Cardiopulmonar y Imaging • Original Research

Lee et al.
High-Resolution CT of Cryptogenic Organizing Pneumonia

Cardiopulmonary Imaging
Original Research
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Cryptogenic Organizing Pneumonia:

Serial High-Resolution CT Findings
in 22 Patients
Ju Won Lee1 OBJECTIVE. We conducted a review of serial high-resolution CT (HRCT) findings of
Kyung Soo Lee1 cryptogenic organizing pneumonia (COP).
Ho Yun Lee1 MATERIALS AND METHODS. Over the course of 14 years, we saw 32 patients with
Man Pyo Chung2 biopsy-confirmed COP. Serial HRCT scans were available for only 22 patients (seven men and
Chin A Yi1 15 women; mean age, 52 years; median follow-up period, 8 months; range, 5–135 months).
Serial CT scans were evaluated by two chest radiologists who reached a conclusion by con-
Tae Sung Kim1
sensus. Overall changes in disease extent were classified as cured, improved (i.e., ≥ 10% de-
Myung Jin Chung1 crease in extent), not changed, or progressed (i.e., ≥ 10% increase in extent). When there were
Lee JW, Lee KS, Lee HY, et al. remaining abnormalities, the final follow-up CT images were analyzed to express observers’
ideas regarding what type of interstitial lung disease the images most likely suggested.
RESULTS. The two most common patterns of lung abnormality on initial scans were
ground-glass opacification (86% of patients [19/22]) and consolidation (77% of patients
[17/22]), distributed along the bronchovascular bundles or subpleural lungs in 13 patients
(59%). In six patients (27%), the disease disappeared completely; in 15 patients (68%), the
disease was decreased in extent; and in one patient (5%), no change in extent was detected on
follow-up CT. When lesions remained, the final follow-up CT findings were reminiscent of
fibrotic nonspecific interstitial pneumonia in 10 of 16 patients (63%).
CONCLUSION. Although COP is a disease with a generally good prognosis, most pa-
tients (73%) with COP have some remaining disease seen on follow-up CT scans, and, in such
cases, the lesions generally resemble a fibrotic nonspecific interstitial pneumonia pattern.

Keywords: cryptogenic organizing pneumonia, lung CT,
lung interstitial disease
DOI:10.2214/AJR.09.3940
Received November 9, 2009; accepted after revision
February 28, 2010.
1
Department of Radiology and Center for Imaging
Science, Samsung Medical Center, Sungkyunkwan
University School of Medicine, 50 Ilwon-Dong,
Kangnam-Ku, Seoul 135-710, Republic of Korea.
Address correspondence to K. S. Lee
(kyungs.lee@samsung.com).
2
Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul,
Republic of Korea.
AJR 2010; 195:916–922
0361–803X/10/1954–916
© American Roentgen Ray Society
C
ryptogenic organizing pneumo-
nia (COP) is characterized histo-
pathologically by plugs of granu-
lation tissue lying within small
airways, alveolar ducts, and alveoli and by
chronic inflammatory cell infiltration in alve-
olar walls [1]. Patients with COP generally
present with subacute illness, including short-
ness of breath, fever, malaise, and weight loss
[1, 2].
Imaging findings of COP at presenta-
tion have been well characterized. Common
chest radiographic findings include bilateral
patchy areas of consolidation showing sub-
pleural and lower lung zone predominance.
High-resolution CT (HRCT) findings consist
of consolidative areas or nodules distributed
along the bronchovascular bundles or along
the subpleural lungs [3–6].
Patients with COP manifest good progno-
ses with corticosteroid therapy [2]. However,
despite this therapy, cases of relapse or pro-
gression have been reported [7, 8]. In addi-
tion, in rare cases, a disease initially identi-
fied as COP progresses to respiratory failure
and death [9]. Thus, more studies as to the
exact clinical outcome of COP, particular-
ly dealing with large number of patients, are
needed. Moreover, to the best of our knowl-
edge, the follow-up HRCT findings of the dis-
ease in a large patient cohort have yet to be
reported. Thus, the principal objective of our
study was to report serial HRCT findings of
COP in a relatively large patient population
and to look for clinical, pulmonary function
test (PFT), or HRCT findings that might fa-
cilitate the prediction of patient prognoses.
Materials and Methods
Patient Enrollment and Demographics
Our institutional review board approved this
retrospective study with a waiver of patient in-
formed consent. We reviewed all surgical biopsy
files recorded from January 1995 to May 2008 in
a single tertiary hospital and identified 72 patients
who had a histopathologic diagnosis of organizing

