{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T12:18:19Z","timestamp":1764937099140,"version":"3.46.0"},"reference-count":23,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Hypersensitivity pneumonitis (HP) is an interstitial lung disease (ILD) caused by repeated exposure to inhaled antigens in susceptible subjects. High-resolution computed tomography (HRCT) of the lungs is the leading diagnostic method for ILDs, but in some cases HRCT findings are not sufficient to distinguish HP and other ILDs, particularly, fibrotic HP (fHP) and usual interstitial pneumonia (UIP). Objective: The aim of this study was to develop HRCT criteria to diagnose fHP in patients with a UIP-like pattern. Methods: In this retrospective study, we analyzed HRCT scans of patients with fHP and a UIP-like pattern who underwent lung biopsy, and patients with idiopathic pulmonary fibrosis (IPF) and a UIP pattern in HRCT. Results: We included 51 patients with confirmed fHP and 24 patients with IPF\/UIP in the analysis. IPF\/UIP patients were older, were prevalently males, and did not have any systemic autoimmune diseases or risk factors for other ILDs. fHP patients were younger, with an equal number of males and females, and were more likely to be exposed to environmental antigens. HRCT abnormalities in the fHP group predominated in the lower lung areas or were diffuse in axial scans, whereas IPF\/UIP patients mostly demonstrated a diffuse craniocaudal distribution and subpleural axial predominance. Centrilobular nodules and mosaic attenuation were present significantly more often in the fHP group; honeycombing, traction bronchiectasis, and emphysema prevailed in IPF\/UIP patients. In the logistic regression analysis, patients with fHP and IPF\/UIP differed in the presence of centrilobular nodules, honeycombing, and in both craniocaudal and axial distributions of HRCT abnormalities. In the ROC analysis, the combination of centrilobular nodules, honeycombing, and diffuse axial and craniocaudal distributions can predict the diagnosis of fHP (AUC, 0.953 \u00b1 0.022; 95%CI, 0.910\u20130.995; p &lt; 0.001). Mosaic attenuation and reticulation did not change the probability of fHP. Conclusions: The most significant HRCT features of fHP compared to the UIP pattern were centrilobular nodules, honeycombing, and a diffuse axial and craniocaudal distribution of abnormal findings. Reticulation, mosaic attenuation, and GGO do not increase the probability of fHP.<\/jats:p>","DOI":"10.3390\/life15121867","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T10:50:38Z","timestamp":1764931838000},"page":"1867","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Role of High-Resolution Lung Computed Tomography to Distinguish Between Fibrosing Hypersensitivity Pneumonitis and Usual Interstitial Pneumonia"],"prefix":"10.3390","volume":"15","author":[{"given":"Dmitry A.","family":"Kuleshov","sequence":"first","affiliation":[{"name":"Federal Central Research Institute of Tuberculosis, Moscow 107564, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5536-9388","authenticated-orcid":false,"given":"Svetlana Yu.","family":"Chikina","sequence":"additional","affiliation":[{"name":"Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Moscow 119991, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Galina V.","family":"Nekludova","sequence":"additional","affiliation":[{"name":"Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Moscow 119991, Russia"},{"name":"Pulmonology Scientific Research Institute, Federal Medical and Biological Agency of Russian Federation, Moscow 115682, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor E.","family":"Tyurin","sequence":"additional","affiliation":[{"name":"Russian Federal Academy of Continued Medical Education, Healthcare Ministry of Russia, Moscow 123995, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergey N.","family":"Avdeev","sequence":"additional","affiliation":[{"name":"Pulmonology Department, I.M. Sechenov First Moscow State Medical University (Sechenov University), Healthcare Ministry of Russia, Moscow 119991, Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"81s","DOI":"10.1183\/09031936.01.18s320081","article-title":"Hypersensitivity pneumonitis: Current concepts","volume":"32","author":"Bourke","year":"2001","journal-title":"Eur. Respir. J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1016\/j.ccm.2011.12.004","article-title":"Chronic hypersensitivity pneumonitis","volume":"33","author":"Costabel","year":"2012","journal-title":"Clin. Chest Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/17476348.2018.1395282","article-title":"Computed tomography in hypersensitivity pneumonitis: Main findings, differential diagnosis and pitfalls","volume":"12","author":"Dias","year":"2018","journal-title":"Expert. Rev. Respir. