A stepwise multi-disciplinary algorithm for diagnosis of fibrosing lung diseases contributing MDCT, MRI, and PET/CT: a study on 250 patients using significance and validation analyses

Abstract Background The new guidelines limited the use of lung biopsy in evaluation fibrosis because its hazards. differential diagnosis interstitial pulmonary (IPF) or usual pneumonia (UIP) is challenging overlapping multi-detector computed tomography (MDCT) morphologic features between and non-interstitial fibrosing diseases. Scar carcinoma a serious complication that needs to be excluded certain conditions. Aim work: To achieve multi-disciplinary algorithm for diseases limit need by combining clinico-laboratory radiological roles. Results This study included two major steps. first step (prevalence/significance analysis contributing parameters diseases) was retrospectively conducted on 150 patients pathologically proved with disease during period January/2016 April/2018. Based P -value < 0.001, honeycombing bronchiectasis significant IPF. Basal traction bronchiectasis/bronchiolectasis relevant non-specific (NSIP). "Head cheese" CT-sign, history allergen exposure, blood eosinophilia, broncho-alveolar lavage (BAL) lymphocytosis were chronic hypersensitivity pneumonitis (HP). Upper peripheral tuberculosis (TB) pleuroparenchymal fibroelastosis (PPFE). Cavitations, tree-in-bud, calcific nodules TB, while "platy-thorax" CT-sign PPFE. upper peribronchovascular sarcoidosis progressive massive (PMF); additionally, changes PMF. Bright T2-signal, diffusion weighted-image (DWI) restriction magnetic-resonance imaging (MRI), high standardized uptake value (SUV) positron emission (PET-CT) scar carcinoma. Eventually, an created. second (validation analysis) prospectively targeted 100 initially diagnosed from June/2018 June/2022. It revealed 83.3–100% sensitivity, 96.3–100% specificity, 85.7–100% PPV, 96.4–100% NPV, 96–100% accuracy, balanced accuracy = 0.91–1. Four consulting radiologists pulmonologists participated this study. Conclusions A valid stepwise proposed hazards biopsy. contributed data, MDCT features, T2-WI DWI-MRI findings as well PET/CT results.