“STUDY OF INTERSTITIAL LUNG DISEASES USING HIGH–RESOLUTION

COMPUTED TOMOGRAPHY AND CORRELATING THE IMAGING FINDINGS WITH

CHEST RADIOGRAPHIC FINDINGS.”
BY
Dr. KATAM SUSHMA REDDY
Regd.No.M22015306097(2022-23)

Dissertation submitted to the

Dr.N.T.R University of Health Sciences,Vijayawada.

In partial fulfillment of the requirements for the degree of

DOCTOR OF MEDICINE
IN THE SPECIALITY OF RADIODIAGNOSIS
Under the guidance of
Dr.ANIL KUMAR KALLEPALLI M.D.

DEPARTMENT OF RADIODIAGNOSIS
MAHARAJAH’S INSTITUTE OF MEDICAL SCIENCES,
NELLIMARLA-535217
 DECLARATION BY THE CANDIDATE

I hereby declare that the dissertation entitled " STUDY OF INTERSTITIAL LUNG

DISEASES USING HIGH–RESOLUTION COMPUTED TOMOGRAPHY AND

CORRELATING THE IMAGING FINDINGS WITH CHEST RADIOGRAPHIC FINDINGS."

is a bonafide and genuine research work carried out by me under the guidance of Prof Dr.

ANIL KUMAR KALLEPALLI M.D. Associate Professor of Radio Diagnosis,

Maharajah's Institute of Medical Sciences, Nellimarla.

Dr. KATAM SUSHMA REDDY, M.B.B.S

POST GRADUATE,
DEPARTMENT OF RADIODIAGNOSIS,
MIMS,
NELLIMARLA,
VIZIANAGARAM.
DR NTR UNIVERSITY OF HEALTH SCIENCES VIJAYAWADA,
ANDHRA PRADESH

ENDORSEMENT BY THE HEAD OF THE DEPARTMENT AND

PRINCIPAL

This is to certify that this dissertation, bearing the registration number:

M22015306097 entitled " STUDY OF INTERSTITIAL LUNG DISEASES USING HIGH

–RESOLUTION COMPUTED TOMOGRAPHY AND CORRELATING THE IMAGING

FINDINGS WITH CHEST RADIOGRAPHIC FINDINGS "is a bonafide research work

done by Dr. KATAM SUSHMA REDDY under the guidance of Associate Prof ANIL

KUMAR KALLEPALLI M.D. associate Professor, Dept. of Radio-diagnosis,

Maharajah's institute of medical sciences, Vizianagaram, in partial fulfillment of

the requirement for the award of the degree of M.D in RADIO-DIAGNOSIS.

Dr. CH.LAKSHMI KUMAR M.D. DTM. Prof. Dr. GS. KEJRIWAL, M.D.
DEAN, Professor and HOD.

Maharajah's Institute of Medical Dept. of Radio-diagnosis,

Sciences Maharajah's Institute of Medical

Nellimarla, Vizianagaram, AP Sciences,

Nellimarla, Vizianagaram, AP
 CERTIFICATE BY THE GUIDE

This is to certify that this " STUDY OF INTERSTITIAL LUNG DISEASES USING HIGH

–RESOLUTION COMPUTED TOMOGRAPHY AND CORRELATING THE IMAGING

FINDINGS WITH CHEST RADIOGRAPHIC FINDINGS ." is the bonafide work done by

Dr. KATAM SUSHMA REDDY, Postgraduate resident in M.D. (Radio Diagnosis),

Maharajah's institute of medical sciences, Nellimarla, under my direct guidance and

supervision to my satisfaction in partial fulfillment of requirement for the degree of M.D

(Radiodiagnosis).

Date: Dr. ANIL KUMAR KALLEPALLI M.D.,

Place: Nellimarla Associate Professor

Dept. of Radio-diagnosis, Maharajah's Institute of MedicalSciences,
Nellimarla, Vizianagaram, AP
 CERTIFICATE

This is to certify that this dissertation, bearing the registration number:

M22015306097 entitled “STUDY OF INTERSTITIAL LUNG DISEASES USING HIGH –

RESOLUTION COMPUTED TOMOGRAPHY AND CORRELATING THE IMAGING

FINDINGS WITH CHEST RADIOGRAPHIC FINDINGS” is a bonafide research work

done by, DR. KATAM SUSHMA REDDY under the guidance of Prof Dr. ANIL

KUMAR KALLEPALLI M.D. Professor, Department of Radio-diagnosis,

Maharajah's institute of medical sciences, Vizianagaram. This dissertation is an original

work done by the candidate herself and no part of this work was used as basis for

obtaining any other degree or publication or part thereof.

Signature of the candidate Signature of guide

Dr. KATAM SUSHMA REDDY Dr. ANIL KUMAR KALLEPALLI.MD,
MBBS (Reg no: APMC/FMR/123323), Professor
Post graduate student, Department of Radio-diagnosis,
Department of Radio-diagnosis, MIMS. MIMS.

Signature of the Dean Signature of the HOD

Dr. CH. LAKSHMI KUMAR. MD. DTM Dr. G.S.KEJRIWAL.MD,
DEAN, Professor and HOD,
MIMS, VIZIANAGARAM. Department of Radio-diagnosis, MIMS.
 PLAGIARISM CERTIFICATE

This is to certify that DR.KATAM SUSHMA REDDY, Dissertation topic Reg No:

M21015306097 dissertation topic/title“STUDY OF INTERSTITIAL LUNG DISEASES

USING HIGH –RESOLUTION COMPUTED TOMOGRAPHY AND CORRELATING

THE IMAGING FINDINGS WITH CHEST RADIOGRAPHIC FINDINGS” or MD Radio-

Diagnosis, student at Maharajah’s Institute of Medical Sciences, Nellimarla,

Vizianagaram. has been subjected to plagiarism check and found satisfactory.

Date: Dr. G .S. KEJRIWAL.MD

Place: Head of the Department

Department of Radiodiagnosis

MIMS,

Nellimarla,

Vizianagaram.
 COPYRIGHT

Declaration by the candidate

I here by declare that the Dr NTR University of Health sciences,Andhra

Pradesh shall have the rights to preserve, use and disseminate this dissertation in

print or electronic format for academic / researchpurposes.

Date: Dr.KATAM SUSHMA REDDY

Place:Nellimarla Postgraduate,
Departmentofradiodiagnosis, MIMS,

Nellimarla,Vizianagaram
 ACKNOWLEDGEMENT

It is appropriate that I begin by expressing my undying gratitude to the

ALMIGHTY GOD for giving me the strength, both mentally and physically, to complete this

task.

I want to express my gratitude to my beloved parents, who are my strength for

their efforts and their hardships, making me where I am today.

It gives me immense pleasure to express my deepest gratitude and sincere thanks to my

guide, DR. K. ANIL KUMAR ,MD Associate Professor Radiodiagnosis department,, MIMS.

Medical College, Nellimarla, for preparing for this task, guiding me with his professional

expertise, showing great care and attention to detail; and without his supervision and

guidance, this dissertation would have been impossible. My special thanks and gratitude to, Dr.

G .S. KEJRIWAL.MD Professor and HOD, Department of Radiodiagnosis,

DR.N.GIRIDHARGOPAL.DMRD.MD, Professor , Department of Radiodiagnosis.

DR.CH.MADHAVI.MD, Professor Radiodiagnosis department, DR.SONICA

SHARMA,MD Professor Radiodiagnosis department, DR.B.BHASKARA

RAO.DMRD.DNB, Assistant Professor Radiodiagnosis department, DR.B.NARENDRA

NAIDU.MD,Assistant Professor Radiodiagnosis department and DR.ALLU RAJESH.MD

SENIOR RESIDENT for their timely suggestions and constant encouragement.

I sincerely thank Dr.CH.LAKSHMI KUMAR,M.D.DTM.,Principal and Dr T

.VENUGOPAL.MD.AcademicDirector of MIMS Medical College,Nellimarla,for their

constant help and inspiration.

 ABBREVIATIONS

ILD : Interstitial Lung Disease

HRCT :High Resolution Computerized Tomography

DPLD : Diffuse Parenchymal Lung Disease

ICF :Informed Consent Form

IEC :Institutional EthicsCommittee

CRF : Case Record Form

CVS :CardiovascularSystem

RS : RespiratorySystem

RR :Respiratory Rate

WHO :WorldHealthOrganization

SOB :Shortnessof Breath

CXR :ChestX-ray

IPF :IdiopathicPulmonaryFibrosis

LIP : Lymphocytic interstitial pneumonia.

NSIP: Non-specific interstitial pneumonia

UIP : Usual interstitial pneumonia

HSP : Hypersensitivity pneumo

LC : Lymphangitis carcinomatosis
 TABLE OF CONTENTS

S.NO CONTENT PAGE NO

1. ABSTRACT 1

2. INTRODUCTION 3

3. AIMS AND OBJECTIVES 5

4. REVIEW OF LITERATURE 12

5. MATERIALS AND METHODS 20

6. OBSERVATIONS AND RESULTS 25

7. DISCUSSION 41

8. SUMMARY 51

10. CONCLUSION 52

11. REFERENCES 53

12. MASTERCHART 58

13. ANNEXURES 67
 LIST OF FIGURES

FIGURE NAMES
NO

1 Normal secondary lobule anatomy

2 Lung anatomy of axial and peripheral interstitum

3 Classification of interstitial lung diseases

Diffusion of gases in lungs.

4
Pathophysiology of interstitial lung diseases
5
 LIST OF TABLES

Table no NAMES

1 Age distribution of patients

2 Sex distribution in the study group

3 Relation between age and gender

4 Smoking history of patients

5 Sex ratio in smokers

6 Various diagnoses of patients with ILD

7 Reticular opacities in patients (HRCT vs. Chest X-ray)

8 Nodular opacities among patients (HRCT vs. Chest X-ray)

9 Septal thickening among patients (HRCT vs. Chest X-ray)

10 Honeycoombing among patients (HRCT vs. Chest X-ray)

11 Traction bronchiectasis among patients (HRCT vs. Chest X-ray)

12 Consolidation among patients (HRCT vs. Chest X-ray)

13 Ground glass opacity among patients (HRCT vs. Chest X-ray)

14 Lymphadenopathy among patients (HRCT vs. Chest X-ray)

15 Overview of imaging findings between HRCT and Chest X-ray

16 Interpretation of imaging findings (HRCT vs. CXR diagnostic yield

with p-values)

17 Comparative analysis of HRCT and CXR from previous similar

studies

18 Diagnostic superiority of HRCT over CXR in ILD (summarized

findings with significance values)
 LIST OF GRAPHS

FIGURE NO NAMES

1 Age distribution of patients

2 Sex distribution in the study group

3 Graphical representation of sex distribution according to age

group

4 Smoking history in the study population

5 Sex ratio in smokers

6 Frequency of diagnosis in patients with ILD

7 Graphical representation of reticular opacities

8 Graphical representation of nodular opacities

9 Graphical representation of septal thickening

10 Graphical representation of honeycombing

11 Graphical representation of traction bronchiectasis

12 Graphical representation of consolidation

13 Graphical representation of ground-glass opacity

14 Graphical representation of lymphadenopathy

15 Overview of number of imaging findings

16 Summary of imaging findings across all patients (Graphical

overview of diagnostic yield)

 Abstract

Aims and Objectives:

The primary objective of this study was to evaluate the diagnostic efficacy of high-

resolution computed tomography (HRCT) compared to conventional chest radiography in

identifying interstitial lung diseases (ILDs). The study aimed to analyze the frequency and

pattern of radiological findings on both imaging modalities in patients presenting with

clinical suspicion of ILD.

