Abstract
Before the advent of high-resolution computed tomography (HRCT), the role of imaging,
chest radiography in particular, in the management of patients with interstitial lung
disease was limited. In the past 25 years, this has radically changed. HRCT has transformed
the diagnostic landscape by providing detailed cross-sectional imaging of the lungs,
which permit ready identification of a variety of different interstitial lung diseases.
Although the position of HRCT as the dominant imaging technique for interstitial lung
disease has remained unchallenged since its introduction in the late 1980s, the roles
assumed by HRCT have undergone a steady evolution. This evolution has occurred in
stages. The first investigations of HRCT in interstitial lung disease during the late
1980s and early 1990s marked a golden era of HRCT-pathologic correlative studies,
typified by the work of Müller and Miller. It was this groundbreaking work that defined
basic HRCT patterns, correlated to histopathologic appearances, which underpin the
pattern recognition approach used to interpret HRCT images to this day. Subsequently,
attention turned to issues of disease reversibility and responsiveness and how this
could be predicted by HRCT. At the turn of the millennium, the previously long accepted
belief in histopathological diagnosis as the reference standard in interstitial lung
disease gave way to a growing perception that histopathology was not infallible. This
change in diagnostic thinking arguably has had the biggest impact on how HRCT's role
subsequently evolved. Recently, HRCT data have been integrated with pulmonary function
in staging models to predict prognosis particularly in idiopathic fibrosing lung disease.
This article reviews these stages of evolution. The emergence of the multidisciplinary
approach to diagnosis will also be considered.
Keywords
HRCT - interstitial lung disease - CT-pathological correlative studies - prognostication
- staging
