and radiofrequency ablation outcome.

OBJECTIVE: To determine whether intrathoracic fat volumes are associated with presence and chronicity of atrial fibrillation (AF) and radiofrequency ablation (RFA) treatment outcome. METHODS: IRB approval was obtained and patient consent was waived for this HIPAA-compliant retrospective study. 169 patients with AF (75 non-paroxysmal and 94 paroxysmal) and 62 control patients underwent cardiac CT examination. Extrapericardial (EPFV) and epicardial fat volumes (EFV) were measured on CT, the sum of which is the total intrathoracic fat volume. Associations between these three fat volumes and presence and chronicity of AF, and outcome after RFA, were evaluated using logistic regression analysis. RESULTS: EFV was significantly associated with presence [OR 1.01 (95 % CI 1.003-1.03), p = 0.01], chronicity of AF [1.008 (1.001-1.020), p = 0.03] and AF recurrence after RFA [1.009 (1.001-1.01), p = 0.02] after adjustment for age, gender and BMI. Patients with a larger EFV had a shorter time to AF recurrence (p = 0.017) and a higher rate of recurrence (54 % vs 46 %) (p = 0.002) after RFA. EPFV had no significant associations. CONCLUSION: Increased epicardial fat is associated with the presence and chronicity of AF, a higher probability of AF recurrence after RFA and a shorter AF-free interval. KEY POINTS: • Increased epicardial fat is associated with presence and chronicity of atrial fibrillation • Extensive epicardial fat is associated with earlier recurrences of AF after ablation • Extensive epicardial fat may reduce transmurality of ablation by affecting current dynamics.

Smoking-related idiopathic interstitial pneumonia.

Cigarette smoking is a key factor in the development of numerous pulmonary diseases. An international group of clinicians, radiologists and pathologists evaluated patients with previously identified idiopathic interstitial pneumonia (IIP) to determine unique features of cigarette smoking. Phase 1 (derivation group) identified smoking-related features in patients with a history of smoking (n=41). Phase 2 (validation group) determined if these features correctly predicted the smoking status of IIP patients (n=100) to participants blinded to smoking history. Finally, the investigators sought to determine if a new smoking-related interstitial lung disease phenotype could be defined. Phase 1 suggested that preserved forced vital capacity with disproportionately reduced diffusing capacity of the lung for carbon monoxide, and various radiographic and histopathological findings were smoking-related features. In phase 2, the kappa coefficient among clinicians was 0.16 (95% CI 0.11-0.21), among the pathologists 0.36 (95% CI 0.32-0.40) and among the radiologists 0.43 (95% CI 0.35-0.52) for smoking-related features. Eight of the 100 cases were felt to represent a potential smoking-related interstitial lung disease. Smoking-related features of interstitial lung disease were identified in a minority of smokers and were not specific for smoking. This study is limited by its retrospective design, the potential for recall bias in smoking history and lack of information on second-hand smoke exposure. Further research is needed to understand the relationship between smoking and interstitial lung disease.

Mixing Rules for Left-Handed Disordered Metamaterials: Effective-Medium and Dispersion Properties.

Left-handed materials are known to exhibit exotic properties in controlling electromagnetic fields, with direct applications in negative reflection and refraction, conformal optical mapping, and electromagnetic cloaking. While typical left-handed materials are constructed periodic metal-dielectric structures, the same effect can be obtained in composite guest-host systems with no periodicity or structural order. Such systems are typically described by the effective-medium approach, in which the components of the electric permittivity tensor are determined as a function of individual material properties and doping concentration. In this paper, we extend the discussion on the mixing rules to include left-handed composite systems and highlight the exotic properties arising from the effective-medium approach in this framework in terms of effective values and dispersion properties.

A contemporary carbon balance for the Northeast region of the United States.

Development of regional policies to reduce net emissions of carbon dioxide (CO2) would benefit from the quantification of the major components of the region's carbon balance--fossil fuel CO2 emissions and net fluxes between land ecosystems and the atmosphere. Through spatially detailed inventories of fossil fuel CO2 emissions and a terrestrial biogeochemistry model, we produce the first estimate of regional carbon balance for the Northeast United States between 2001 and 2005. Our analysis reveals that the region was a net carbon source of 259 Tg C/yr over this period. Carbon sequestration by land ecosystems across the region, mainly forests, compensated for about 6% of the region's fossil fuel emissions. Actions that reduce fossil fuel CO2 emissions are key to improving the region's carbon balance. Careful management of forested lands will be required to protect their role as a net carbon sink and a provider of important ecosystem services such as water purification, erosion control, wildlife habitat and diversity, and scenic landscapes.