Results:

A total of 50 patients were included, with a male predominance (68%) and the highest

incidence in the 61–70 year age group (34%). HRCT demonstrated superior diagnostic

yield across multiple parameters, including reticular opacities (86% vs. 70%), septal

thickening (62% vs. 20%), honeycombing (48% vs. 16%), and traction bronchiectasis

(58% vs. 24%), with statistically significant differences (p < 0.05) compared to chest

radiography. Ground-glass opacities and lymphadenopathy were also better visualized

on HRCT. Usual Interstitial Pneumonia (UIP) was the most common subtype diagnosed

(48%).

Conclusion:While chest X-ray remains a valuable screening tool, HRCT provides greater

sensitivity and specificity in the evaluation of ILDs. It can detect early and subtle

interstitial changes, often missed on chest radiography, and plays a pivotal role in the

non-invasive, pattern-based diagnosis and management of ILDs. HRCT should be

1
recommended in all clinically suspected ILD cases for accurate diagnosis and disease

characterization.

2
 INTRODUCTION

Interstitial lung disease (ILD), also known as diffuse parenchymal lung disease (DPLD),

encompasses a group of respiratory conditions that affect the lung interstitium—the

tissue and space surrounding the alveoli. The condition arises when an injury to the lungs

triggers an abnormal healing process, leading to scarring and thickening of the tissue

around the alveoli. This fibrosis interferes with oxygen transfer into the bloodstream. 1

Figure1:Normal secondary lobule anatomy

Common symptoms include shortness of breath (dyspnea), a persistent dry cough,

fatigue, and weight loss. The disease often progresses gradually over several months.

The prognosis varies, with average survival rates ranging between three to five years 2.

Patients frequently present with nonspecific symptoms, and the initial diagnostic step is

typically a chest X-ray (CXR). In some cases, ILD can lead to pulmonary fibrosis.

Idiopathic pulmonary fibrosis (IPF), a specific type of ILD, is characterized by distinct

radiographic features, such as basal and pleural-based fibrosis with honeycombing, as

well as
3
pathological findings like spatially and temporally heterogeneous fibrosis, honeycombing,

and fibroblastic foci.

Figure 2:Lung anatomy of axial and peripheral interstitum

While some individuals with ILD may have normal chest X-ray findings, high-resolution

computed tomography (HRCT) can detect abnormalities not visible on standard imaging.

HRCT is crucial for differentiating among various forms of ILD. Definitive diagnosis often

requires a multidisciplinary approach, integrating radiological, clinical, and occasionally

pathological data.

The incidence3 of interstitial lung disease (ILD) ranges from 1 to 31.5 cases per 100,000

person-years. Hypersensitivity pneumonitis, a specific form of ILD, is notably more

prevalent in Asia, particularly in India, where the incidence ranges from 10.7% to 47.3%,

and in Pakistan. According to the Global Burden of Disease study, ILDs accounted for

0.26% of all deaths in 2017, marking an 86% increase in ILD-related years of life lost

over the past two decades 4.

4
Although previous studies have reported on the accurate detection of interstitial lung

disease (ILD), there is limited data from Andhra Pradesh regarding diagnostic techniques

such as conventional radiography and high-resolution computed tomography (HRCT).

The topic has not been thoroughly investigated, and the available literature is insufficient

to draw definitive conclusions for improving reliable diagnosis and disease grading.

Therefore, this study was conducted to evaluate the role of conventional radiography and

HRCT in diagnosing ILD. Once published, the findings could help identify various risk

factors, ultimately contributing to improved clinical outcomes.5

The present study was conducted at the Maharajah Institute of Medical Sciences in

Vizianagaram, a tertiary care center equipped with comprehensive facilities within the

Department of Radiodiagnosis to assess the parameters outlined in the study. The

investigator conducting the research was well-qualified to ensure its successful

execution. On average, approximately eight patients with suspected interstitial lung

disease (ILD) were referred to the Radiology Department each month for diagnostic

evaluations. Over the 18-month study period, data were collected from around 50

patients who were referred by the Pulmonology Department for further investigation.

Participants were selected based on predefined study criteria and sample size

estimations. The Department of Radiodiagnosis was adequately equipped to perform all

necessary diagnostic tests for the study. Additionally, the Medical Intensive Care Unit

(ICU) at the tertiary care center was available to manage any emergencies that might

arise during the study period.

5
AIM & OBJECTIVES

AIM OF THE STUDY: To study the efficiency of HRCT over conventional chest

radiography in the diagnosis of interstitial lung diseases.

OBJECTIVES:

To study the effectiveness of HRCT to detect pulmonary abnormalities in patients with

suspected ILD, with chest radiographic findings.

To correlate the findings of conventional chest radiography and HRCT in interstitial lung

diseases.

Review of Literature

In 1944, Hamman and Rich et al reported the first four cases of fatal diffuse interstitial

fibrosis. This condition, characterized by diffuse interstitial lung disease with mononuclear

cell infiltration, became known as "Hamman-Rich syndrome. 6" Between the 1950s and

1970s, extensive research was conducted to better understand the radiographic and

pathological characteristics of interstitial lung diseases.7 In 1964, Scadding introduced

the term "diffuse fibrosingalveolitis" to describe the interstitial and alveolar changes

associated with these diseases.8

Liebow9classified chronic idiopathic interstitial pneumonias into four distinct

histopathological subtypes, which include:

Bronchiolitis interstitial pneumonia (BIP)

Usual interstitial pneum0nia (UIP)

Lymphoid interstitial pneum0nia (LIP)

Desquamative interstitial pneum0nia (DIP)

6
Additional classifications, such as acute interstitial pneum0nia (also known as Hamman-

Rich syndrome) and n0nspecific interstitial pneumonia (NSIP) 10, have also been

recognized.

11
In 2001, a panel from the American Thoracic Society (ATS) updated Katzenstein and

Myers’ classification to emphasize the significance of integrating clinical, radiologic, and

pathologic perspectives in understanding interstitial pneumonias. In 2002, the ATS

further revised the classification of interstitial lung diseases, introducing the term "diffuse

parenchymal lung diseases" (DPLD). 12

In 2008, Nicole S.L. Goh et al developed algorithms for patients with systemic scler0sis

by integrating findings from high-resolution computed tomography (HRCT) and

pulmonary function test (PFT). HRCT was utilized to evaluate disease severity, offering

valuable prognostic insights.12

Shelley L Schmidt et al reported that HRCT can be used to detect histopathological

14
pattern of UIP.

Causes andRisk Factors: 15

Prolonged exposure to certain environmental and occupational agents can contribute to

the development of interstitial lung disease (ILD), including:

Silica dust

Asbestos

Grain dust

7
Bird droppings

Radiation therapy for lung or breast cancer

Medications:16

Various drugs have been associated with ILD, such as:

Cyclophosphamide and methotrexate

Nitrofurantoin

Amiodarone

Propranolol

Rituximab

Ethambutol

Bleomycin

Sulfasalazine

Autoimmune disorders 17 are often associated with interstitial lung disease (ILD). These

include:

Dermatomyositis and polymyositis

Scleroderma

Rheumatoid arthritis

Mixed connective tissue disease

Ankylosing spondylitis

Sjogren's syndrome

8
Classification of ILD:18

Figure 3: Classification of interstitial lung diseases

Risk factors:

for interstitial lung disease (ILD) include advancing age, occupations in mining, farming,

and construction, smoking, and the presence of gastroesophageal reflux disease

(GERD)19, all of which can elevate the likelihood of developing ILD.

Pathophyisology of ILD:20

Interstitial lung disease (ILD) develops as a result of chronic lung inflammation and

fibrosis, which leads to thickening of the alveolar-capillary membrane and pulmonary

vascular remodeling. These changes contribute to shortness of breath (SOB) and a

decline in both muscular and cardiovascular function.20

9
 Figure 4:Diffusion of gases in lungs.

The following image illustrates the pathophysiology of ILD21

Figure 5: Pathophysiology of interstitial lung diseases

10
The clinical presentation of interstitial lung disease (ILD) is often characterized by the "3

Cs": cough, nail clubbing, and coarse crackles upon auscultation. Pulmonary function

tests typically reveal an abnormal restrictive pattern and a decreased diffusing capacity. 22

Complications:23

CorPulmonale

Pulmonary hypertension,

Respiratory failure

Radiographic features:

Diffuse lung diseases often lead to infiltrative opacification, typically affecting the

peripheral regions of the lungs. The most common radiographic finding is a symmetric,

frequently basal reticular pattern, which may become more widespread over time and
24
progress to honeycombing. This radiographic pattern is histologically associated with

diffuse alveolar damage.

Role of HRCT:

HRCT has become a crucial tool in diagnosing ILD, reducing the need for procedures like

bronchoalveolar lavage and surgical biopsy. This approach has been reinforced by

noninvasivediagnostic criteria for idiopathic pulmonary fibrosis (IPF). However,

histological assessment remains essential in certain cases. Despite its importance,

challenges remain for clinicians and radiologists in applying HRCT findings in routine

practice. Key HRCT features include prominent interlobular septa, ground-glass

attenuation, patchy consolidation, parenchymal bands, irregular peri-bronchovascular

thickening, and sub-pleural lines.

11
Honeycombing is seen in 16% of patients with abnormal chest X-rays. Consolidation,

with or without ground-glass attenuation, may suggest organizing diffuse alveolar

damage. Over time, patchy consolidation, parenchymal bands, and irregular peri-

bronchovascular thickening improve, becoming pleural irregularities, prominent

interlobular septa, ground-glass attenuation, and sub-pleural lines. These changes are

reversible.25

HRCT findings in ILD are as follows:

LIP: Ground-glass opacity and perivascular cysts

NSIP: Basal ground-glass or reticular pattern along with traction bronchiectasis

UIP: Basal and peripheral reticular pattern, honeycombing, and traction bronchiectasis

HSP:Ground glass attenuation nodules, air trapping and mosaic attenuation.

Lymphangitis carcinomatosis: Nodular septal thickenings.

Sarcoidosis:Miliaryopacities,hilar and mediastinal lymphadenopathy.

Review of literature of previous studies:

1.Navneet ranjanlal et al26 (2024) conducted a study total on 30 patients. The objective

of this study was to compare the diagnostic findings of chest radiography and high-

resolution computed tomography (HRCT) in patients with suspected interstitial lung

disease (ILD). Individuals presenting with clinical features suggestive of ILD were

evaluated using both imaging modalities. This study encompassed a variety of

conditions, including sarcoidosis (23.3%), rheumatoid arthritis-related ILD (10%), silicosis

(16.7%), disseminated tuberculosis(6.7%),hypersensitivitypneumonitis (6.7%),allergic

12
bronchopulmonary aspergillosis (6.7%), and lymphangitic carcinomatosis (6.7%). Based

on the findings, this study concluded that HRCT is the imaging modality of choice for

evaluating patients with suspected interstitial lung disease. Given the limited sensitivity of

chest radiography, HRCT should be strongly considered in all cases where there is a

clinical suspicion of interstitial lung involvement.