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1164\/rccm.202005-2032ST","article-title":"Diagnosis of Hypersensitivity Pneumonitis in Adults. An Official ATS\/JRS\/ALAT Clinical Practice Guideline","volume":"202","author":"Raghu","year":"2020","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e44","DOI":"10.1164\/rccm.201807-1255ST","article-title":"Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS\/ERS\/JRS\/ALAT Clinical Practice Guideline","volume":"198","author":"Raghu","year":"2018","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e18","DOI":"10.1164\/rccm.202202-0399ST","article-title":"Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS\/ERS\/JRS\/ALAT Clinical Practice Guideline","volume":"205","author":"Raghu","year":"2022","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1007\/s11604-020-00932-6","article-title":"High-resolution CT features distinguishing usual interstitial pneumonia pattern in chronic hypersensitivity pneumonitis from those with idiopathic pulmonary fibrosis","volume":"38","author":"Tateishi","year":"2020","journal-title":"Jpn. J. Radiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1148\/radiol.2462070712","article-title":"Fleischner Society: Glossary of terms for thoracic imaging","volume":"246","author":"Hansell","year":"2008","journal-title":"Radiology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3993","DOI":"10.1007\/s00330-020-07469-2","article-title":"Serial changes of CT findings in patients with chronic hypersensitivity pneumonitis: Imaging trajectories and predictors of fibrotic progression and acute exacerbation","volume":"31","author":"Choe","year":"2021","journal-title":"Eur. Radiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1016\/j.chest.2023.07.068","article-title":"Integration and Application of Radiologic Patterns From Clinical Practice Guidelines on Idiopathic Pulmonary Fibrosis and Fibrotic Hypersensitivity Pneumonitis","volume":"164","author":"Marinescu","year":"2023","journal-title":"Chest"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.resinv.2024.07.002","article-title":"Validation of a computed tomography diagnostic model for differentiating fibrotic hypersensitivity pneumonitis from idiopathic pulmonary fibrosis","volume":"62","author":"Sumikawa","year":"2024","journal-title":"Respir. Investig."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jrid.2020.03.003","article-title":"Advances in differential diagnosis of pulmonary ground glass opacity on high resolution computed tomography and histopathology","volume":"7","author":"Zhuo","year":"2020","journal-title":"Radiol. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2353","DOI":"10.21037\/jtd-23-1845","article-title":"Compatible with fibrotic hypersensitivity pneumonitis on high-resolution computed tomography: From the ATS\/JRS\/ALAT 2020 hypersensitivity pneumonitis guidelines","volume":"16","author":"Kaburaki","year":"2024","journal-title":"J. Thorac. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e230165","DOI":"10.1148\/rg.230165","article-title":"Central Role of CT in Management of Pulmonary Fibrosis","volume":"44","author":"Chae","year":"2024","journal-title":"Radiographics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e230068","DOI":"10.1148\/ryct.230068","article-title":"Hypersensitivity Pneumonitis on Thin-Section Chest CT Scans: Diagnostic Performance of the ATS\/JRS\/ALAT versus ACCP Imaging Guidelines","volume":"6","author":"Chelala","year":"2024","journal-title":"Radiol. Cardiothorac. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"160","DOI":"10.26442\/20751753.2022.3.201522","article-title":"High-resolution computed tomography in the diagnosis of fibrotic hypersensitivity pneumonitis: A review","volume":"24","author":"Kuleshov","year":"2022","journal-title":"Cons. Medicum."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"215","DOI":"10.4103\/lungindia.lungindia_293_17","article-title":"High-resolution computerized tomography changes in diffuse parenchymal lung disease from chronic hypersensitivity pneumonitis related to bird antigen","volume":"35","author":"Bhattacharyya","year":"2018","journal-title":"Lung India"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2001808","DOI":"10.1183\/13993003.01808-2020","article-title":"Rapid onset honeycombing fibrosis in spontaneously breathing patient with COVID-19","volume":"56","author":"Combet","year":"2020","journal-title":"Eur. Respir. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1136\/thoraxjnl-2021-218275","article-title":"Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: A systematic review and meta-analysis","volume":"78","author":"Fabbri","year":"2023","journal-title":"Thorax"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1164\/rccm.202203-0564OC","article-title":"Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study","volume":"207","author":"Stewart","year":"2023","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Rahman, M.T., Nahar, N.U., Ibrahim, M., Islam, I., Bhowmik, B., Shirin, M., Khan, M.M.R., Akkas, N., and Molla, M.M.A. (2023). Early Prediction and HRCT Evaluation of Post COVID-19 Related Lung Fibrosis. Microbiol. Insights, 16.","DOI":"10.1177\/11786361231190334"},{"key":"ref_22","first-page":"51","article-title":"Radiological diagnosis of Coronavirus Disease 2019 (COVID-19): A Practical Guide","volume":"91","author":"Floridi","year":"2020","journal-title":"Acta Biomed."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Johnston, J., Dorrian, D., Linden, D., Stanel, S.C., Rivera-Ortega, P., and Chaudhuri, N. (2023). Pulmonary Sequelae of COVID-19: Focus on Interstitial Lung Disease. Cells, 12.","DOI":"10.3390\/cells12182238"}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/12\/1867\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T12:13:05Z","timestamp":1764936785000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/15\/12\/1867"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":23,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["life15121867"],"URL":"https:\/\/doi.org\/10.3390\/life15121867","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]}}}