916 AJR:195, October 2010

 High-Resolution CT of Cryptogenic Organizing Pneumonia
pneumonia. Among the 72 patients, 16 patients had
underlying collagen vascular disease, 14 patients
had concurrent pulmonary infection, and 10 had
drug-associated lung diseases. We excluded these
40 patients from this study. Therefore, the remain-
ing 32 patients had a histopathologic diagnosis of
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organizing pneumonia of unknown cause (i.e.,
COP). Among these 32 patients, 10 had received
no follow-up CT or follow-up examination only
within a 1-month interval. None of these 10 pa-
tients died of COP. For the remaining 22 patients,
follow-up CT studies were obtained at least once,
and the shortest follow-up period was 2 months.
Thus, a total of 22 patients with COP (seven men
and 15 women; mean [± SD] age, 52 ± 11.2 years;
range, 28–70 years) were ultimately included in
this study. The serial HRCT scans were obtained
over a mean follow-up period of 18 ± 29.6 months
(median, 7 months; range, 2–135 months).
All patients underwent surgical lung biopsies
(video-assisted thoracoscopic surgery biopsy, n =
21; open lung biopsy, n = 1). Surgical lung biopsy
specimens were acquired from three lobes in two
patients, from two lobes in 11 patients, and from
one lobe in nine patients.
PFT
Initial PFT data were obtained for 19 patients.
Forced spirometry and single-breath carbon mon-
oxide diffusing capacity of the lung (DLCOSB) were
obtained with pulmonary function units (Vmax 22,
SensorMedics Corporation). Forced vital capacity
(FVC) and DLCOSB were expressed as a percent-
age of the predicted value based on height, age,
sex, and ethnic origin. Additionally, arterial oxy-
gen tension at room air (PaO2) was measured at
TABLE 1:  Clinical and Physiologic Analysis Results in 22 Patients With
Biopsy-Proved Cryptogenic Organizing Pneumonia
Result
Clinical
Men, no. (%) of patients
Smokers, no. (%) of patients
Age at diagnosis (y)
Duration from onset of symptom to treatment (mo)
Physiologic
Forced vital capacity (% of predicted value)a
Single-breath carbon monoxide diffusing capacity of the lung
(% of predicted value)b
Arterial oxygen tension at room air (mm Hg)d
Note— Except where noted, data are mean ± SD. NA = not applicable.
aData were available for 19 patients.
bData were available for 13 patients.
cData were available for 11 patients.
dData were available for 15 patients.
eData were available for 9 patients.
AJR:195, October 2010 917
the time of biopsy or when PFT results were ob-
tained. Serial trends in PFT results and PaO2 val-
ues at follow-up studies were defined as improve-
ment (i.e., an increase of > 15% in FVC or DLCOSB
or an increase of > 15 mm Hg in PaO2), decline
(i.e., a decrease of > 15% in FVC or DLCOSB or a
decrease of > 15 mm Hg in PaO2), or stability (i.e.,
a change of < 15% in FVC or DLCOSB or a change
of < 15 mm Hg in PaO2).
Image Acquisition
Twenty-two patients underwent a total of 80
HRCT studies (mean, 3.6 ± 1.8 CT examinations
per patient; range, 2–9 CT examinations). For the
total of 44 CT studies performed for 22 patients as
the initial and final follow-up scans, various he-
lical CT scanners from different vendor compa-
nies with various numbers of detectors were used
for CT image acquisition. A single-detector scan-
ner was used for 17 studies, a 4-MDCT scanner
was used for six studies, an 8-MDCT scanner was
used for six studies, a 16-MDCT scanner was used
