# Radiological Insights into UIP Pattern: A Comparison Between IPF and Non-IPF Patients

## TL;DR

This study compares radiological features of primary and secondary UIP patterns in lung CT scans to improve diagnostic accuracy.

## Contribution

The study identifies distinct radiological markers to differentiate primary UIP/IPF from secondary UIP using expert analysis and AI tools.

## Key findings

- Primary UIP cases showed uniform honeycombing and cranio-caudal fibrosis distribution.
- Secondary UIP exhibited patchy fibrosis and irregular GGO distribution, with features like exuberant honeycombing and wedge-shaped fibrosis.
- Expert radiologists achieved high sensitivity and specificity in distinguishing primary from secondary UIP.

## Abstract

Background/Objectives: This study aims to distinguish radiological differences between primary idiopathic Usual Interstitial Pneumonia (UIP) and secondary UIP patterns Methods: This retrospective study included patients with HRCT findings consistent with a UIP pattern. Final diagnoses were established via multidisciplinary discussion and classified as primary UIP/IPF or secondary UIP, following the 2022 ATS/ERS/JRS/ALAT guidelines. An expert thoracic radiologist (>10 years of experience), blinded to clinical data, reviewed the earliest available HRCT assessing key imaging features: honeycombing (micro-, macro- or exuberant), fibrosis distribution (symmetry, anterior-upper lobe sign, etc.), ground-glass opacities (GGO), dilatation of esophagus. Additionally, AI software AVIEW Build 1.1.46.28-win Coreline (©Coreline Soft Co., Ltd. All Rights Reserved). performed lung texture analysis, quantifying total lung volume and radiological patterns. Statistical analysis was performed to reveal results. Results: Among 53 cases, 31 were classified as IPF and 22 as secondary UIP cases. The expert radiologist achieved a diagnostic sensitivity of 82.9%, specificity of 889%, with a positive predictive value of 93.5%—in distinguishing between primary and secondary UIP. Primary UIP cases exhibited typical hallmark radiological features, including uniform honeycombing with cranio-caudal distribution (90.3%). Reticulations contributed significantly to the fibrotic texture, maintaining a consistent cranio-caudal gradient and axial symmetry (84.8%). Secondary UIP displayed more significant radiological heterogeneity, including patchy fibrosis with irregular GGO distribution (84.5% versus 53.33%); other findings—such as exuberant honeycombing, four corner sign and wedge-shaped fibrosis—were mainly observed in secondary pattern with respective percentages of 31.8%, 9% and 49%. Conclusions: Experienced thoracic radiologists, leveraging hallmark imaging features, play a critical role in improving diagnostic accuracy between primary and secondary UIP patterns.