2.Abhijeet taori et al27(2023) conducted a study total on 48 patients with suspicion of

interstitial lung disease. In their study 2 patients had normal chest xray however hrct

showed abnormalities. The most frequently observed abnormality on chest radiographs

was the presence of reticular opacities, identified in 89% of patients. In comparison,

HRCT detected these opacities in 98% of cases, demonstrating its superior sensitivity in

recognizing such parenchymal changes. HRCT demonstrated a statistically significant

advantage over Chest X-Ray in diagnosing ILDs, with 4 out of 6 evaluated parameters

showing a significant p-value. This study highlights the crucial role of CT scans in the

assessment of ILDs.

3.Adarsh AD et al28(2023) conducted a cross sectionalstudy to evaluate and compare

the effectiveness of chest radiography and high-resolution computed tomography in

diagnosing interstitial lung disease. All enrolled patients underwent both chest

radiography in and high-resolution computed tomography. A higher prevalence among

female patients was noted. HRCT proved to be more effective in detecting abnormalities

such as reticular and nodular opacities, septal thickening, honeycombing, traction

bronchiectasis, and mosaic attenuation. The difference in diagnostic yield between HRCT

and chest X-ray was statistically significant (P < 0.05). Clinical features of interstitial lung

disease (ILD) are often overlooked or misattributed to more common conditions l ike

chronic obstructive pulmonary disease (COPD), leading to delays in diagnosis.

13
Therefore, HRCT plays a vital role in the accurate diagnosis, management, and follow-up

of diffuse lung diseases.

4.In a study conducted by P. Madhu et al,29 in Telangana in 2020, the authors compared

the diagnostic accuracy of conventional radiography and High-Resolution Computed

Tomography (HRCT) for identifying interstitial lung diseases (ILDs). The patients in the

study underwent both conventional radiography and HRCT. The results indicated that the

majority of the patients were male. HRCT was more effective than conventional

radiography in detecting significant findings, with notable differences in the identification

of nodular opacities and septal thickening. Among the 30 patients, two showed normal

chest radiographs, but HRCT was able to reveal reticular opacities in these individuals.

This highlights the superior sensitivity of HRCT in detecting ILDs compared to

conventional radiography.

5.Ankit Kumar Shah et al. (2020) conducted a prospective observational study involving

50 patients, all above 30 years of age, to evaluate interstitial lung disease (ILD). The

study observed that the highest incidence of ILD occurred in the 51–60-year age group

(38%), with a male predominance of 58%. Approximately 16% of the patients had ILD

secondary to connective tissue disorders, such as rheumatoid arthritis, systemic

sclerosis, and polymyositis. Chest radiography alone enabled a confident diagnosis in

29% of the cases. However, high-resolution computed tomography (HRCT) provided

more definitive diagnostic information, revealing specific ILD patterns in 82% of the

patients, while 18% demonstrated nonspecific patterns and were categorized under

idiopathic interstitial pneumonia (IIP). Among the 41 cases with identifiable patterns,

idiopathic pulmonary fibrosis (IPF) was the most common diagnosis (20 cases), followed

by nonspecific interstitial pneumonia (NSIP), connective tissue disease-associated ILDs,

cryptogenic organizing pneumonia (COP) or bronchiolitis obliterans organizing

14
pneumonia (BOOP), smoking-related ILDs, and sarcoidosis. Occupational and radiation-

related ILDs were each seen in one patient. The authors concluded that while chest X-

ray serves as an important initial screening tool, HRCT remains the superior imaging

modality for accurately identifying the distribution, extent, and specific patterns of ILD.

6.In a study conducted by Somiya and Vijay Prabhu et al,31 in 2020, 30 patients with a

clinical diagnosis of interstitial lung disease (ILD) underwent High-Res0lution Computed

Tomography (HRCT). The authors compared HRCT with conventional CT scans. The

most common patterns observed included Non-Specific Interstitial Pneumonia (NSIP),

followed by Usual Interstitial Pneum0nia (UIP) and honeycombing reticular patterns. Two

radiologists performed the qualitative assessment. The study utilized a high-frequency

algorithm for HRCT, which takes advantage of the lung parenchyma's high contrast

environment and provides improved spatial resolution. The results showed significant

differences in scan time, radiation dose, and signal-to-noise ratio (SNR) between CT and

HRCT. The authors concluded that the HRCT protocol is the gold standard for

diagnosing interstitial lung diseases.

7.In a study conducted by Tarak Patel et al32 in 2020, 60 patients referred from

pulmonology and general medicine departments were evaluated in the Radiology

department. Each patient underwent both chest X-ray (CXR) and High-Resolution

Computed Tomography (HRCT) from January 2018 to June 2019. The results

demonstrated that HRCT was more effective than conventional chest radiographs in

detecting abnormalities associated with interstitial lung diseases (ILDs). The study

concluded that while CXR remains a fundamental diagnostic tool for ILD, HRCT stands

out as the most accurate imaging method for diagnosing ILD. Furthermore, the ability to

accurately diagnose ILD opens the door for the development of new medications

targeting specific molecular mechanisms, ultimately improving patient management.

15
8.Tahir et al ,33(2019), It was cross-sectional study, that included 148 patients. Out of

148 patients, there were 65 (43.9%) males and 83 (56.1%) were females.Patients from

all age groups were included in this study, the mean age was 55.89 ±14.39 years. Out of

148 Patchy ground glass appearance 92.6%, Honey Comb Appearance 45.9%, Centri

lobular 29.1% and Parenchymal appearance 24.3% inHRCT and concluded thatHRCT is

more accurate and highly reliable technique or diagnostic tool to diagnose interstitial lung

disease as compared to chest X-ray.

9.Manoj Kumar Agarwal et al. (2019) carried out a descriptive study involving 40

patients clinically suspected of having interstitial lung disease (ILD), with ages ranging

from 30 to 74 years. The study population comprised 65% males and 35% females. A

wide range of ILDs was documented, including idiopathic pulmonary fibrosis (25%),

hypersensitivity pneumonitis (17.5%), sarcoidosis (15%), rheumatoid arthritis-associated

ILD (10%), silicosis (10%), lymphangioleiomyomatosis (LAM, 7.5%), allergic

bronchopulmonary aspergillosis (5%), lymphangitis carcinomatosis (5%), and cryptogenic

organizing pneumonia (COP, 5%). Radiographic evaluation revealed reticular opacities in

85% of cases, while high-resolution computed tomography (HRCT) demonstrated these

findings in 70%. Traction bronchiectasis was detected in 45% of patients on HRCT

compared to 30% on chest X-ray. Similarly, honeycombing was observed in 35% of

cases using HRCT and only 17.5% on chest radiography. The study concluded that

HRCT plays a crucial role in the early and precise diagnosis of ILD, offering superior

visualization of characteristic imaging patterns when integrated with clinical evaluation.

10.In a study conducted by Anusmriti Palet al35in 2019, the authors aimed to evaluate

the radiological patterns and their distribution in chest X-rays (CXR) and HRCT scans

among patients with interstitial lung disease (ILD). This was a single-center, cross-

16
sectional study conducted over six months in 2018, using a convenient sampling method.

Statistical analysis was performed using the Student's t-test for mean comparisons and

the chi-square test for proportions. The study included 30 patients with either suspected

or confirmed ILD. Each patient underwent both CXR and HRCT. The findings revealed

that HRCT detected significantly more abnormalities per patient than CXR (4 versus 2).

The most common finding was reticular opacity, seen in 50% of CXR cases and 56.6% of

HRCT cases. Notably, one of the 30 patients had a normal CXR. In a 2016 study by

11.Siddhant et al,36 the authors recommended chest radiographs (CXR) as the initial

diagnostic tool for patients with interstitial lung disease (ILD). H0wever, when CXR

results are inconclusive or appear normal, HRCT can be used to identify abnormalities

that may not be visible on CXR. The study compared the findings from HRCT and chest

radiographs in ILD cases. The results revealed that the spectrum of diseases included

sarcoidosis (23.3%), rheumatoid arthritis (10%), idiopathic pulmonary fibrosis (23.3%),

silicosis (16.7%), disseminated tuberculosis (6.7%), hypersensitivity pneumonitis (6.7%),

allergic bronchopulmonary aspergillosis (6.7%), and lymphangitis carcinomatosis (6.7%).

The study concluded that HRCT is the preferred method for diagnosing ILD.

12.In a study conducted by Desai SR, Veeraraghavan S, Hansell DMet al,37et al in

2005, they aimed to discuss the significance of various pulmonary and extra pulmonary

abnormalities that may be identified on HRCT chest of systemic sclerosis patients. They

inferred HRCT chest is the well established gold standard imaginginvestigation used for

this purpose.

13.Ahmet savranlar et al,38(2004) conducted a study on 71 malecoal workers. For all

patients both chest xray and HRCT was done. There was a significant discrepancy

between CXR and HRCT findings, particularly in cases of early pneumoconiosis with a

17
negative CXR. The discordance rates were notably higher in early pneumoconiosis cases

(60%) compared to low-grade pneumoconiosis (36% and 8%, respectively). Among coal

miners with a normal CXR, HRCT identified pneumoconiosis in 6out of 10 cases.The

majority of workers classified as category 0 on CXR (10 out of 16) were reclassified as

category 1 based on HRCT findings. Additionally, among those diagnosed as category 1

on CXR,HRCT reclassified 7 cases as category 0 and 4cases as category 2. Among 8

cases categorized as category 2 on CXR, HRCT reassigned 4 cases as category 1. The

study concluded that HRCT is the standard method to diagnose normal and early

pneumoconiosis.

14.Johkoh T et al39 (2002) conducted a study to assess findings of lymphocytic

interstitial pneumonia. This study includes 22 patients with biopsy proven lymph0cytic

interstitial pneumonia.Thereis apredominant of lower lobe ground glass attenuation and

centrilobular nodules in all patients. They concluded that LIP typically presents with

ground-glass opacities, ill-defined centrilobular nodules, and interstitial thickening that

follows the distribution of lymphatic vessels. Enlarged lymph nodes are also a frequent

finding, observed in approximately 68% of affected individuals —more often than

previously thought.

StudySetting:

The study was conducted at the Department of Radiodiagnosis, Maharajah Institute of

Medical Sciences, Vizianagaram, Andhra Pradesh, India.

StudyPeriod:

The study span was 18 months, from March 2023 to September 2024.

18
DataCollection:

Data collection was carried out over a period of 18months.

StudyType:

Cross-sectional observational study.

The study is observational because the researcher does not interfere with the natural
course or environment of the subjects. There was no treatment or intervention applied.
Since the data was gathered at a single point in time, the study is also cross-sectional.

NumberofGroups:

The study included one group: patients with suspected or diagnosed interstitial lung

disease (ILD).

Source of Data:

After obtaining approval from the Institutional Ethics Committee, patients referred to the

Radiodiagnosdepartment with suspected ILD were selected as the study sample.

Sampling size: 50

INCLUSION CRITERIA

1. Patients with long standing dyspnea and following chest radiographic findings

-B/L reticular / reticulo-nodular opacities

-Distortion of lung architecture and changes of tractional Bronchiectasis.

2. Patients presenting with chest symptoms in collagen vascular diseases like SLE,

rheumatoiddiseases,systemic sclerosis.

19
3. Industrial exposure related diseases like silicosis,asbestosis,coalworker

pneumoconiosis.