for nine studies, a 40-MDCT scanner was used for
two studies, and a 64-MDCT scanner was used for
four studies. None of the patients received IV in-
jections of contrast medium for the CT study.
The scanning parameters were 120 kVp and
90–170 mA. With MDCT scanners, helical CT
scans (beam width of 10–20 mm and beam pitch
of 1.375–1.5) were obtained throughout the tho-
rax, and the scan data were reconstructed with
1.0–1.25-mm section thickness and at 10-mm in-
tervals, covering from the lung apices to the bot-
tom of the lungs. With a single-detector scanner,
1.0-mm high-resolution lung-window CT imag-
es were obtained throughout the thorax at 10-mm
Initial Follow-Up
7 (32) NA
5 (23) NA
52 ± 11.2 NA
4 NA
70 ± 21.6a 85 ± 22.4a
75 ± 18.2b 86.3 ± 3.9c
80 ± 16.5d 93 ± 9.4e
intervals. In both single-detector CT and MDCT,
data were reconstructed by using a bone algorithm.
Image data were displayed directly on the monitors
(four monitors with 1,536 × 2,048 image matrices,
8-bit viewable gray-scale, and 60-foot-lambert lu-
minescence) of a PACS (PathSpeed or Centricity
2.0; GE Healthcare Integrated Imaging Solutions).
Both mediastinal (window width, 400 HU; win-
dow level, 20 HU) and lung (window width, 1,500
HU; window level, −700 HU) window images were
available for analysis on the monitors.
Analyses of Thin-Section CT Findings
Patterns (consolidation, ground-glass opacifica-
tion [GGO], nodule, reticulation, and honeycomb-
ing), extent (to the nearest 5%), and distribution of
lung abnormalities at the initial and final follow-
up CT scan were evaluated by two chest radiolo-
gists with 5 and 20 years of experience in thoracic
CT interpretation, respectively, who reached their
conclusions by consensus. Overall disease extent
changes were evaluated by comparing the initial
and the final follow-up CT scans [10], and then
the changes were divided into the following cat-
egories: completely resolved, improved (i.e., ≥ 10%
decrease in total extent), not changed, and pro-
gressed (i.e., ≥ 10% increase in extent). In cases
of complete disappearance, the follow-up inter-
val was defined as period between the initial CT
and the first follow-up CT that showed complete-
ly resolved parenchymal lesions. After the esti-
mation of lung lesion extent, the final follow-up
CT images were given again to the same two ob-
servers, who were asked to express their ideas in-
dependently as to what disease the given images
most suggested (i.e., COP, nonspecific interstitial
pneumonia [NSIP], or usual interstitial pneumo-
nia [UIP]), according to previously published CT
findings of idiopathic interstitial pneumonias [2].
When there was disagreement regarding which re-
sidual pattern the interstitial lung disease on fol-
low-up CT scans suggested, the final decision was
arrived at by consensus. The presence of pleural
effusion, pleural thickening, pericardial effusion,
and lymphadenopathy were also recorded.
Clinical Outcome of Patients
We reviewed the patients’ medical records. Rel-
evant data included clinical symptoms at initial
presentation, time interval between onset of symp-
tom and treatment, treatment regimens, and re-
lapse and survival of the patients. Relapses of COP
were defined as the appearance of new character-
istic opacities on chest imaging, with compatible
clinical features, after some period of stable or im-
proved state. Patients’ survival was identified from
medical records or by contacting the patient’s fam-
ily when necessary.
 Lee et al.