Towards Highly Efficient Nitrogen Dioxide Gas Sensors in Humid and Wet Environments Using Triggerable-Polymer Metasurfaces.

We report simulations on a highly-sensitive class of metasurface-based nitrogen dioxide (NO2) gas sensors, operating in the telecom C band around the 1550 nm line and exhibiting strong variations in terms of the reflection coefficient after assimilation of NO2 molecules. The unit architecture employs a polymer-based (polyvinylidene fluoride-PVDF or polyimide-PI) motif of either half-rings, rods, or disks having selected sizes and orientations, deposited on a gold substrate. On top of this, we add a layer of hydrophyllic polymer (POEGMA) functionalized with a NO2-responsive monomer (PAPUEMA), which is able to adsorb water molecules only in the presence of NO2 molecules. In this process, the POEGMA raises its hidrophyllicity, while not triggering a phase change in the bulk material, which, in turn, modifies its electrical properties. Contrary to absorption-based gas detection and electrical signal-based sensors, which experience considerable limitations in humid or wet environments, our method stands out by simple exploitation of the basic material properties of the functionalized polymer. The results show that NO2-triggered water molecule adsorption from humid and wet environments can be used in conjunction with our metasurface architecture in order to provide a highly-sensitive response in the desired spectral window. Additionally, instead of measuring the absorption spectrum of the NO2 gas, in which humidity counts as a parasitic effect due to spectral overlap, this method allows tuning to a desired wavelength at which the water molecules are transparent, by scaling the geometry and thicknesses of the layers to respond to a desired wavelength. All these advantages make our proposed sensor architecture an extremely-viable candidate for both biological and atmospheric NO2 gas-sensing applications.

Thoracic CT findings in Birt-Hogg-Dube syndrome.

OBJECTIVE: Birt-Hogg-Dubé syndrome manifests in the thorax as lung cysts. The purpose of this article is to describe the CT characteristics of cysts in patients with Birt-Hogg-Dubé syndrome and to note other thoracic findings. MATERIALS AND METHODS: The thoracic CT examinations of 17 patients with Birt-Hogg-Dubé syndrome were reviewed retrospectively for the presence, anatomic distribution (upper lung predominant, lower lung predominant, or diffuse), extent (size, number), and morphology (shape, wall thickness) of cysts. Any additional thoracic findings were also noted. RESULTS: The study population consisted of 13 women (76%) and four men (24%) with a mean age of 50.2 ±15.2 years. Two patients (12%) had normal findings on CT. Fifteen patients had cystic lung disease, all of whom had more than one cyst. Most patients had bilateral (13/15, 87%) and lower lung-predominant cysts (13/15, 87%). The cysts varied in size from 0.2 to 7.8 cm. The largest cysts were located in the lower lobes of 14 of 15 patients (93%). Of the nine patients with large cysts, most had at least one multiseptated cyst (7/9, 78%). Five of 15 patients (33%) had more than 20 cysts. Cyst shape varied among the 15 patients and also within individual patients (10/15, 67%) ranging from round to oval, lentiform, and multiseptated. Cysts showed no central or peripheral predominance. CONCLUSION: Discrete thin-walled cysts in patients with Birt-Hogg-Dubé syndrome are more numerous and larger in the lower lobes and vary in size and shape. Large lung cysts are frequently multiseptated. These features may aid in differentiating Birt-Hogg-Dubé syndrome from other more common cystic lung diseases.

Reference normal absolute and indexed values from ECG-gated MDCT: left atrial volume, function, and diameter.

OBJECTIVE: The purpose of this study was to retrospectively determine CT-based normal reference values of left atrial volume, function, and diameter normalized by age, sex, and body surface area. MATERIALS AND METHODS: The study group consisted of 74 subjects with normal findings at ECG-gated coronary CT angiography performed with retrospective gating. Analysis of left atrial volume (end-diastolic, end-systolic, and stroke volume) and function (ejection fraction) was performed with the Simpson method. Left atrial diameter was measured in the anteroposterior dimension. General linear model analysis was performed to model the data and assess statistical significance by age group after adjustment for sex and body surface area. RESULTS: The reference range for left atrial volume, function, and diameter was normalized (indexed) to age, sex, and body surface area in healthy subjects. A statistically significant difference was noted between left atrial volume and age without adjustment for sex and body surface area, but no statistically significant difference was found after adjustment for these variables. Sex and body surface area had a significant influence on left atrial volume, function, and diameter. CONCLUSION: Left atrial volume, function, and diameter normalized to age, sex, and body surface area can be reported from CTA datasets and may provide information important for patient care.