4. Medication,drugs and radiation exposure related diseases

EXCLUSION CRITERIA

The study excludes those patients.

1. Known case of infective etiology like tuberculosis.

2. Pregnant patients.

3. Patients who are unwilling to participate.

Methodology and materials:

Patients with a confirmed diagnosis of rheumatoid arthritis or those suspected of having

interstitial lung disease (ILD) were initially screened clinically for signs and symptoms of

ILD.

All patients underwent chest imaging, including both X-ray and HRCT.

They were receiving standard drug treatments as per the established protocol.

A comprehensive history was taken using a standardized proforma, which included

personal details, smoking habits, and the primary complaints such as cough (with or

without expectoration), dyspnea, wheezing, chest pain, and hemoptysis.

General symptoms like weight loss, fatigue, fever, and anorexia were also recorded.

A thorough physical examination was conducted, documenting signs such as pallor,

cyanosis, clubbing, pedal edema, and respiratory findings including bibasilar crackles,

tachypnea, rhonchi, and signs of heart failure.

20
All 50 patients underwent both HRCT scans and chest radiographs.

The imaging procedures were conducted with the patients in a supine position.

HRCT scans were performed using a GE High-Resolution 16-Slice CT scanner during

suspended inspiration, with a kVp of 130 and mAs set between 60-70. The window width

was adjusted between 1200-1500, and the window level was set between -600 to -700.

The matrix used was 512 x 512, and the pitch was set at 1:1.

For chest X-rays (CXR), imaging was done using a SIEMENS 600mA X-ray machine.

The patients underwent postero-anterior chest radiography at 60 kVp and 16mAs. The

CXR patterns were classified as normal, nodular, honeycombing, ground-glass, or

reticular patterns. HRCT scans were taken with 1mm slice thickness.

The investigator analyzed the reports, and the final report was based on a consensus.

The patterns were categorized as pure reticular, pure ground-glass, mixed pattern,

normal, or other patterns such as emphysema, bronchiectasis, or consolidation.

Definitions:

The reticular pattern refers to the presence of intersecting lines, with the appearance

ranging from a fine network to more pronounced honeycombing. 37

The mixed pattern is characterized by an equal proportion of ground-glass opacities and

reticulation.

Parameters collected:

Demographics:

Age, Gender

History:

21
Allergies

Addiction:

Smoking

Assessment and Comparison of Findings Between Plain Radiograph and HRCT:

Air Space Consolidation

Kerley Lines

Septal Thickening

Reticular Opacities

Honeycombing

Nodular Opacities

Nodule Distribution

Reticulonodular Opacities

Air Trapping

Emphysematous Changes

Fissure Thickening

Traction Bronchiectasis

Hilar and Mediastinal Lymphadenopathy

Pleural Thickening

Architectural Distortion

Peribronchial Cuffing
22
Diagnosis:

Study Flow Chart

Ethical considerations:

Approval for the study was obtained from the Institutional Ethics Committee of Maharajah

Institute of Medical Sciences, Vizianagaram, before initiating the research.

Each patient was thoroughly informed about the study process and the benefits of using

their data for research purposes.

Patients were also assured that their information would remain confidential.

After explaining the details, an informed consent form was provided in the local or easily

understandable language, and the patients were asked to sign it or provide a thumb

impression.

23
They were also reassured that any questions or concerns could be addressed at any

time.

STATISTICAL ANALYSIS:

The following assumptions were made regarding the data:

The dependent variables were assumed to be normally distributed.

The collected data was entered into MS Excel 2019, and analysis was performed using

both Microsoft Excel and the SPSS statistical software (version 26).

The results were presented using descriptive and inferential statistics.

A p-value of <0.05 was considered statistically significant. Frequencies and percentages

were used for categorical data, while for continuous variables; the mean and standard

deviation (SD) were calculated.

The chi-square test was used for categorical comparisons.

24
 RESULTS

The study was conducted in the Department of Radiodiagnosis at a tertiary care center in

Andhra Pradesh. Individuals aged 18 years and above, with a clinical suspicion of

interstitial lung disease (ILD), who were referred for diagnostic imaging and met the

defined inclusion criteria, were enrolled in the study.

ANALYSIS AND INTERPRETATION

AGE DISTRIBUTION:

In my study most patients belong to age group of 61-70 years. The age range was 21 to

70 years. Incidence of ILD increases with increasing age.

AGE GROUP IN YRS NUMBER OF PATIENTS PERCENTAGE

21-30 5 10%

31-40 5 10%

41-50 9 18%

51-60 12 24%

61-70 17 34%

>71 2 4%

TABLE 1: Age distribution of patients.

25
 NUMBER OF PATIENTS

4 10
20-30
10
31-40
34
41-50
51-60
18
61-70
>71
24

GRAPH 1: Age distribution of patients.

Sex Distribution :In my study most patients are males. This indicates ILD were more

common in males.

SEX NUMBER PERCENTAGE

MALES 34 68%

FEMALES 16 32%

TABLE 2: Sex distribution in the study group

SEX DISTRIBUTION IN PERCENTAGE

32
MALES
FEMALES
68

GRAPH 2: Sex distribution in the study group

26
AGE AND GENDER RELATION:

Sex distribution according to age group predominant age group i.e., 61-70 yrs showed

male predominance(13 in no.) where as female were 4 in number.

AGE DISTRIBUTION IN MALES FEMALES

YRS

21-30 4 1

31-40 3 2

41-50 7 2

51-60 9 3

61-70 13 4

>71 1 1

TABLE 3: Relation between age and gender

14
13

12

10
9

8
7
MALES
6 FEMALES

4 4
4
3 3
2 2
2 1 1 1

0
20-30 31-40 41-50 51-60 61-70 >71

GRAPH 3: Graphical Representation Of Sex Distribution AccordingTo Age Group

27
SMOKING HISTORY:

Out of 50 patients 32 were smokers and 18 were non-smokers.

Smoking history in the study age group showed 64% smokers and 36% non smokers

SMOKING HISTORY NO OF PATIENTS PERCENTAGE

SMOKERS 32 64%

NON SMOKERS 18 36%

TABLE 4:Smoking history

35 32

30

25
18
20

15

10

0
smokers non smokers

GRAPH 4:GRAPHICAL REPRESENTATION OF SMOKING HISTORY

28
SEX RATIO IN SMOKERS:

In smoking history most of the patients are males total of 26 patients.

Sex ratio in smokers showed male predominance with 81.25%.

SEX NO OF PATIENTS PERCENTAGE

MALES 26 81.25%

FEMALES 6 18.75%

TABLE 5: Sex ratio in smokers

NO OF PATIENTS
30
26

25

20

15

10 6

0
MALES FEMALES

GRAPH 5: Sex ratio in smokers

29
Diagnosis: Most patients had usual interstitial pneumonia(UIP). Followed by non

interstitial pneumonia(NSIP).

DIAGNOSIS FREQUENCY PERCENTAGE

UIP 24 48%

NSIP 11 22%

PNEUMOCONIOSIS 4 8%

HSP 3 6%

LYMPHANGITIS 4 8%

CARCINOMATOSIS

LIP 2 4%

COP 1 2%

SARCOIDOSIS 1 2%

TABLE 6: Various diagnosis of patients

30

24 FREQUENCY
25

20

15
11
10

5 4 4
3
2
1 1
0

GRAPH 6: Frequency of diagnosis in patients.

30
Reticular opacities:

Reticular opacities were found more in HRCT compared to Xray.There was significant

difference in no of reticular opacities found in HRCT compared to X ray. P value was

>0.05.

Reticular HRCT X-ray Total X2

opacity No. % No. %

Present 43 86% 35 70% 78 3.72

Absent 7 14% 15 30% 22 P VALUE

Total 50 100% 50 100% 100 >0.005

TABLE 7: Reticular opacities in patients

50
43
45

40 35

35

30

25 Present
Absent
20
15
15

10 7
5

0
hrct xray

GRAPH 7: Graphical Representation Of Reticular Opacities

31
Nodularopacities:

Nodular opacities were found more in HRCT compared to Xray. There was significant

difference in no of Nodular opacities found in HRCT compared to X ray. P value was

<0.005

Nodular HRCT X-ray Total X2

opacities No. % No. %

Present 28 56% 15 30% 43 6.89

Absent 22 44% 35 70% 57

P value

Total 50 100% 50 100% 100 <0.005

TABLE 8: Nodular opacities among patients.

40
35
35
28
30

25 22

20 Present
15
Absent
15

10

0
HRCT X RAY

GRAPH 8:Graphical representation of nodular opacities.

32
Septal thickening:

Septal thickenings were found more in HRCT compared to Xray.There was significant

difference in no of septal thickenings found in HRCT compared to X ray. P value was

<0.005

Septal HRCT X-ray Total X2

thickenings No. % No. %

Present 31 62% 10 20% 41 12.1123

Absent 19 38% 40 80% 59 P value

Total 50 100% 50 100% 100 <0.005

TABLE 9: Septal thickenings among patients.

45
40
40

35
31
30

25
19 Present
20 Absent
15
10
10

0
HRCT XRAY Category 3

GRAPH 9: Graphical Representation Of Septal thickenings.

33
Honey combing:

Honey coombing were found more in HRCT compared to Xray.There was significant

difference in no of honey coombing found in HRCT compared to X ray. P value was

0.0060.

Honey HRCT X-ray Total X2

coombing No. % No. %

Present 24 48% 8 16% 32 11.7647

Absent 26 52% 42 84% 68 P value

Total 50 100% 50 100% 100 0.006

TABLE 10: Honeycoombing among patients.

45 42

40

35

30 27 26

25
Present
20 Absent
15
8
10

0
HRCT XRAY

GRAPH 10: Graphical Representation OfHoney combing.

34
Traction bronchiectasis:

Traction Bronchiectasis was found more often in HRCT compared to Xray. There was

significant variation in no of tractional bronchiectases found in HRCT compared to X ray.

P value was 0.000547.

Traction HRCT X-ray Total X2

bronchiectasis No. % No. %

Present 29 58% 12 24% 41 11.7647

Absent 21 42% 38 76% 59

P value

Total 50 100% 50 100% 100 0.005

TABLE 11: Traction Bronchiectasis among patients.

35

30 29

25
21
20
Present
15 Absent
12

10

4.4
5

0
HRCT X RAY

GRAPH 11: Graphical RepresentationOf TractionBronchiectasis .

35
Consolidation:

Consolidation were found equal in both HRCT and Xray.There was no significant

variation in no of consolidations found in HRCT compared to X ray. P value was 1.

Consolidation HRCT X-ray Total X2

No. % No. %

Present 19 38% 19 38% 38 0

Absent 31 62% 31 62% 62 P

Total 50 100% 50 100% 100 value

TABLE 12: Consolidationamong patients.

35 31 31

30

25
19 19
20
Present
15 Absent

10

0
HRCT XRAY

GRAPH 12: Graphical Representation Of Consolidation.

36
Ground glass opacity:

GGO was found more often in HRCT compared to X ray. There was significant variation

in no of GGOs found in HRCT compared to Xray.P value was 0.0001

Ground HRCT X-ray Total X2

glass No. % No. %

opacity

Present 16 32% 9 18% 25 2.61

Absent 34 68% 41 82% 75 P value

Total 50 100% 50 100% 100 0.0001

TABLE 13: Ground glass opacityamong patients.