Statistical Analysis TABLE 2:  Initial and Follow-Up CT Patterns, Distribution, and Extent of Lung
Statistical analyses were conducted by using SPSS Involvement in 22 Patients With Cryptogenic Organizing Pneumonia
software (version 12.0, SPSS, Inc.). The relation- Initial CT Follow-Up CT
ship between the changes in serial CT findings (pa-
No. (%) of Average No. (%) of Average
tients with completely disappeared disease and
Parameter Patients Extent (%) Patients Extent (%)
with remaining disease) and the initial PFT or CT
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finding results was correlated. Univariate and mul- Pattern

tivariate analyses were conducted to seek clinical Consolidation 17 (77) 27 1 (5) 20
information or initial CT findings that would help Ground-glass opacification 19 (86) 33 16 (72) 21
to predict remaining disease on follow-up CT. Con-
Nodule 7 (32) 10 1 (5) 10
tinuous data were compared between the complete
resolution group and the remaining disease group Reticulation 4 (18) 10 11 (50) 12
by using the Mann-Whitney U test, and categorical Honeycombing 0 0 2 (9) 8
data were compared by using Fisher’s exact test. In Distribution
all statistical analyses, p values less than 0.05 were
Lower lung predominance 12 (55) NA 10 (45) NA
considered statistically significant.
Subpleural 9 (41) NA 8 (36) NA
Results Peribronchovascular 5 (23) NA 4 (18) NA
The demographic and clinical findings of Note— NA = not applicable.
22 patients with biopsy-confirmed COP are
summarized in Table 1. All 22 patients pre- initial and follow-up DLCOSB examinations. common patterns of lung abnormality on the
sented with dyspnea, cough, or fever. Seven- Six patients (55%) were deemed stable, five initial scans were GGO (observed in 19 pa-
teen patients were nonsmokers, three were patients (45%) had an interval increase, and tients [86%]) and consolidation (observed in
ex-smokers (mean duration, 19 pack-years), none exhibited an interval decrease on fol- 17 patients [77%]), and they were distribut-
and two were smokers (mean duration, 33 low-up DLCOSB examinations. ed along the bronchovascular bundles or sub-
pack-years). Initial PaO2 results were available for pleural lungs in 13 (59%) of 22 patients. All
15 patients. The mean PaO2 was 80 ± 16.5 initial scans showed lung abnormality in the
PFT Results mm Hg. Nine patients had both initial and lower lobes, and lower lobe predominance
PFT results are also summarized in Table follow-up PaO2. Three patients (33%) were was noted in 12 patients (55%). Pleural effu-
1. Among 19 patients for whom FVC results stable, six patients (67%) showed an interval sion and subcarinal lymphadenopathy were
(percentage of predicted value) was avail- increase, and none exhibited an interval de- detected in one patient each. Pericardial ef-
able, an interval increase was noted in 11 pa- crease on follow-up PaO2 examinations. fusion was not detected in any patient.
tients (58%), and stability was noted in eight On the follow-up CT scans, the disease
patients (42%) on follow-up examinations. Serial Thin-Section CT Findings disappeared completely in six of 22 patients
None of the patients exhibited an interval The initial and follow-up CT scan findings (27%) (Fig. 1), 15 (68%) showed a decrease
decrease in FVC. Eleven patients had both are summarized in Table 2. The two most in disease severity (Figs. 2 and 3), one (5%)

A B
Fig. 1—43-year-old woman with cryptogenic organizing pneumonia showing complete resolution on follow-up CT scans.
A, Transverse thin-section (1.0-mm section thickness) CT scan obtained at level of basal segmental bronchi shows bilateral patchy ground-glass opacification (GGO)
lesions distributed along bronchovascular bundles in lower lung zones. Linear consolidation surrounds internal GGO, so-called “reversed halo sign” (arrows), in right
lower lobe. There was no parenchymal opacity in upper and middle lung zones (not shown here). Total extent of parenchymal abnormalities on CT scans was 20%
(consolidation, 10%; GGO, 10%).
B, Nine-month follow-up CT scan obtained at similar level to panel A shows complete resolution of lung lesions without remaining disease.

