Imaging patterns are associated with interstitial lung abnormality progression and mortality

Rachel K. Putman*, Gunnar Gudmundsson, Gisli Thor Axelsson, Tomoyuki Hida, Osamu Honda, Tetsuro Araki, Masahiro Yanagawa, Mizuki Nishino, Ezra R. Miller, Gudny Eiriksdottir, Elías F. Gudmundsson, Noriyuki Tomiyama, Hiroshi Honda, Ivan O. Rosas, George R. Washko, Michael H. Cho, David A. Schwartz, Vilmundur Gudnason, Hiroto Hatabu, Gary M. Hunninghake

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

39 Citations (Scopus)


Rationale: Interstitial lung abnormalities (ILA) are radiologic abnormalities on chest computed tomography scans that have been associated with an early or mild form of pulmonary fibrosis. Although ILA have been associated with radiologic progression, it is not known if specific imaging patterns are associated with progression or risk of mortality. Objectives: To determine the role of imaging patterns on the risk of death and ILA progression. Methods: ILA (and imaging pattern) were assessed in 5,320 participants from the AGES-Reykjavik Study, and ILA progression was assessed in 3,167 participants. Multivariable logistic regression was used to assess factors associated with ILA progression, and Cox proportional hazards models were used to assess time to mortality. Measurements and Main Results: Over 5 years, 327 (10%) had ILA on at least one computed tomography, and 1,435 (45%) did not have ILA on either computed tomography. Of those with ILA, 238 (73%) had imaging progression, whereas 89 (27%) had stable to improved imaging; increasing age and copies of MUC5B genotype were associated with imaging progression. The definite fibrosis pattern was associated with the highest risk of progression (odds ratio, 8.4; 95% confidence interval, 2.7–25; P = 0.0003). Specific imaging patterns were also associated with an increased risk of death. After adjustment, both a probable usual interstitial pneumonia and usual interstitial pneumonia pattern were associated with an increased risk of death when compared with those indeterminate for usual interstitial pneumonia (hazard ratio, 1.7; 95% confidence interval, 1.2–2.4; P = 0.001; hazard ratio, 3.9; 95% confidence interval, 2.3–6.8; P, 0.0001), respectively. Conclusions: In those with ILA, imaging patterns can be used to help predict who is at the greatest risk of progression and early death.

Original languageEnglish
Pages (from-to)175-183
Number of pages9
JournalAmerican Journal of Respiratory and Critical Care Medicine
Issue number2
Publication statusPublished - 2019

Bibliographical note

Publisher Copyright:
Copyright © 2019 by the American Thoracic Society

Other keywords

  • Idiopathic pulmonary fibrosis
  • Imaging pattern
  • Interstitial lung abnormalities
  • Mortality
  • Progression


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