40

35 34

30

25

20 Present
16 Absent
15

10 9

4.4
5

0
HRCT X RAY

GRAPH 13: Graphical Representation Of Ground glass opacity.

37
Lymphadenopathy:

Lymphadenopathy was found more often in HRCT compared to X ray. There was

significant variation in no of lymphadenopathy found in HRCT compared to X ray. P value

was 0.0010

Lymphadenopathy HRCT X-ray Total X2

No. % No. %

Present 23 46% 16 32% 39 2.05

Absent 27 54% 34 68% 61 P

Total 50 100% 50 100% 100 value

0.001

TABLE 14: Lymphadenopathyamong patients.

40
34
35

30 27

23
25

20 16 Present
Absent
15

10

0
HRCT X RAY

GRAPH 14: Graphical Representation Of Lymphadenopathy.

38
Overview of findings between CXR and HRCT.

Sno Findings CXR HRCT % of patients

affected-as

PerHRCT

1 Reticularopacities 35 43 86%

2 Nodularopacities 15 28 56%

3 Septal thickening 10 31 62%

4 Honeycombing 8 24 48%

5 Tractional 12 29 58%

Bronchiectasis

6 Consolidation 19 19 38%

7 GGO 9 16 32%

8 Lymphadenopathy 16 23 46.%

TABLE 15: Overview of imaging findings.

In the current study, reticular opacity emerged as the most common radiological finding,

observed in 86% of patients, followed by septal thickening in 62% of cases. Other

frequently identified features included nodular opacities (56%), traction bronchiectasis

39
(58%), lymphadenopathy (46%), and ground-glass opacities (32%). Consolidation was

noted in 38% of patients, while honeycombing was seen in 48%.

50
45 43

40
35
31
28 29
30
24 23
25
19
20
16
HRCT
15
X RAY
10
5
0

GRAPH 15: overview of no of findings

% of patients
100%
86%
90%
80%
70% 62% 58%
56%
60% 48% 46%
50% 38%
40% 32%
30%
20%
10%
0%

GRAPH 16: summary of imaging findings.

40
DISCUSSION

41
Interstitial lung diseases (ILDs) represent a broad spectrum of diffuse parenchymal lung

disorders characterized by varying degrees of inflammation and fibrosis. In recent years,

the role of imaging—particularly high-resolution computed tomography (HRCT)—has

become pivotal in the early and accurate diagnosis of ILDs. This study aimed to assess

the diagnostic yield of HRCT in comparison with conventional chest radiography (CXR) in

patients suspected of having ILD. The findings from this research strongly support the

superior diagnostic capacity of HRCT, in line with existing literature.

Demographics and Clinical Profile

The current study revealed that ILD was more prevalent among males (68%) compared

to females (32%), with the peak incidence in the 61–70 years age group (34%). A strong

male predominance among smokers was also evident, with 81.25% of smokers being

male. These findings echo the observations by Ankit Kumar Shah et al.30 (2020), who

also reported a male predominance (58%) and a peak incidence in middle-aged

individuals (51–60 years). Similarly, Tahir et al.33 (2019) demonstrated a slightly higher

female proportion but noted a mean age consistent with the sixth decade, reinforcing the

correlation between advancing age and ILD onset.

As per Choi et al40the incidence of ILD increases with increasing age and it was more

common among males.

In a study conducted by Vizoli et al,41 104 patients diagnosed with interstitial lung

diseases (ILDs) were included. The age of participants ranged from 24 to 90 years, with

a mean age of 65 years, indicating a higher prevalence of ILD in the sixth decade—

similar to the findings in the present study. However, the mean age in the current study

was slightly lower, which may be attributed to the smaller sample size.

42
 In Vizoli’s et al 41study, 54% of the patients were male, reflecting a male predominance

that aligns with the current study's observations.

Diagnostic Patterns: HRCT vs Chest Radiograph

The diagnostic comparison between HRCT and CXR across key radiological findings

demonstrated a significantly higher detection rate with HRCT, especially for reticular

opacities (86% vs 70%), septal thickening (62% vs 20%), honeycombing (48% vs 16%),

traction bronchiectasis (58% vs 24%), and ground-glass opacities (32% vs 18%).

Imaging Feature Detected by Detected by P Interpretation

HRCT CXR Value

Reticular Opacities 86% 70% >0.05 Higher sensitivity with

HRCT

Nodular Opacities 56% 30% <0.005 Statistically significant

improvement

Septal Thickening 62% 20% 0.005 HRCT clearly superior

Honeycombing 48% 16% 0.006 Strong HRCT advantage

Traction 58% 24% 0.0005 Highly significant

Bronchiectasis difference

Ground-glass 32% 18% 0.0001 Statistically significant

Opacity improvement

TABLE 16: Interpretation of imaging findings.

43
These findings are consistent with several studies. Madhu et al.29 (2020) demonstrated

that HRCT could identify abnormalities in patients with normal chest X-rays, underlining

its superior sensitivity. Similarly, Patel et al. 32 (2020) reported HRCT as the modality of

choice,

identifying ILD-specific patterns in 82% of cases, compared to just 29% with chest

radiographs.

Dominant Subtypes and HRCT Pattern Recognition

Among the 50 patients, the most frequently observed HRCT diagnosis was Usual

Interstitial Pneumonia (UIP) (48%), followed by Non-Specific Interstitial Pneumonia

(NSIP) (22%), pneumoconiosis (8%), lymphangitis carcinomatosis (8%), and

hypersensitivity pneumonitis (6%). These results align with the study by Ankit Kumar

Shah et al. 30, who identified UIP as the most prevalent ILD subtype, followed by NSIP

and connective tissue-associated ILDs. Additionally, the findings are in concordance with

Manoj Kumar Agarwal et al. 34 (2019) who reported IPF (25%) and hypersensitivity

pneumonitis2(17.5%) as major subtypes in their cohort.

In particular, the identification of traction bronchiectasis and honeycombing was more

prominent in UIP cases, which is pathognomonic and supports the role of HRCT in not

just detection, but in narrowing down specific ILD subtypes without invasive biopsy.

Johkoh et al.39(2002) also emphasized that ground-glass opacities, centrilobular

nodules, and lymph node enlargement are indicative of lymphocytic interstitial

pneumonia—patterns that HRCT excels at capturing.

Comparative Analysis with Previous Studies

The diagnostic accuracy of HRCT over CXR across different studies is outlined in the

following table.
44
Study Sample Most HRCT Key Finding HRCT vs CXR

Size Common Advantage

ILD

Present Study 50 UIP (48%) Reticular opacities HRCT superior

(2024) (86%), for all patterns

honeycombing (48%)

Madhuetal.29 30 NSIP/UIP Reticular opacities, HRCT detected

(2020) septal thickening abnormalities in

CXR-normal pts

Shah et al.36 50 UIP (40%) UIP, NSIP, COP, HRCT

(2020) sarcoidosis diagnosed 82%

cases

confidently

Tahir et al. 148 UIP GGO (92.6%), HRCT highly

(2019) 33 Honeycombing reliable

(45.9%) diagnostic tool

Anusmriti Pal et 30 NSIP Reticular pattern, HRCT: 4

al. (2019)35 GGO findings/patient

vs CXR: 2

ManojKumar 40 IPF (25%) Reticular, HRCT more

Agarwal et al.34 honeycombing, consistent with

bronchiectasis histopathology

TABLE 17: Comparative analysis with previous studies.

45
Karazincer et al42,(2007) found interstitial lung involvement in 36% of RA patients, with

air trapping in 20% and bronchiectasis in 16%. Similarly, the current study reported no

emphysema but did observe honeycombing. HRCT proved more sensitive than CXR in

detecting pleural changes, reticular opacities, and ground-glass opacities, aligning with

his findings.

Ground-Glass Opacity and Early ILD

Ground-glass opacities (GGO) were reported in 32% of patients on HRCT in the current

study. Although not the most common pattern, GGOs are essential markers of early or

active inflammation in ILD and are often not visible on chest radiographs. The importance
38
of GGO was similarly underscored in studies by Savranlar et al. (2004)andJohkoh et

al. 39(2008), both of which reported a significant role of HRCT in detecting early

pneumoconiosis and systemic sclerosis-related ILD, respectively.

In the study by Primack et al 43 involving nine patients diagnosed with acute

interstitial pneumonia, ground-glass attenuation with a patchy distribution was observed

in 67% of cases, while a diffuse pattern was noted in three patients. Air-space

consolidation was also present in 67% of the cohort, predominantly affecting the lower

lung zones in three patients and the upper zones in one patient. In two cases, the

consolidation was diffuse. The most frequent distribution pattern was subpleural.

Unfortunately, eight out of the nine patients succumbed to the illness within three months

of presentation. In contrast, no mortality was reported in the current study cohort.

Concordance and Discordance Between Modalities

In our study, the concordance between CXR and HRCT was highest for consolidation

(38%), suggesting that alveolar processes may be equally well visualized in both
46
modalities. However, for interstitial patterns like septal thickening and honeycombing,

HRCT dramatically outperformed CXR. This is consistent with Somiya and Vijay Prabhu

(2020) 31, who concluded that HRCT protocols using high spatial resolution drastically

improved the detection of subtle interstitial changes.

Relevance in Occupational and Autoimmune ILDs

Our findings also revealed ILDs linked to occupational exposures (e.g., pneumoconiosis)

and autoimmune diseases (e.g., rheumatoid arthritis, systemic sclerosis). These align

with the classification spectrum observed in Barnes et al.13 (2019) for silica-related lung

disease and Karazincir et al.42 (2009) for rheumatoid arthritis-related ILD. HRCT’s

capability to differentiate between fibrotic and inflammatory phenotypes in such settings

enhances its clinical utility.

Clinical Implications

The study reinforces that HRCT is indispensable in diagnosing ILDs, especially in:

Early detection when chest X-ray is normal

Characterizing specific radiological patterns (UIP, NSIP, LIP)

Guiding management strategies (e.g., steroids vs antifibrotic therapy)

Reducing the need for surgical biopsy in classic radiologic presentations

47
TABLE 18: Diagnostic Superiority of HRCT Over CXR in ILD (Current Study)

Feature Statistical CXR HRCT Remarks

Significance (P Detection Detection

Value) (%) (%)

Reticular Opacities >0.05 70 86 Most common

feature

Nodular Opacities <0.005 30 56 Significantly better

visualized on

HRCT

Septal Thickening 0.005 20 62 Often missed on

chest radiograph

Honeycombing 0.006 16 48 Crucial for UIP

diagnosis

Traction 0.0005 24 58 Marker of fibrotic

Bronchiectasis changes

Ground-glass 0.0001 18 32 Suggests early or

Opacities active

inflammation

Lymphadenopathy 0.001 32 46 Better delineated

with HRCT

Consolidation 1 38 38 Equal sensitivity

44found
SunJetal et al that HRCT is more reliable compared to radiography, due to more

agreement between readers and the better association with PFTs, irrespective of

smoking and chronic bronchitis.

48
Benefits and strength of this study:

The imaging patterns of interstitial lung disease (ILD) were thoroughly analyzed to

determine the most effective diagnostic modality capable of identifying early signs of

complications. This approach aims to support timely clinical intervention and

management.

All patients received counseling on the importance of consistent medication adherence,

as non-compliance was commonly observed in the study population.

The insights gained from this study will be shared with all relevant stakeholders, with the

expectation that this information will contribute to better clinical outcomes and help in the

prevention of disease-related complications.