918 AJR:195, October 2010

 High-Resolution CT of Cryptogenic Organizing Pneumonia
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A B
Fig. 2—56-year-old woman with cryptogenic organizing pneumonia showing improvement but remaining disease.
A, Transverse thin-section (1.0-mm section thickness) CT scan obtained at level of liver dome shows bilateral patchy areas of consolidation and nodules distributed along
bronchovascular bundles in lower lung zones. Total extent of parenchymal abnormalities on CT scans was 50% (consolidation, 40%; nodule, 10%).
B, Nine-month follow-up CT scan obtained at similar level to panel A shows decreased extent of parenchymal lesions. Total extent of remaining lung lesions was 30%
(ground-glass opacification, 20%; reticulation, 10%). Note associated traction bronchiectasis (arrows) in both lower lobes. Remaining abnormalities are suggestive of
fibrotic nonspecific interstitial pneumonia.

showed no change in disease extent, and none
of the patients exhibited interval progression.
The mean follow-up period for the patients
whose disease had completely disappeared
was 6 ± 2.3 months (range, 2–9 months), and
that for the patients with remaining disease
was 23 ± 33.6 months (range, 5–135 months).
The most common CT findings on follow-up
CT scans were GGO (observed in 16 patients
[73%]), followed by reticulation (observed in
11 patients [50%]).
Among the 16 (73%) patients who had re-
maining disease on follow-up CT scans, 10
patients (63%) showed a pattern of lung ab-
normalities most similar to that of fibrotic
NSIP (Fig. 2). The principal findings were
GGO and reticulation involving predomi-
nantly subpleural and basal lungs. Traction
bronchiectasis was noted in two of these 10
patients. The 10 patients exhibited neither
consolidation nor honeycombing. In two pa-
tients (13%), CT findings composed by only
GGO without any predominance in distri-
bution, although nonspecific, reminded the
observer of hypersensitivity pneumonitis.
In another two patients (13%), honeycomb-
ing with lower lung zone predominance
was noted; thus, the CT findings were most
similar to the UIP pattern (Fig. 3). Traction
bronchiectasis was also present in these two
patients. One patient each (6%) showed a
cellular NSIP pattern (subpleural and lower
lung zone–predominant GGO, with little re-
ticulation and without traction bronchiecta-
sis) and residual COP pattern on their follow-
up CT scans, in the opinion of the reviewers.
In the last case, in which the residual disease
was finally classified as cellular NSIP, the
two observers had different ideas about the
remaining lesion pattern—one classified it
as continuing COP, and the other classified it
as cellular NSIP pattern.
Clinical Outcomes of Patients
All 22 patients had begun a course of cor-
ticosteroid treatment a median of 3 months
(range, 1–24 months) from symptom onset.
Two of 22 patients (9%) had clinically recur-
ring COP. Both of the patients survived, and
their final follow-up periods were 147 and 72
months, respectively. In the former patient,
follow-up CT scans obtained 135 months af-
ter the initial scan revealed several new sub-
pleural nodular lesions in both upper lobes,
in addition to the usual interstitial pneumo-
nialike fibrosis in the middle and lower lung
zones. The latter patient was deemed cured
on the final available follow-up CT scans.
Afterward, the patient had several episodes
of relapse and exhibited an interval increase
in the extent of bilateral parenchymal opaci-
ties, with lower lung zone predominance on
the final follow-up chest radiographs.
Six patients were lost to clinical long-term
follow-up, and the remaining 16 patients
were still surviving. None of the patients
died of COP, or for any other reason.
Interrelationship Between Imaging
and Laboratory Findings
Neither clinical information nor the pattern
of parenchymal abnormalities on the initial
CT scans differed significantly between the
two groups (patients with complete disappear-
ance of lung lesions on follow-up CT [n = 6]
and with remaining lung abnormalities [n =
16]; p > 0.05). None of the variables on the
initial CT findings helped to predict the fol-
low-up CT finding results (Table 3). The ini-
tial FVC (percentage of predicted value) and
initial DLCOSB (percentage of predicted val-
ue) results for patients with completely re-
solved disease were significantly higher than
those of patients with remaining disease (p <
0.05) (Table 3).
Discussion
It has been shown that most patients who
respond to corticosteroids show complete
clearing or are left with small residual opaci-
ties [2]. If reticular opacities are the initial ra-
diographic findings in patients with COP, the
patient is less likely to respond to corticoster-
oids and may progress to lung fibrosis [11]. In
our study, four patients exhibited reticulation
on their initial CT images. These four pa-
tients had remaining diseases on their follow-
up CT scans (mean follow-up period, 15
months; range, 5–55 months), three patients
exhibited decreased extent of abnormalities,
and one patient manifested unchanged dis-
ease extent. However, unlike a previous study
[11], in the present study, the pattern of paren-
chymal abnormalities on the initial CT scans
clearly did not constitute a prognosis-deter-
mining factor on a univariate or multivariate
analysis. We cannot explain the difference in
results between the previous study and ours.

