Despite recent technological advances, agreement amongst clinicians on an algorithm for the optimal management of cryptogenic fibrosing alveolitis (CFA) has proved to be elusive. The non-invasive diagnosis of CFA is often uncertain as the clinical features may mimic those of other interstitial lung diseases. Even when the diagnosis is secure, therapeutic decisions are not straightforward. Reversible inflammatory disease requires aggressive treatment, but side effects from an over-vigorous approach to irreversible fibrotic disease need to be avoided. The extent of disease may influence the approach to treatment, but the optimal means of staging initial severity remains contentious. Furthermore, precision in monitoring changes in disease severity at follow up is unattainable in some cases and this complicates therapeutic decisions. This review explores the impact of high resolution computed tomographic (CT) scanning on the diagnosis and management of CFA.

The integration of a new test into routine management is the product of rigorous initial assessment and subsequent accumulated clinical experience. Enduring changes in clinical practice seldom result solely from “landmark” series. For example, early reports suggested that bronchoalveolar lavage (BAL) might offer invaluable additional diagnostic and prognostic information in diffuse lung disease.1 2 However, subsequent clinical experience has shown that diagnostic and prognostic trends obtained fron BAL in groups of patients are not sufficiently robust to change management substantially in most cases.3 In the same way, although disease activity defined by 67-gallium scanning was shown to correlate with inflammatory cell content on open lung biopsy material,4 it transpired that 67-gallium scanning did not predict responsiveness to treatment.5 Initial enthusiasm generated by early studies of diagnostic tests followed by disappointment is a familiar cycle for clinicians managing patients with interstitial lung disease.

Will this sequence of events apply equally to the use of CT scanning in the management of CFA? …