Economic benefits to patients:

• Partial reimbursement of travel expenses was provided to all participants to support

their regular visitsto our institution.

• All laboratory investigations, including imaging studies, were conducted free of charge

for all participants.

Limitations of my study:

• The study included a sample size of 50 participants, which represents a relatively small

cohort and constitutes a primary limitation in the interpretation and generalisation of the

findings.

• Smaller sample sizes tend to yield less reliable results when compared to larger

studies, which typically offer narrower confidence intervals (ranging from 95% to 99%)

and greater statistical accuracy.

49
Additionally, the duration of treatment usage among participants was not evaluated.

Duration of hospitalization was not assessed.

Cost of therapy was not assessed.

50
 Summary

The study was conducted in the Department of Radiodiagnosis at Maharajah Institute of

Medical Sciences, Vizianagaram, involving a total of 50 patients. The age group most

commonly represented in the study population was between 61 and 70 years, accounting

for 34% of the cases. When analyzing gender distribution, it was observed that males

made up the majority, comprising 68% of the participants.

A significant proportion of the patients, specifically 32 out of 50, had a history of smoking,

indicating a strong association between smoking and the clinical presentations observed.

The average duration of symptoms reported by the patients was 3.2 years, suggesting a

prolonged course of illness prior to clinical evaluation.

Among the various symptoms, dyspnea emerged as the most prevalent, affecting half of

the study population. Radiological evaluations revealed that High-Resolution Computed

Tomography (HRCT) outperformed conventional chest X-rays in identifying a wide range

of abnormalities. These included reticular and nodular opacities, septal thickening, air

trapping, traction bronchiectasis, ground-glass opacities, and lymphadenopathy.

Statistical analysis using the chi-square test confirmed that the difference in the

diagnostic yield between HRCT and chest X-ray was significant.

51
 Conclusion

Chest radiography serves as an initial screening tool for evaluating pulmonary conditions

due to its affordability and ease of use. However, high-resolution computed tomography

(HRCT) is considered the gold standard for diagnosing interstitial lung diseases (ILDs).

The diagnostic accuracy between these two modalities shows statistically significant

differences. A normal chest X-ray does not exclude the presence of ILD, as HRCT can

identify pathological changes even in cases where clinical signs are subtle or the

radiograph appears normal.

HRCT chest imaging is integral to the diagnostic approach for ILD, as each subtype

typically presents with distinct imaging patterns, allowing for a more definitive diagnosis

either independently or in conjunction with clinical findings.

52
 References
1. Meyer, Keith C; Decker, Catherine A (2017-04-03). "Role of pirfenidone in the
management of pulmonary fibrosis". Therapeutics and Clinical Risk Management. 13: 427–
437.doi:10.2147/TCRM.S81141.ISSN1176-6336.PMC5388201.PMID28435277.

2. Kaul B, Cottin V, Collard HR, Valenzuela C. Variability in global prevalence of interstitial

lung disease. Front Med (Lausanne). 2021; 8:751181. Available from:
https://www.frontiersin.org/articles/10.3389/fmed.2021.751181/full

3. Collaborators GBDCRD. Prevalence and attributable health burden of chronic

respiratorydiseases, 1990–2017: asystematic analysis fortheGlobal Burdenof Disease Study
2017. Lancet Respir Med. 2020; 8:585–96. doi: 10.1016/S2213-2600(20)30105-3

4. Sun J, Weng D, Jin C, Yan B, Xu G, Jin B, et al. The Value of High Resolution Computed
Tomography in the Diagnostics of Small Opacities and Complications of Silicosis in Mine
Machinery Manufacturing Workers, Compared to Radiography. J Occup Health. 2008;
50(5):400–405. Available from: https://dx.doi.org/10.1539/joh.l8015.

5. TalmadgeE.King.ClinicalAdvancesintheDiagnosisandTherapyofthe Interstitial Lung

Diseases. Jr.Am J Respir Crit Care Med 2005;172: 268–279.

6. Hamman,L.,andRich,A.R.:FulminatingDiffuseInterstitialFibrosisoftheLungs,Tr.
Am.Clin.&Climatol.A.51:154-163,1935.

7. Scadding JG. Chronic diffuse interstitial fibrosis of the lungs. BMJ 1960; 1:443– 450.

8. LiebowAA,CarringtonDB.Theinterstitialpneumonias.In:SimonM,PotchenEJ, LeMay M,
editors. Frontiers of pulmonary radiology. New York: Grune & Stratteon; 1969.
pp.102–141.

9. ScaddingJG.Diffusepulmonaryalveolarfibrosis.Thorax1974;29:271–281.
10. American Thoracic Society; European Respiratory Society. American Thoracic
Society/European Respiratory Society International Multidisciplinary Consensus Classification of
the Idiopathic Interstitial Pneumonias. This joint statement of the
AmericanThoracicSociety(ATS),andtheEuropeanRespiratorySociety(ERS) was adopted by the
ATS board of directors, June 2001 and by the ERS Executive Committee, June 2001. Am J Respir
Crit Care Med. 2002 Jan 15; 165(2):277-304. doi: 10.1164/ajrccm.165.2.ats01. Erratum in: Am J
Respir Crit Care Med2002 Aug 1; 166(3):426. PMID: 11790668.

11. Clinical relevance of pathologic classification. AmJ Respir Crit Care Med 1998;
157:1301–1315.

53
12. Goh NS, Desai SR, Veeraraghavan S, Hansell DM, Copley SJ, Maher TM, Corte
TJ, Sander CR, Ratoff J, Devaraj A, Bozovic G, Denton CP, Black CM, du Bois RM,
Wells AU. Interstitial lung disease in systemic sclerosis: a simple staging system. Am J
Respir Crit Care Med. 2008 Jun 1; 177(11):1248-54. doi: 10.1164/rccm.200706-
877OC. Epub 2008 Mar 27. PMID: 18369202.
13. MorgenthauAS,PadillaML.Spectrumoffibrosingdiffuseparenchymallung disease.
MtSinaiJMed.2009Feb;76(1):2-23

14. Barnes H, Goh NSL, Leong TL, Hoy R. Silica-associated lung disease: An old-world
exposure in modern industries. Respirology. 2019 Dec; 24(12):1165-1175. doi:
10.1111/resp.13695. Epub 2019 Sep 13. PMID: 31517432.

15. Schwaiblmair M, Behr W, Haeckel T, Märkl B, Foerg W, Berghaus T. Drug induced

interstitial lung disease. Open Respir Med J. 2012; 6:63-74. doi:
10.2174/1874306401206010063. Epub 2012 Jul 27. PMID: 22896776; PMCID:
PMC3415629.

16. VijR,NothI,StrekME.Autoimmune-
featuredinterstitiallungdisease:adistinctentity.Chest.2011Nov;140(5):1292-
1299.doi:10.1378/chest.10-2662.Epub2011May12. PMID: 21565966; PMCID: PMC3205845.

17. Soares RV, Forsythe A, Hogarth K, Sweiss NJ, Noth I, Patti MG. Interstitial lung
diseaseandgastroesophagealrefluxdisease:keyroleofesophagealfunctiontestsin

the diagnosis and treatment. Arq Gastroenterol. 2011 Apr-Jun; 48(2):91-7. doi:
10.1590/s0004-28032011000200002. PMID: 21709948.

18. Molgat-Seon Y, Schaeffer MR, Ryerson CJ, Guenette JA. Exercise pathophysiology in
interstitial lung disease. Clin Chest Med. 2019; 40(2):405–20. Available from:
http://dx.doi.org/10.1016/j.ccm.2019.02.011

19. SchwarzMI.Thelunginpolymyositis.ClinChestMed1998;19:701-702

20. Tazelaar HD, Viggiano RW, Pickersgill J, et al. Interstitial lung disease in polymyositis
and dermatomyositis: clinical features and prognosis as correlated with histologic findings.
Am Rev Respir Dis 1990; 141:727-733

21. Akira M, Hara H, Sakatani M. Interstitial lung disease in association with polymyositis-
dermatomyositis: long-term follow-up CT evaluation in seven patients. Radiology 1999;
210:333-338.

22. Falaschi F, Battolla L, Paolicchi A, Paggiaro P, Talini D, Carrara M, et al. High- resolution
computed tomography compared with the thoracic radiogram and respiratory function tests in
54
assessing workers exposed to silica. Radiol Med. 1995; 89(4):424–433.
23. Bani AM, Bhadane SH, Kulkarni DV, Jagdale AM, Mohgaonkar MM. High Resolution
ComputedTomography findingsof interstitial lung diseases: A cross-sectional study. Int j anat
radiol surg. 2021; Available from: http://dx.doi.org/10.7860/ijars/2021/47180.2630

24. Lolge SS, Kachewar SG, Ghule SS, Lakhkar DL, Tamhane TM, Shinde PP.
Comparative study of HRCT thorax with plain chest radiograph in evaluating the patients with
interstitial lung diseases. Scholars Journal of Applied Medical Sciences. 2016; 4(11C):4028-
33. ISSN 2320-6691

25. Nishimura K, Izumi T, Kitaichi M, Nagai S, Itoh H. The diagnostic accuracy of high-
resolution computed tomography in diffuse infiltrative lung diseases. Chest. 1993
Oct;104(4):1149-55. doi: 10.1378/chest.104.4.1149. PMID: 8404183.

26. Lal NR, Raj G, Boruah DK. Comparative Analysis of Conventional Chest Radiographs
and HRCT Thorax for the Assessment of Patients with Interstitial Lung Disorders.
International Journal of Pharmaceutical and Clinical Research 2024; 16(6); 2219-2224

27. Abhijeet Taori & Divya Malpani. Comparative Analysis of Interstitial Lung Diseases on
Chest Radiographs and HRCT. SAS J Med, 2023 Mar 9(3): 174-179.

28. Comparative study of chest radiograph versus high-resolution computed tomography in

evaluation of interstitiall lung disease
Dr. Adarsh AD Dr. Mohd Talha, Dr. Simran Gupta, . Dr. Sagar Dubey, . Dr. Iman Ikram, . Dr.
Bhoopchand Maurya, . Dr Lalit Kumar , Dr Deeksha Singh, Dr. sarita yadav
JCDR. 2023; , Issue 7: 1392-1396

29. P. Madhu, D. Santhosh. Comparison between conventional radiography and high

resolution computed tomography in interstitial disease of lungs. Asian j med radiol res. 2020
;8(1):159–65. Available from:
https://aijournals.com/index.php/ajmrr/article/view/1649

30. Shah AK, Kushwah APS, Pandey S, et al. Role of hrct in interstitial lung disease with
radiographic correlation. J Evid Based Med Healthc 2020; 7(44), 2573 2578. DOI:
10.18410/jebmh/2020/531 22.PatelT, IlangovanG, BalganesanH. Comparative studyofX-
rayandhighresolution
computedtomographyinthediagnosisofinterstitiallungdisease.Intjcontempmedsurg radiol
[Internet]. 2020;5(1). Available from: http://dx.doi.org/10.21276/ijcmsr.2020.5.1.58

31. Prabhu.RDV,ChettinadHospitalandresearchInstitute,Chennai,India.Comparison between

conventional computed tomography and high resolution tomography in interstitial lung
diseases. J med sci clin res. 2020; 08(03). Available from:
http://dx.doi.org/10.18535/jmscr/v8i3.73.
55
 32. Patel T, Ilangovan G, Balganesan H. Comparative Study of X-ray and High Resolution
Computed Tomography in the Diagnosis of Interstitial Lung Disease. International Journal of
Contemporary Medicine Surgery and Radiology. 2020;5(1):A263-7.