AJR:195, October 2010 919

 Lee et al.

In the previous study [11], the results were
based on chest radiographic finding analyses,
not on CT examination results, as in ours. In
addition, in both studies, the number of pa-
tients included was small.
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In our study, six patients (27%) had en-
tered complete remission on follow-up CT
examination. To the best of our knowledge,
there has been no study thus far regarding
the follow-up CT findings in COP. In a previ-
ous study [12], 24 of 50 patients (48%) man-
ifested completely normal follow-up chest
radiographs. In another study dealing with
12 immunocompromised patients with orga-
nizing pneumonia [13], five patients (42%)

A B

C D

E F
Fig. 3—35-year-old man with cryptogenic organizing pneumonia showing decrease in total extent of disease (improvement) but remaining disease.
A–C, Transverse thin-section (1.0-mm section thickness) CT scans obtained at levels of trachea (A), superior segmental bronchi of lower lobes (B), and liver dome (C),
respectively, show bilateral consolidation, ground-glass opacification (GGO), and nodules of lower lung zone and subpleural distribution. Total extent of parenchymal
abnormalities on CT scans were 70% (consolidation, 40%; GGO, 20%; nodules, 10%).
D–F, Follow-up CT scans (135 months) obtained at similar levels to panels A, B, and C, respectively, show decreased extent of parenchymal lesions. Total extent of
remaining lesions was 40% (GGO, 20%; reticulation, 10%; honeycombing [arrows], 10%). Remaining abnormalities show subpleural and lower lung zone predominance
and simulate usual interstitial pneumonia pattern.

920 AJR:195, October 2010

 High-Resolution CT of Cryptogenic Organizing Pneumonia

TABLE 3:  Comparison of Clinical, Imaging, and Pulmonary Function Test Findings Between Patients With Complete
Disappearance and Remaining Disease
Patients With Complete Patients With Remaining
Parameter Disappearance (n = 6) Disease (n = 16) p
Clinical information
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Men, no. (%) of patients 1 (17) 6 (38) 0.616

Smokers, no. (%) of patients 1 (17) 4 (25) 1.000
Age (y) 50 ± 12.0 53 ± 11.2 0.800
Duration from onset of symptom to treatment (mos) 5 ± 3.9 4 ± 5.6 0.331
CT findings
Total extent (%) 45 ± 26.6 58 ± 20.4 0.189
Consolidation (%) 13 ± 12.1 24 ± 15.9 0.157
Ground-glass opacification (%) 28 ± 31.9 29 ± 23.9 0.822
Nodule (%) 3 ± 5.2 3 ± 4.8 0.964
Reticulation (%) 0 3 ± 4.5 0.205
Honeycombing (%) 0 0 1.000
Pulmonary function test findings
Forced vital capacity (% of predicted value) 93 ± 7.2 58 ± 16.2a 0.001b
Single-breath carbon monoxide diffusing capacity of the lung (% of predicted value) 86 ± 15.8 65 ± 14.2c 0.038b
Arterial oxygen tension at room air (mm Hg) 88 ± 12.6d 76 ± 17.0e 0.133
Note—Except where noted, data are mean ± SD.
aData were available for 13 patients.
bStatistically significant.
cData were available for seven patients.
dData were available for four patients.
eData were available for 11 patients.