Neural network approach to retrieve the inherent optical properties of the ocean from observations of MODIS.

Retrieving the inherent optical properties of water from remote sensing multispectral reflectance measurements is difficult due to both the complex nature of the forward modeling and the inherent nonlinearity of the inverse problem. In such cases, neural network (NN) techniques have a long history in inverting complex nonlinear systems. The process we adopt utilizes two NNs in parallel. The first NN is used to relate the remote sensing reflectance at available MODIS-visible wavelengths (except the 678 nm fluorescence channel) to the absorption and backscatter coefficients at 442 nm (peak of chlorophyll absorption). The second NN separates algal and nonalgal absorption components, outputting the ratio of algal-to-nonalgal absorption. The resulting synthetically trained algorithm is tested using both the NASA Bio-Optical Marine Algorithm Data Set (NOMAD), as well as our own field datasets from the Chesapeake Bay and Long Island Sound, New York. Very good agreement is obtained, with R² values of 93.75%, 90.67%, and 86.43% for the total, algal, and nonalgal absorption, respectively, for the NOMAD. For our field data, which cover absorbing waters up to about 6 m⁻¹, R² is 91.87% for the total measured absorption.

Calibration of the 1064 nm lidar channel using water phase and cirrus clouds.

Calibration is essential to derive aerosol backscatter coefficients from elastic scattering lidar. Unlike the visible UV wavelengths where calibration is based on a molecular reference, calibration of the 1064 nm lidar channel requires other approaches, which depend on various assumptions. In this paper, we analyze two independent calibration methods which use (i) low-altitude water phase clouds and (ii) high cirrus clouds. In particular, we show that to achieve optimal performance, aerosol attenuation below the cloud base and cloud multiple scattering must be accounted for. When all important processes are considered, we find that these two independent methods can provide a consistent calibration constant with relative differences less than 15%. We apply these calibration techniques to demonstrate the stability of our lidar on a monthly scale, along with a natural reduction of the lidar efficiency on an annual scale. Furthermore, our calibration procedure allows us to derive consistent aerosol backscatter coefficients and angstrom coefficient profiles (532-1064 nm) along with column extinction-to-backscatter ratios which are in good agreement with sky radiometer inversions.

Clinical predictors of a diagnosis of idiopathic pulmonary fibrosis.

RATIONALE: Idiopathic pulmonary fibrosis (IPF) and other idiopathic interstitial pneumonias (IIPs) have similar clinical and radiographic features, but their histopathology, response to therapy, and natural history differ. A surgical lung biopsy is often required to distinguish between these entities. OBJECTIVES: We sought to determine if clinical variables could predict a histopathologic diagnosis of IPF in patients without honeycomb change on high-resolution computed tomography (HRCT). METHODS: Data from 97 patients with biopsy-proven IPF and 38 patients with other IIPs were examined. Logistic regression models were built to identify the clinical variables that predict histopathologic diagnosis of IPF. MEASUREMENTS AND MAIN RESULTS: Increasing age and average total HRCT interstitial score on HRCT scan of the chest may predict a biopsy confirmation of IPF. Sex, pulmonary function, presence of desaturation, or distance walked during a 6-minute walk test did not help discriminate pulmonary fibrosis from other IIPs. CONCLUSIONS: Clinical data may be used to predict a diagnosis of IPF over other IIPs. Validation of these data with a prospective study is needed.

Synergistic aircraft and ground observations of transported wildfire smoke and its impact on air quality in New York City during the 2018 LISTOS campaign.