33. Tahir A, Hafeez H, Afzal N, Malik SS, Farooq MY, Saleem N, Sarwar M, Hamad A, Khan
SG, Iyaz M. Findings of High Resolution Computed Tomography in Patients Presenting with
Signs and Symptoms of Interstitial Lung Disease Having Normal Chest X-Ray. Journal of
Health and Medical Sciences. 2019 Sep 16;2(3).

34. Agrawal MK, Kumar A, Agrawal R, Rana R. To study the significance of HRCT over
Chest x-ray in the diagnosis of interstitial lung diseases. Journal of Evolution of Medical and
Dental Sciences. 2019 Jan 14;8(2):94-98.
35. Pal A, Yadav MK, Pant C, Shrestha BK. High resolution computed tomography and chest
radiography findings among interstitial lung disease patients. Journal of Chitwan Medical College.
2019 Dec 27;9(4):24-7.

36. Lolge SS, Kachewar SG, Ghule SS, Lakhkar DL, Tamhane TM, Shinde PP. Comparative
study of HRCT thorax with plain chest radiograph in evaluating the patients with interstitial
lung diseases. Scholars Journal of Applied Medical Sciences. 2016; 4(11C):4028-33. ISSN
2320-6691
37. Desai SR, Veeraraghavan S, Hansell DM, Nikolakopolou A, Goh NS, Nicholson AG, Colby
TV, Denton CP, Black CM, du Bois RM, Wells AU. CT features of lung disease in patients
with systemic sclerosis: comparison with idiopathic pulmonary fibrosis and nonspecific
interstitial pneumonia. Radiology. 2004 Aug;232(2):560-7. doi: 10.1148/radiol.2322031223.
PMID: 15286324.
38. Savranlar A, Altin R, Mahmutyazicioğlu K, Ozdemir H, Kart L, Ozer T, Gündoğdu S.
Comparison of chest radiography and high-resolution computed tomography findings in early
and low-grade coal worker's pneumoconiosis. Eur J Radiol. 2004 Aug;51(2):175-80. doi:
10.1016/j.ejrad.2003.10.017. PMID: 15246524.

39. Johkoh T, Müller NL, Pickford HA, Hartman TE, Ichikado K, Akira M, Honda O,
Nakamura H. Lymphocytic interstitial pneumonia: thin-section CT findings in 22 patients.
Radiology. 1999 Aug;212(2):567-72. doi: 10.1148/radiology.212.2.r99au05567. PMID:
10429719.

40. Choi, WI., Dauti, S., Kim, H.J. et al. Risk factors for interstitial lung disease: a 9-year
Nationwide population-based study. BMC Pulm Med 18, 96 (2018).
https://doi.org/10.1186/s12890-018-0660-2

41. VizioliL,CiccareseF,FortiP,ChiesaAM,GiovagnoliM,MughettiM,etal.
Integrated use of lung ultrasound and chest X-ray in the detection of interstitial lung disease.
Respiration. 2017;93(1):15–22. Available
from: https://www.karger.com/DOI/10.1159/000452225.

56
42. KarazincirS,AkoğluS,GülerH,BalciA,BabayiğitC,EğilmezE.Theevaluationof early pulmonary
involvement with high resolution computerized tomography in asymptomatic and nonsmoker
patients with rheumatoid arthritis. Tuberk Toraks. 2009; 57(1):14–21
43. Primack SL, Hartman TE, Ikezoe J, Akira M, Sakatani M, Müller NL. Acute interstitial
pneumonia: radiographic and CT findings in nine patients. Radiology. 1993 Sep; 188(3):817-
20. doi: 10.1148/radiology.188.3.8351354. PMID: 8351354.
44. Khoirom Surendrajit. Comparison between conventional radiography and high resolution
computerized tomography in interstitial diseases of the lungs. 2009-2011. Thesis submitted to
Rajiv Gandhi University of Health Sciences, Karnataka.
45. Bhat IM, Bhat JA, Shamshad M, Malik AA, Mir S. Role of High-resolution Computed
Tomography Chest in Interstitial Lung Diseases. International Journal of Scientific Study.
2016; 4(2).
46. Niewoehner DE, Kleinerman J, Rice DB (1974) Pathologic changes in the peripheral airways
of young cigarette smokers. N Engl J Med 291:755
47. Fraig M, Shreesha U, Savici D, Katzenstein (2002) Respiratory bronchiolitis: a
clinicopathologic study in current smokers, ex-smokers, and never-smokers. Am J Surg
Pathol 26:647.
48. Nakanishi M, Demura Y, Mizuno S, Ameshima S, Chiba Y, Miyamori I, Itoh H, KitaichiM,
IshizakiT. ChangesinHRCT findingsin patientswithrespiratorybronchiolitis- associated
interstitial lung disease after smoking cessation. Eur Respir J; 2007:29:453
49. Kathy B. Baumgartner, Jonathan M. Samet, David B. Coultas et al.. Waldron, Collaborating
Centers, Occupational and Environmental Risk Factors for Idiopathic Pulmonary Fibrosis: A
Multicenter Case-Control Study, American Journal of
Epidemiology,Volume152,Issue4,15August2000,Pages307–
50. 50.Bani AM, Bhadane SH, Kulkarni DV, Jagdale AM, Mohgaonkar MM. High Resolution
ComputedTomography findingsof interstitial lung diseases: A cross-sectional study. Int j anat
radiol surg. 2021; Available from: http://dx.doi.org/10.7860/ijars/2021/47180.2630

57
 MASTERCHART

Tractiona Bronchiectasis HRCT

Traction Bronchiectasis Xray
Nodular opacities HRCT
Reticular opacities HRCT
Reticular opacities Xray

Nodular opacities Xray

Lymphadenopathy HRCT
Lymphadenopathy Xray
Septal thickening HRCT
Septal thickening X ray

Honeycombing HRCT
Honey combing Xray

Consolidation Xray

Consildation HRCT

GGO HRCT
GGO Xray
Diagnosis
Gender

Smoker
S No

Age

1 45 F no UIP Y Y N Y N N N Y N Y Y Y N Y N Y

2 57 F no NSIP Y Y N N N N N N N N N N N N N N

3 59 M yes PNEUMOCONI N Y Y Y Y Y N N N Y Y Y N Y Y Y
OSIS
4 25 M no LC N N N Y N N N N N Y N N N N Y Y

5 72 F yes UIP Y Y N N Y Y Y Y Y Y N N N N N N

6 44 M yes LIP Y Y N Y N Y N N N Y Y Y Y Y Y Y

7 27 M yes NSIP Y Y N Y N N N N N Y N N N N N N

8 51 M yes UIP N N Y Y N N N Y N N N N N N N N

9 54 F yes cop Y Y N Y N Y N N N N N N N N N N

10 68 M no NSIP Y Y Y Y Y Y N N N Y Y Y N Y N Y

11 22 M yes UIP Y Y N Y Y Y Y Y Y N N N N N Y Y

12 67 F no HSP N Y N N N N N N N N N N N N N N

13 58 M yes PNEUMOCONI Y Y N N Y Y N N N Y N N N N N N
OSIS
14 24 M yes UIP Y Y N Y N Y N Y Y Y Y Y Y Y Y Y

15 55 M yes sarcoidosis N N Y Y N N N N N N Y Y N Y Y Y

16 47 M no UIP Y Y N N N N N Y Y N Y Y N Y N Y

17 70 M yes UIP N Y Y Y N Y N Y N Y N N N N N N

18 61 M no UIP Y Y N Y Y Y Y Y Y Y N N N N N N

19 29 F yes NSIP Y Y N N Y Y N N N N Y Y Y Y Y Y

20 69 M yes HSP N Y Y Y N Y N N N N N N N N N N

21 48 M yes NSIP Y Y N N N N N N Y Y Y Y N Y Y Y

22 68 M yes UIP Y Y N N N Y N Y N Y N N N N Y Y

23 43 F no UIP Y Y N N N N N Y N N N N N N N N

24 32 M yes UIP N N Y Y Y Y Y Y N Y N N N N N N

25 63 M yes LC Y Y N N N N N N N N Y Y Y Y N Y

26 70 F no UIP Y Y Y Y N Y N Y Y Y N N Y Y N Y

27 62 M yes NSIP Y Y N N N Y N N Y Y Y Y N Y N Y

28 64 M yes UIP N Y Y Y N N N Y N N N N N N N N

29 46 M yes UIP Y Y N N N Y N Y N N Y Y N Y N N

30 51 M no UIP Y Y N N N Y N Y N Y N N Y Y N Y

31 62 M yes NSIP Y Y Y Y N Y N N N N N N N N N N
58
32 66 F yes PNEUMOCONI N N N N N Y N N N Y N N N N N N
OSIS
33 38 M no UIP Y Y Y Y N Y Y Y Y Y N N N N Y Y

34 67 M yes UIP N Y N N Y N N Y N N N N Y N N N

35 71 M yes LIP Y Y Y Y N N N N N Y Y Y N N Y Y

36 49 M no UIP Y Y N N N Y Y Y N N Y Y N N N N

37 57 M yes UIP N N N Y N Y Y Y Y Y N N N N N N

38 46 M no NSIP Y Y N N N N N N N Y N N Y N Y Y

39 44 M yes UIP Y Y Y Y Y N N Y N Y N N N N N N

40 60 M no LC Y Y N Y N N N N N N N N N N N N

41 34 F yes UIP N N N N N Y Y Y N N Y Y N N N N

42 54 M yes NSIP Y Y Y Y N Y N N N Y N N N Y N N

43 65 F no UIP Y Y N N N N N Y N Y Y Y N N Y Y

44 50 M no UIP Y Y N N N Y N Y Y N N N N N N N

45 52 M yes NSIP Y Y N N Y Y N N N N Y Y Y N Y Y

46 70 M yes LC Y Y N Y N Y N N N Y N N N N N N

47 37 M no UIP N Y N N N N N Y Y Y N N N Y N N

48 61 M yes NSIP Y Y Y Y N Y N N N Y Y Y N N Y Y

49 40 F no HSP Y Y N N N Y N N N N Y Y N N N N

50 59 F yes PNEUMOCONI N Y N Y N Y N N N Y N N N N Y Y
OSIS

59
 KEY TO MASTER CHART
Gender:
M-Male
F:Female
Othercategories:
Y:Yes
N: No

Diagnosis:
UIP:Usual interstitial pneumonia
NSIP:Nonspecific interstitial pneumonia
Pneumoconiosis
HSP:Hypersensitivity pneumonitis
LC:Lymphangitis carcinomatosis
LIP: Lymphocytic interstitial pneumonia
COP:Cryptogenic organising pneumonia
Sarcoidosis

60
 IMAGES
Patient no : 1

Chest x ray: Diffuse reticular opacities are noted in bilateral lung fields.

HRCT: Areas of interlobular septal thickening with reticulation ,honeycombing and traction
bronchiectasis

61
Patient no: 10

Chest x ray: Thin linear opacities in bilateral lung parenchyma predominantly in upper
and zone -s/o patchy fibrotic changes.

