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This review aims to provide a literature update focused on the role of imaging in the diagnosis, prognosis and quantification of interstitial lung diseases (ILDs). Special emphasis is given in the management of atypical cases and in the multidisciplinary team approach in reaching the diagnosis of the various ILDs.

RECENT FINDINGS: Accumulated knowledge on imaging has increased the accuracy of differential diagnosis in atypical cases, in overlap of findings and in secondary as opposed to idiopathic ILDs. There is increasing awareness about interstitial lung abnormalities in smokers' lungs from lung cancer screening and indirect evidence of linkage of fibrosis and smoking. Improvement in radiologic-pathologic correlation reveals less typical high-resolution computed tomography patterns to be predictive of pulmonary fibrosis. Major diagnostic criteria such as honeycombing may be hampered by the coexistence of emphysema. High-resolution computed tomography may predict clinical outcome and survival of patients in ILDs and is a decision maker in the multidisciplinary approach of diagnosis.

SUMMARY: High-resolution computed tomography plays a crucial role in the diagnosis, prognosis, quantification and monitoring of ILDs. It provides a definite noninvasive diagnosis in typical findings and helps in reaching the most accurate diagnosis in a multidisciplinary discussion in equivocal cases.

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Bronchial artery angiography with embolization has become a mainstay in the treatment of massive hemoptysis. Whereas the immediate success rate is high, the reported long-term success rate varies widely among different groups. We aimed to explore the long-term outcome and clinical predictors associated with recurrent bleeding following bronchial artery embolization.

METHODS: We reviewed the clinical characteristics, underlying etiologies, procedure details, and outcome of bronchial artery embolization performed for massive hemoptysis between 1999 and 2012.

RESULTS: All 52 consecutive patients treated by bronchial artery embolization during the study period were included. The major etiologies of massive hemoptysis were bronchiectasis (mostly post-infectious) in 53.8%, and primary and metastatic lung cancer in 30.8%. The immediate success rate was high (48/52; 92%). Of 45 patients who survived more than 24 hours following bronchial artery embolization, recurrent bleeding did not occur in 19 (42.2%) during a median follow-up period of 60 months (range 6-130 months). Bleeding recurred in 26 (57.7%); within 30 days in 15 (33.3%) and after 1 month in the other 11 (24.4%). The average time to onset of early and late repeat bleeding was 2 and 506 days, respectively. Idiopathic bronchiectasis and lung cancer were associated with a high likelihood of late bleeding recurrence.

CONCLUSIONS: Bronchial artery embolization is an effective immediate treatment for massive hemoptysis. Because the bleeding recurrence rate is high in patients with lung cancer or idiopathic bronchiectasis, surgery should be considered in these patients following initial stabilization by bronchial artery embolization. For other underlying etiologies, the long-term outcome is excellent.

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PURPOSE: We retrospectively analyzed patients with clinically diagnosed interstitial pneumonia to investigate the factors which contribute to the difference in prognosis from the initiation of long-term oxygen therapy (LTOT) among subtypes.

METHODS: Seventy-six patients with clinically diagnosed idiopathic interstitial pneumonia (IIP; n = 49) or interstitial pneumonia associated with collagen vascular disease (CVD-IP; n = 27) in whom LTOT was initiated in our facility from January 1999 to December 2012 were analyzed.

RESULTS: Patients with CVD-IP had significantly longer survival time from the initiation of LTOT than those with IIP with the median survival of 51.7 months versus 18.8 months, respectively. The 1-year survival rate was 92.4 % for patients with CVD-IP versus 76.5 % for those with IIP, and 2-year survival was 88.6 versus 36.0 %, respectively. The patterns classified with high-resolution computed tomography (HRCT) were not associated with prognosis. The association between pulmonary hypertension and prognosis was unclear. In results of the multivariate Cox analysis which included factors demonstrating p < 0.1 in the univariate Cox analysis, male gender, low body mass index, and the absence of collagen vascular disease (CVD) were significantly associated with poor prognosis.

CONCLUSIONS: After the initiation of LTOT, patients with IIP had poor prognosis regardless of the patterns classified with HRCT, while those with CVD-IP survived longer. Male gender, low body mass index, and the absence of CVD were the independent negative prognostic factors in patients with interstitial pneumonia receiving LTOT.

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Non-small-cell lung cancers (NSCLCs), the most common lung cancers, are known to have diverse pathological features. During the past decade, in-depth analyses of lung cancer genomes and signalling pathways have further defined NSCLCs as a group of distinct diseases with genetic and cellular heterogeneity. Consequently, an impressive list of potential therapeutic targets was unveiled, drastically altering the clinical evaluation and treatment of patients. Many targeted therapies have been developed with compelling clinical proofs of concept; however, treatment responses are typically short-lived.

Further studies of the tumour microenvironment have uncovered new possible avenues to control this deadly disease, including immunotherapy.

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