Air pollution associated with wildfire smoke transport during the summer can significantly affect ozone (O3) and particulate matter (PM) concentrations, even in heavily populated areas like New York City (NYC). Here, we use observations from aircraft, ground-based lidar, in-situ analyzers and satellite to study and assess wildfire smoke transport, vertical distribution, optical properties, and potential impact on air quality in the NYC urban and coastal areas during the summer 2018 Long Island Sound Tropospheric Ozone Study (LISTOS). We investigate an episode of dense smoke transported and mixed into the planetary boundary layer (PBL) on August 15-17, 2018. The horizontal advection of the smoke is shown to be characterized with the prevailing northwest winds in the PBL (velocity > 10 m/s) based on Doppler wind lidar measurements. The wildfire sources and smoke transport paths from the northwest US/Canada to northeast US are identified from the NOAA hazard mapping system (HMS) fires and smoke product and NOAA-HYbrid Single Particle Lagrangian Integrated Trajectory (HYSPLIT) backward trajectory analysis. The smoke particles are distinguished from the urban aerosols by showing larger lidar-ratio (70-sr at 532-nm) and smaller depolarization ratio (0.02) at 1064-nm using the NASA High Altitude Lidar Observatory (HALO) airborne high-spectral resolution lidar (HSRL) measurements. The extinction-related angstrom exponents in the near-infrared (IR at 1020-1640 nm) and Ultraviolet (UV at 340-440 nm) from NASA-Aerosol Robotic Network (AERONET) product show a reverse variation trend along the smoke loadings, and their absolute differences indicate strong correlation with the smoke-Aerosol Optical Depth (AOD) (R > 0.94). We show that the aloft smoke plumes can contribute as much as 60-70% to the column AOD and that concurrent high-loadings of O3, carbon monoxide (CO), and black carbon (BC) were found in the elevated smoke layers from the University of Maryland (UMD) aircraft in-situ observations. Meanwhile, the surface PM2.5 (PM with diameter ≤ 2.5 µm), organic carbon (OC) and CO measurements show coincident and sharp increase (e.g., PM2.5 from 5 µg/m3 before the plume intrusion to ~30 µg/m3) with the onset of the plume intrusions into the PBL along with hourly O3 exceedances in the NYC region. We further evaluate the NOAA-National Air Quality Forecasting Capability (NAQFC) model PBL-height, PM2.5, and O3 with the observations and demonstrate good consistency near the ground during the convective PBL period, but significant bias at other times. The aloft smoke layers are sometimes missed by the model.

The prognostic value of cardiopulmonary exercise testing in idiopathic pulmonary fibrosis.

RATIONALE: Idiopathic pulmonary fibrosis (IPF) is characterized by progressive dyspnea, impaired gas exchange, and ultimate mortality. OBJECTIVES: To test the hypothesis that maximal oxygen uptake during cardiopulmonary exercise testing at baseline and with short-term longitudinal measures would predict mortality in patients with idiopathic pulmonary fibrosis. METHODS: Data from 117 patients with IPF and longitudinal cardiopulmonary exercise tests were examined retrospectively. Survival was calculated from the date of the first cardiopulmonary exercise test. MEASUREMENTS AND MAIN RESULTS: Patients with baseline maximal oxygen uptake less than 8.3 ml/kg/min had an increased risk of death (n = 8; hazard ratio, 3.24; 95% confidence interval, 1.10-9.56; P = 0.03) after adjusting for age, gender, smoking status, baseline forced vital capacity, and baseline diffusion capacity for carbon monoxide. We were unable to define a unit change in maximal oxygen uptake that predicted survival in our cohort. CONCLUSIONS: We conclude that a threshold maximal oxygen uptake of 8.3 ml/kg/min during cardiopulmonary exercise testing at baseline adds prognostic information for patients with IPF.

Novel optical techniques for detecting and classifying toxic dinoflagellate Karenia brevis blooms using satellite imagery.

Karenia brevis (K. brevis) blooms are of great interest and have been commonly reported throughout the Gulf of Mexico. In this study we propose a detection technique for blooms with low backscatter characteristics, which we name the Red Band Difference (RBD) technique, coupled with a selective K. brevis bloom classification technique, which we name the K. brevis Bloom Index (KBBI). These techniques take advantage of the relatively high solar induced chlorophyll fluorescence and low backscattering of K. brevis blooms. The techniques are applied to the detection and classification of K. brevis blooms from Moderate Resolution Imaging Spectroradiometer (MODIS) ocean color measurements off the Gulf of Mexico. To assess the efficacy of the techniques for detection and classification, simulations, including chlorophyll fluorescence (assuming 0.75% quantum yield) based on K. brevis blooms and non-K. brevis blooms conditions were performed. These show that effective bloom detection from satellite measurements requires a threshold of RBD>0.15W/m(2)/microm/sr, corresponding to about 5mg/m(3) of chlorophyll. Blooms can be detected at lower concentration by lowering the RBD threshold but false positives may increase. The classification technique is found most effective for thresholds of RBD>0.15W/m(2)/microm/sr and KBBI>0.3*RBD. The techniques were applied and shown to be effective for well documented blooms of K. brevis in the Gulf of Mexico and compared to other detection techniques, including FLH approaches. Impacts of different atmospheric corrections on results were also examined.

