Idiopathic dendriform pulmonary ossification as the phenotype of interstitial lung abnormalities: CT-pathologic correlation and prevalence

Midori Ueno; Ryoko Egashira; Mikiko Hashisako; Kiminori Fujimoto; Taiki Fukuda; Yoshiko Hayashida; Hiromitsu Sumikawa; Junya Tominaga; Tomonori Tanaka; Yasuhiro Terasaki; Junya Fukuoka; Yasuhiko Nishioka; Takatoshi Aoki; Toshifumi Gabata; Hiroto Hatabu; Takeshi Johkoh

doi:10.1007/s11604-024-01590-8

Idiopathic dendriform pulmonary ossification as the phenotype of interstitial lung abnormalities: CT-pathologic correlation and prevalence

Jpn J Radiol. 2024 May 14. doi: 10.1007/s11604-024-01590-8. Online ahead of print.

Authors

Midori Ueno¹, Ryoko Egashira², Mikiko Hashisako³, Kiminori Fujimoto⁴, Taiki Fukuda⁵, Yoshiko Hayashida⁶, Hiromitsu Sumikawa⁷, Junya Tominaga⁸, Tomonori Tanaka⁹, Yasuhiro Terasaki¹⁰, Junya Fukuoka¹¹, Yasuhiko Nishioka¹², Takatoshi Aoki⁶, Toshifumi Gabata¹³, Hiroto Hatabu¹⁴, Takeshi Johkoh¹⁵

Affiliations

¹ Department of Radiology, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Kitakyushu City, Fukuoka, 807-8555, Japan. mueno@med.uoeh-u.ac.jp.
² Department of Radiology, Faculty of Medicine, Saga University, 5-1-1, Nabesima, Saga City, Saga, 849-8501, Japan.
³ Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medicine Sciences, Kyushu University, 3-1-1, Maedashi, Fukuoka City, Fukuoka, 812-8582, Japan.
⁴ Department of Radiology, Kurume University School of Medicine, 67, Asahimachi, Kurume City, Fukuoka, 830-0011, Japan.
⁵ Department of Radiology, The Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-Ku, Tokyo, 105-8461, Japan.
⁶ Department of Radiology, University of Occupational and Environmental Health School of Medicine, 1-1 Iseigaoka, Kitakyushu City, Fukuoka, 807-8555, Japan.
⁷ Department of Radiology, National Hospital Organization Kinki-Chuo Chest Medical Center, 1180, Nagasonecyo, Kita-Ku, Sakai City, Osaka, 591-8555, Japan.
⁸ Department of Diagnostic Radiology, Tohoku University School of Medicine, 1-1, Seiryoucyo, Aoba-Ku, Sendai City, Miyagi, 980-8574, Japan.
⁹ Department of Diagnostic Pathology, Kobe University Hospital, 7-5-2, Kusumachi, Cyuoh-Ku, Kobe City, Hyogo, 65017, Japan.
¹⁰ Department of Analytic Human Pathology, Nippon Medical School Hospital, 1-1-5, Sendaki, Bunkyo-Ku, Tokyo, 113-8603, Japan.
¹¹ Department of Pathology Informatics, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1, Sakamoto, Nagasaki City, Nagasaki, 852-8501, Japan.
¹² Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, 2-50-1, Kuramotocyo, Tokushima City, Tokusima, 770-0042, Japan.
¹³ Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1, Takaramachi, Kanazawa City, Isihikawa, 920-8641, Japan.
¹⁴ Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75, Francis Street, Boston, 02115, USA.
¹⁵ Department of Radiology, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki City, Hyogo, 660-0064, Japan.

PMID: 38740642
DOI: 10.1007/s11604-024-01590-8

Abstract

Background and purpose: Idiopathic dendriform pulmonary ossification (DPO) is mostly asymptomatic, and detected incidentally in lung CT. There have been no reports on the precise CT-pathologic correlation and the prevalence of idiopathic DPO. This study aimed to clarify the histological background and prevalence of idiopathic DPO.

Materials and methods: Sixteen patients with histologically confirmed idiopathic DPO (12 men and 4 women; mean age, 38.8 years; range 22-56 years) were identified in a nationwide epidemiological survey. Local HRCT findings of pre-biopsy examinations, such as branching, round, linear structures with or without high attenuation were compared side by side with histological findings. The attenuation of branching, round, and linear structures was classified into three-point levels on bone window images (width, 2500 HU; level, 500 HU). Furthermore, we collected continuous pulmonary CT images of 8111 cases for checking up metastasis from extrathoracic malignancy at a single institution, and evaluated the prevalence of interstitial lung abnormalities (ILAs) and DPO.

Results: In all 16 cases, branching (n = 15, 93%), round (n = 5, 31%), or linear (n = 5, 31%) structures were identified, histologically corresponding to dendriform ossification and cicatricial organizing pneumonia (OP)/fibrosis. Histologically, ossification was confirmed in all the 16 patients. However, in two cases, a highly attenuated structure could not be detected on the pre-biopsy CT of the same area. Regarding the prevalence of idiopathic DPO, 283 (3.5%) of 8111 patients had ILAs, of which a total of 26 (0.3% of all cases, 9.2% of ILAs cases) had DPO.

Conclusion: Idiopathic DPO showed linear or branching structures with or without high attenuation on CT, corresponded to ossification, cicatricial OP/fibrosis. DPO was seen in 9.2% of ILAs cases. Idiopathic DPO is one of pathologic phenotypes of ILAs.

Keywords: Cicatricial organizing pneumonia; Dendriform pulmonary ossification; Interstitial lung abnormalities; Radiologic–pathologic correlation; Thin-section CT.