HRCT:
• Few cystic areas are noted involving the subpleural regions of right upper lobe.

• Diffuse ground glass attenuation is noted in bilateral lower lobes.

• Prominent oesophageal dilatation.

- f/s/o NSIP pattern.

62
 Patient no : 25

Chest x ray:
• Well defined lobulated mass measuring 9x 5 cm in left upper and midzone with medial
incomplete borders

• Adjacent to mass reticular opacities are seen in left mid zone.

HRCT
• Groundglass attenuation and interlobular septal thickening are seen in right lower lobe
surrounding the mass -f/s/o lymphangitis carcinomatosa in both lower lobe.

63
Patient no : 11

Chest x ray:
Reticulonodular opacities are noted in bilateral lung fields with surrounding haziness.

HRCT
• Extensive subpleural honeycombing noted involving bilateral lung fields predominantly
in bilateral lowerlobes.

• Areas of ground glass opacifiaction with inter and intralobular septal thickening

-f/s/o of usual interstitial pneumonia.

64
Patient no : 35

Chest x ray: clear lungs with normal cardiac shiloutte.

HRCT: Numerours thin walled air cyst of various sizes randomly distributed throughout the
lungs.scattered ground glass attenuation and small centrilobular nodules with septal thickenings
are noted in ,lower lobes –f/s/o Lymphocytic interstitial pneumonia.

65
Patient no : 12

Chest x ray: xray showing subtle perihilar alveolar infiltrates.

HRCT :
Multiple soft ground glass attenuation nodules noted in bilateral lung parenchyma.
No evidence of any fibrosis.
f/s/o – Hypersensitivity pneumonitis.

66
 ANNEXURES

ANNEXURE I

PROFORMA

● Patient details:

a. Name:

b. Age:

c. Sex:

d. Date:

e. Address:

f. IP/OP No:

● Investigations:

a. CHEST X RAY:

b. HRCT:

• Clinical diagnosis:

• Impression from HRCT imaging

• Impression of CHEST XRAY

67
 ANNEXURE II

PARTICIPANT CONSENT FORM

I/Wehavebeenwellinformedoftheaimandsignificanceofthisresearch,and I/We know all the

information I/We provide on behalf of my/our relative (patient) will be confidential. My/our

relative(patient) will participate in the research voluntarily without any coercion or inducement. We

guarantee all the information provided is correct and true. We understand that we have the right to

withdraw our consent at any time without any negative consequences to our relation (patient) or

his/her treatment. Therefore, I / We give my/our support to the above criteria for my/our relation

(patient) to participate in the research work of “STUDY OF INTERSTITIAL LUNG

DISEASES USING HIGH –RESOLUTION COMPUTED TOMOGRAPHY AND

CORRELATING THE IMAGING FINDINGS WITH CHEST RADIOGRAPHIC

FINDINGS” In MIMS Hospital, Nellimarla, Vizianagaram District.

Patient’s details

Name: Age: Sex:

Signatureofpatient: Date:

Parent/Attendants details

Name:

Relation to Patient:

Signatureof parent/attendant:

Date:

Research Scholar:

68
 ANNEXURE III
INFORMED CONSENT FORM(ICF)
INSTITUTIONAL ETHICS COMMITTEE

MAHARAJAH’S INSTITUTE OF MEDICAL SCIENCES NELLIMARLA–535 217

Confidential

Title of project: “STUDY OF INTERSTITIAL LUNG DISEASES USING HIGH –

RESOLUTION COMPUTED TOMOGRAPHY AND CORRELATING THE IMAGING
FINDINGS WITH CHEST RADIOGRAPHIC FINDINGS.

Investigator’s name: Dr. KATAM SUSHMA REDDY

I, aged years resident of

fully aware of the work and the procedures of the research, in my Free will;
without any pressure or incentive in any kind; hereby give my consent (as well as consent on
behalf of the patient named
Aged

years as his/her relative) to be included as

subject in the said clinical study. I have clearly understood that I have been informed of my
right to opt out of his research project at any time without giving any reason for doing so. My
information and identity will be kept secret.

I acknowledge the receipt of “Patient’s Information Sheet'' and also the doctors have
informed me about this research project suitably and sufficiently to my satisfaction. I agree to let
my X-ray, Other investigations, Photographs and blood samples be drawn as required. I agree to
take necessary medicines regularly as per this trial doctor’s instructions and shall not mix any
other treatment during the period of this trial. I shall report to the hospital or other place where
called on given appointment dates and time.

I shall inform the doctors for any adverse effects or unusual symptoms noticed by me. I shall
cooperate with doctors and paramedical staff in all respects. I permit the public the results of my
participation in this study. I shall not be given any reimbursement of compensation.

I here by record my consent for participation in the said trial.

• Patients name/Name of the person providing consent:-

Signature / Thumbprint :- Date :- Time :-

• Witness Name :- Signature / Thumbprint :-

Date :- Time :-

• Investigator’s Name :- Signature

/ Thumbprint :-

Date :- Time :-

69
 ANNEXURE IV

సమాచార సమ్మ తిపత్రం (ICF)

ఇన్స్టిూ
ట్య ష నల్ ఎథిక్స్ స్టస్ట కమిటీ

మ్హారాజాస్ ఇన్స్టిూ
ట్య ష ్ ఆఫ్ మెడిక్ సైన్స్ స్, న్సళ్లమ్
ి ర ి – 535 217

రహసష పూరిరమైలది

పరిశోధల త్ాజెక్టట్య శీరి ిక:

“హై-రిజల్యష నన్ కంపూష టెడ్ టోమోత్రఫీ (HRCT) ఉపయోగంచి ఇంటర్స్్ ీషియ్ లంగ్
డిసీజ్ల అధష యలం మ్రియు వాటి చిత్రణ ఫలితాలను ఛాతీ ఎక్స్ -రే చిత్తాలతో పోలిి
విశ్ల ినణ”

పరిశోధక్టరాలు: డాక ట్యర్ కటం సుష్మమ రెడిి

నేను, ________________________________________, వయసు్ ______ సంవర్ రాలు,

___________________________ నివాి, ఈ పరిశోధలలో చేయబోయే త్పత్ియలు
మ్రియు విధానాలను పూరి ిగా అర థం చేసుకొని, ఎలంటి ఒతిిడి లేక్టండా, ఎలంటి
మోతాదైల త్పోతా్ హం లేక్టండా, నా స్వే చ్ఛ తో ఈ అధష యలంలో ాల్గొలడానిి నా
సమ్మ తిని ఇసుినాా ను.

అలగే, __________________________ అనే రోగి సంబంధిర వష ి ిగా, అరను/ఆమె

వయసు్ ______ సంవర్ రాలు,
అరని/ఆమె రరపుల కూడా నేను సమ్మ తిని తెలియజేసుినాా ను.

నాక్ట ఈ పరిశోధల నుండి ఎపుు డైనా నిత్నర మించ్డానిి హక్టర ఉందని

తెలియజేయబడింది. నా వష ిరరి వివరాలు మ్రియు గురి ింపును గోపష ంగా ఉంచుతారు.

“రోగ సమాచార పత్రం” నాక్ట అందించ్బడింది మ్రియు ఈ పరిశోధల త్ాజెక్టట్య గురించి

వైద్యష లు నాక్ట రగల విధంగా మ్రియు పూరి ి సంరృప్తి కలిగేల వివరించారు.

నేను అంగీకరిసుినాా ను:

 నా ఎక్స్ -రేలు, ఇరర పర్స్క్షలు, ఫోటోలు మ్రియు రక ి లమూనాలు అవసరమైతే

తీసుకోవచుి ను.
 పరిశోధల సమ్యంలో సూచించిల ఔనధాలను త్కమ్ంగా వాడతాను.
 ఇరర చిిర్ లను ఈ కాలంలో మిళ్లరం చేయను.
 నిర్స్ ీర తేదీ మ్రియు సమ్యానిి ఆసుపత్తిి లేదా సూచించిల త్పదేశానిి
హాజరవుతాను.

70
ఏవైనా త్పతికూల త్పభావాలు లేదా అసాధారణ లక్షణాలు ఉంటే వైద్యష లక్ట
తెలియజేసాిను. వైద్యష లు మ్రియు ఇరర ఆరోరష ిబబ ందిి అనిా విధాల సహకరిసాిను.
ఈ పరిశోధలలో నా ాల్గొనుడి ఫలితాలను త్పజలక్ట తెలియజేయడానిి నేను అనుమ్తి

ఇసుినాా ను.
ఈ అధష యలంలో ాల్గొలడం కోసం నాక్ట ఎటువంటి లరద్య ారితోషికం ఇవే బడద్య.

నేను ఈ పరిశోధలలో ాల్గొలడానిి నా సమ్మ తిని ఇదివరకే లమోద్య చేసుినాా ను.

• రోగ పేరు / సమ్మ తి తెలిపే వష ి ి పేరు:

సంరకం / వేలిముత్ద: _______________________

తేదీ: _______________
సమ్యం: _______________

• సాక్షి పేరు: _______________________

సంరకం / వేలిముత్ద: _______________________
తేదీ: _______________
సమ్యం: _______________

• పరిశోధక్టరాలి పేరు: డాక ట్యర్ కటం సుష్మమ రెడిి

సంరకం / వేలిముత్ద: _______________________
తేదీ: _______________
సమ్యం: _______________

71
 Dr. NTR UNIVERSITY OF HEALTH SCIENCES
Certificate of Plagiarism Check for Dissertation

Author Name DR.KATAM SUSHMA REDDY

Course of Study MD RADI0 DIAGNOSIS

Name of Guide DR ANIL KUMAR KALLEPALLI

Department RADIO DIAGNOSIS

Acceptable Maximum Limit 19

Submitted By dsskraju@gmail.com

Paper Title MD RADIO DIAGNOSIS

Similarity 6%

Paper ID 3489082

Total Pages 51

Submission Date 2025-04-11 15:43:28

Sudnaellyk
Signature of Sludent Signature of Guide

Head of the Department

Authorized person DEAN

This report has been generated by DrillBit Anti-Plagiarism Software

 INSTITUTIONALETHICS COMMITTEE
MAHARAJAH'S INSTITUTE OF MEDICAL SCIENCES
NELLIMARLA –535 217; VIZIANAGARAM- DIST.

Dated..............202
Lr.No......... chairman-IEC, MIMS,Nellimarla,Vizianagaram Dist.,

PROVISIONAL CERTIFICATE

(for Post Graduate Student)

bas
TheInstitutional Ethics Committee meeting held on alD4la3
protocol titied SruDy oF INTERSTITBL LUNG SEASES uSINg -
approved the thesis

CND CORRELATI NG IMPGING FINDINGS WITH CHEST R9DIOGRAPHOI FINDINqS

HIáH-RESOLVTION CompUTED TOMOGRAPHY
REDDY under the guidance of
Dr. keTAM SUSHMA

Dr. KUMAR KALLEPALL of ReDIO D|9GNos\5

ANIL

Department for M.D.MS. RADID DIPGNOSS ( )tobe conducted

at MAHHRAJAH INSTITUTE OF mEDAL SIGNCES
during MAY -Q033 to ocTOBER-DA4

Cómmittee
Institutonics Sciences
Insttute of Medicat
Maharajah's 17
Nellimarla-5352

The original certificate is to be preserved by the candidate.

thesis.
Xerox copy is to be attached to the proje ct report/