exhibited complete resolution in follow-up
radiographs obtained at a mean of 15 weeks.
Of the 12 patients, four had available follow-
up CT scans, and all four patients had re-
maining disease as shown by such findings
as focal reticulation, nodules, consolidation,
or GGO.
There were two patients (9%) in our study
whose follow-up clinical status showed some
progression of disease after the stable period,
which is suggestive of relapse. One patient
showed no change in the extent of parenchymal
opacity between the initial and final follow-up
radiographs. The other patient had a slightly in-
creased extent of parenchymal opacity between
the initial and final follow-up radiographs. The
proportion (9%) of relapsed COP cases in the
current study is comparable to that reported in
some previous studies [9, 14]. However, in the
other studies, more than half of the patients
with COP had relapsed disease [7, 15]. Larger-
scale and prospective studies will be required
to search for relapse rates and to detect any cor-
relation between relapse and remaining disease
on follow-up CT scans.
In 10 patients (63% of 16 patients who had
remaining disease), the findings of follow-up
CT scans reminded the observers of fibrotic
NSIP. The principal findings indicated that the
remaining diseases were GGO and reticula-
tion, predominantly involving the subpleural or
basal lungs. The findings revealed neither con-
solidations nor honeycombing. It is interesting
to note that the remaining lung findings of
COP, even after corticosteroid treatment, mim-
ic those of fibrotic NSIP. To the best of our
knowledge, this is the first report to specifically
address the follow-up CT findings. It is impor-
tant, however, to note that the follow-up assess-
ments were based only on the experienced ob-
servers’ best estimate of the CT pattern.
Radiologic-pathologic correlation would be
necessary to confirm these opinions regarding
treated patients with COP.
It should also be elaborated that the im-
aging findings of NSIP are diverse [16, 17].
The patterns of lung abnormalities in NSIP
range from consolidation or GGO to retic-
ulation. Therefore, the similarities between
the CT findings of residual COP and NSIP
may not be unexpected news. Moreover,
there is potential difficulty in separating
COP and NSIP histopathologically [18]. Be-
cause half of NSIP biopsy specimens contain
areas of organizing pneumonia component
at the time of diagnosis, it may be possible
that some of the cases of COP in our series
might have been misdiagnosed and may, in
fact, have represented NSIP.
To our knowledge, there have been no stud-
ies thus far conducted in which a correlation
was drawn between the physiologic data and
the follow-up CT results. In one study [7], no
significant difference was detected between
nonrelapsing and relapsing groups in terms
of PFT results. In our study, the initial FVC
and initial DLcoSB values of patients with
completely resolved disease were signifi-
cantly higher than those for patients with re-
maining disease. Additionally, one important
finding on PFT results is that, although sev-
eral patients had fibrotic pattern of NSIP on
follow-up HRCT scans, there was no evidence
of any crucial decline in pulmonary function.
This study has some limitations. First, the
study design was retrospective. Second, the
number of patients included in the study was
rather small. Only 22 of the original 32 pa-
tients with biopsy-proven COP were includ-
ed in the study. The remaining 10 patients
did not have follow-up CT examinations.
This may have introduced a major bias into
the investigation, because those patients who
did not undergo follow-up CT examinations

AJR:195, October 2010 921


may have done extremely well clinically and
may not have had residual disease. Third, the
follow-up intervals varied, with the shortest
follow-up period being only 2 months, and
this may have affected the relapse data [7].
In conclusion, although COP is a disease
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generally associated with good prognoses,
the majority of patients (73%) with COP
manifest signs of remaining disease of in-
terstitial lung disease pattern on follow-up
CT scans. When lesions remain, they largely
mimic the fibrotic NSIP pattern. Higher ini-
tial FVC and DLCOSB levels in patients with
COP may predict complete resolution of pa-
renchymal opacity on follow-up CT scans.
Recurrence after corticosteroid treatment
occurs in approximately 10% of patients.
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