Polarized light in coastal waters: hyperspectral and multiangular analysis.

Measurements of the underwater polarized light field were performed at different stations, atmospheric conditions and water compositions using a newly developed hyperspectral and multiangular polarimeter during a recent cruise in the coastal areas of New York Harbor - Sandy Hook, NJ region (USA). Results are presented for waters with chlorophyll concentrations 1.3-4.8 microg/l and minerals concentrations 2.0- 3.9 mg/l. Angular and spectral variations of the degree of polarization are found to be consistent with theory. Maximum values of the degree of polarization do not exceed 0.4 and the position of the maximum is close to 100 masculine scattering angle. Normalized radiances and degrees of polarization are compared with simulated ones obtained with a Monte Carlo radiative transfer code for the atmosphere-ocean system and show satisfactory agreement.

Evaluation of the Uncertainty in Satellite-Based Crop State Variable Retrievals Due to Site and Growth Stage Specific Factors and Their Potential in Coupling with Crop Growth Models.

Coupling crop growth models and remote sensing provides the potential to improve our understanding of the genotype x environment x management (G × E × M) variability of crop growth on a global scale. Unfortunately, the uncertainty in the relationship between the satellite measurements and the crop state variables across different sites and growth stages makes it difficult to perform the coupling. In this study, we evaluate the effects of this uncertainty with MODIS data at the Mead, Nebraska Ameriflux sites (US-Ne1, US-Ne2, and US-Ne3) and accurate, collocated Hybrid-Maize (HM) simulations of leaf area index (LAI) and canopy light use efficiency (LUECanopy). The simulations are used to both explore the sensitivity of the satellite-estimated genotype × management (G × M) parameters to the satellite retrieval regression coefficients and to quantify the amount of uncertainty attributable to site and growth stage specific factors. Additional ground-truth datasets of LAI and LUECanopy are used to validate the analysis. The results show that uncertainty in the LAI/satellite measurement regression coefficients lead to large uncertainty in the G × M parameters retrievable from satellites. In addition to traditional leave-one-site-out regression analysis, the regression coefficient uncertainty is assessed by evaluating the retrieval performance of the temporal change in LAI and LUECanopy. The weekly change in LAI is shown to be retrievable with a correlation coefficient absolute value (|r|) of 0.70 and root-mean square error (RMSE) value of 0.4, which is significantly better than the performance expected if the uncertainty was caused by random error rather than secondary effects caused by site and growth stage specific factors (an expected |r| value of 0.36 and RMSE value of 1.46 assuming random error). As a result, this study highlights the importance of accounting for site and growth stage specific factors in remote sensing retrievals for future work developing methods coupling remote sensing with crop growth models.

Hypersensitivity Pneumonitis: Radiologic Phenotypes Are Associated With Distinct Survival Time and Pulmonary Function Trajectory.

BACKGROUND: Hypersensitivity pneumonitis (HP) is an interstitial lung disease with a better prognosis, on average, than idiopathic pulmonary fibrosis (IPF). We compare survival time and pulmonary function trajectory in patients with HP and IPF by radiologic phenotype. METHODS: HP (n = 117) was diagnosed if surgical/transbronchial lung biopsy, BAL, and exposure history results suggested this diagnosis. IPF (n = 152) was clinically and histopathologically diagnosed. All participants had a baseline high-resolution CT (HRCT) scan and FVC % predicted. Three thoracic radiologists documented radiologic features. Survival time is from HRCT scan to death or lung transplant. Cox proportional hazards models identify variables associated with survival time. Linear mixed models compare post-HRCT scan FVC % predicted trajectories. RESULTS: Subjects were grouped by clinical diagnosis and three mutually exclusive radiologic phenotypes: honeycomb present, non-honeycomb fibrosis (traction bronchiectasis and reticulation) present, and nonfibrotic. Nonfibrotic HP had the longest event-free median survival (> 14.73 years) and improving FVC % predicted (1.92%; 95% CI, 0.49-3.35; P = .009). HP with non-honeycomb fibrosis had longer survival than IPF (> 7.95 vs 5.20 years), and both groups experienced a significant decline in FVC % predicted. Subjects with HP and IPF with honeycombing had poor survival (2.76 and 2.81 years, respectively) and significant decline in FVC % predicted. CONCLUSIONS: Three prognostically distinct, radiologically defined phenotypes are identified among patients with HP. The importance of pursuing a specific diagnosis (eg, HP vs IPF) among patients with non-honeycomb fibrosis is highlighted. When radiologic honeycombing is present, invasive diagnostic testing directed at determining the diagnosis may be of limited value given a uniformly poor prognosis.

Accuracy of high-resolution CT in the diagnosis of diffuse lung disease: effect of predominance and distribution of findings.

OBJECTIVE: The purpose of this study was to determine whether the predominant findings at high-resolution CT influence the accuracy of diagnosis of diffuse lung disease. MATERIALS AND METHODS: The cases of 100 patients with diffuse lung disease who underwent high-resolution CT and tissue diagnosis were studied. Three thoracic radiologists reviewed high-resolution CT images blindly and independently for patterns of abnormality, listing their three main diagnoses and level of confidence in the first choice. The effect of the findings on accuracy was analyzed. RESULTS: For honeycombing, the accuracy of the main diagnosis was 96.6%, 92.2%, and 92.3% for the three readers, and that of the three main diagnoses was 96.6%, 96.1%, and 92.3%. For cysts, the accuracy of the main diagnosis was 88.9%, 80%, and 81.8% and of the three main diagnoses was 100%, 90%, and 90.9%. For bronchovascular thickening, the accuracy of the main diagnosis was 91.7%, 87.5%, and 90.9% and of the three main diagnoses was 91.7%, 100%, and 90.9%. For ground-glass opacification (GGO), the accuracy of the main diagnosis was 75.5%, 55%, and 44.2% and of the three main diagnoses was 89.8%, 75%, and 65.4%. Only combining honeycombing with GGO improved the accuracy of GGO. Anatomic craniocaudal distribution improved reader accuracy when GGO was predominantly present in the lower part of the lung. Interobserver agreement on the presence of major findings was a mean kappa value of 0.45 for honeycombing, 0.74 for lung cysts, 0.63 for bronchovascular thickening, and 0.56 for GGO. Agreement for the craniocaudal distribution of major findings was a mean kappa value of 0.48 for honeycombing, 0.52 for bronchovascular thickening, and 0.32 for GGO. CONCLUSION: The predominant findings of honeycombing and bronchovascular thickening are associated with more than 90% accuracy in the first-choice diagnosis of diffuse lung disease; the finding of lung cysts has 80-89% accuracy. GGO as a predominant pattern had unreliable accuracy, but the accuracy improved when GGO was combined with either honeycombing or lower-lung distribution.

Smoking-related interstitial lung disease: radiologic-clinical-pathologic correlation.

Cigarette smoking is a recognized risk factor for development of interstitial lung disease (ILD). There is strong evidence supporting a causal role for cigarette smoking in development of respiratory bronchiolitis ILD (RB-ILD), desquamative interstitial pneumonitis (DIP), and pulmonary Langerhans cell histiocytosis (PLCH). In addition, former and current smokers may be at increased risk for developing idiopathic pulmonary fibrosis (IPF). The combination of lower lung fibrosis and upper lung emphysema is being increasingly recognized as a distinct clinical entity in smokers. High-resolution computed tomography is sensitive for detection and characterization of ILD and may allow recognition and classification of the smoking-related ILDs (SR-ILDs) into distinct individual entities. However, the clinical, radiologic, and histologic features overlap among the different SR-ILDs, and mixed patterns of disease frequently coexist in the same patient. The overlap is most significant between RB-ILD and DIP. Macrophage accumulation is bronchiolocentric in RB-ILD, producing centrilobular ground-glass opacity, and more diffuse in DIP, producing widespread ground-glass changes. The coexistence of upper lung nodules and cysts in a smoker allows confident diagnosis of PLCH. Final diagnosis of an SR-ILD and identification of the specific entity can be achieved with certainty only after the pulmonologist, radiologist, and pathologist have reviewed all of the clinical, radiologic, and pathologic data.