# UIP HRCT — ATS/ERS/JRS/ALAT HRCT pattern classification for usual interstitial pneumonia

> Classifies one technically adequate HRCT as UIP, probable UIP, indeterminate for UIP, or suggestive of an alternative diagnosis. The pattern is morphology, not etiology: UIP can occur outside idiopathic pulmonary fibrosis, and no category alone diagnoses IPF, predicts an individual course, orders biopsy, or starts antifibrotic therapy.

**Situação:** vigente · **Órgão:** Tórax · **Órgão emissor:** ATS / ERS / JRS / ALAT · **Versão:** 2018 four-pattern framework; 2022 diagnostic update; 2025 multidisciplinary terminology context · **Ano:** 2018

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: CT
- Fonte primária: Raghu G, Remy-Jardin M, Myers JL, et al.. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline (2018) — https://www.thoracic.org/statements/resources/interstitial-lung-disease/diagnosis-IPF-full-length.pdf
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Classify the CT pattern, then reason about etiology and diagnosis. Pattern, diagnosis, prognosis, sampling and treatment are separate agent outputs.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| uip | UIP pattern | UIP HRCT pattern: subpleural and basal-predominant fibrosis, often heterogeneous, with honeycombing. Peripheral traction bronchiectasis or bronchiolectasis may coexist; mild ground-glass opacity may coexist but must not be the dominant abnormality. A dominant alternative distribution or feature prevents an uncomplicated UIP assignment. | After medication, exposure and connective-tissue-disease causes have been assessed, an HRCT UIP pattern in an appropriate IPF diagnostic setting generally avoids lung biopsy solely to prove UIP and should be integrated in multidisciplinary discussion. It does not itself start antifibrotic therapy, select transplant evaluation or exclude treatment for another cause. | UIP morphology strongly supports histopathologic UIP in the intended population, but it is not synonymous with idiopathic pulmonary fibrosis and is not a calibrated individual prognosis. Secondary UIP-pattern disease and acute superimposed processes remain possible. | Raghu et al. 2018 official guideline, DOI 10.1164/rccm.201807-1255ST, Table 4 UIP column and diagnostic recommendations; Raghu et al. 2022, PMC9851481, UIP can occur in HP, CTD or exposure-related ILD and updated diagnostic algorithm; Ryerson et al. 2025, DOI 10.1183/13993003.00158-2025, multidisciplinary pattern context. | ✓ |
| probable-uip | Probable UIP pattern | Probable UIP HRCT pattern: subpleural and basal-predominant, often heterogeneous reticulation with peripheral traction bronchiectasis or bronchiolectasis, no honeycombing, and no dominant feature suggesting an alternative diagnosis. Mild ground-glass opacity may be present but is not predominant. | The 2022 update permits a confident IPF diagnosis without histologic sampling in an appropriate clinical setting after multidisciplinary discussion. This is not a universal no-biopsy instruction: exposure and CTD assessment, diagnostic confidence, patient procedural risk and whether tissue would change care determine further testing. | Many patients in the intended older, clinically suspected IPF population have histopathologic UIP, but predictive value changes with age and competing etiologies. Probable UIP neither proves IPF nor means a more favorable or less advanced disease than UIP. | Raghu et al. 2018, DOI 10.1164/rccm.201807-1255ST, Table 4 probable-UIP column and pp e49-e50; Raghu et al. 2022, DOI 10.1164/rccm.202202-0399ST, PMC9851481, probable-UIP diagnostic pathway and no-biopsy-in-appropriate-context update. | ✓ |
| indeterminate | Indeterminate for UIP | Indeterminate for UIP: fibrosis is present but the examination meets neither UIP nor probable-UIP criteria and has no feature set that specifically suggests an alternative diagnosis. It includes subtle subpleural reticulation with or without mild ground-glass opacity or distortion sometimes described as an early UIP pattern, once dependent atelectasis has been excluded when necessary. | Clarify technique and dependent opacity, complete the etiologic work-up and use multidisciplinary discussion. BAL, cryobiopsy, surgical biopsy or surveillance may be considered only when case-specific diagnostic value exceeds risk; indeterminate does not automatically mandate tissue sampling or empiric IPF therapy. | The category expresses unresolved morphology, not intermediate clinical severity or a fixed probability of IPF. Histopathologic UIP, another fibrotic ILD or an early/limited process can underlie it, and one CT cannot establish progression or prognosis. | Raghu et al. 2018, DOI 10.1164/rccm.201807-1255ST, Table 4 and indeterminate-for-UIP section including prone confirmation of subtle dependent subpleural opacity; Raghu et al. 2022, PMC9851481, diagnostic combinations and TBLC boundary. | ✓ |
| alternative | Alternative diagnosis | Suggestive of an alternative diagnosis: a dominant feature or distribution such as marked mosaic attenuation or extensive air trapping, predominant ground-glass opacity, cysts, profuse micronodules or centrilobular nodules, consolidation, peribronchovascular/perilymphatic or upper/mid-lung predominance, subpleural sparing, or supportive pleural/extrapulmonary clues. | Name the leading alternative and pursue disease-specific clinical, exposure, serologic, bronchoalveolar or tissue evaluation through multidisciplinary review. The category neither proves one alternative disease nor automatically excludes IPF, and it cannot independently select immunosuppression, antifibrotic therapy or biopsy. | These findings reduce confidence that the CT represents uncomplicated IPF-pattern UIP and can point toward fibrotic hypersensitivity pneumonitis, CTD-ILD, fibrotic NSIP, sarcoidosis, asbestos-related disease or another cause. The category is diagnostic direction, not a severity or survival tier. | Raghu et al. 2018, DOI 10.1164/rccm.201807-1255ST, Table 4 alternative-diagnosis column and examples; Raghu et al. 2022, PMC9851481, radiographic UIP and etiologic boundary; Ryerson et al. 2025, DOI 10.1183/13993003.00158-2025. | ✓ |

### Citações por categoria
- **uip**: Raghu G, Remy-Jardin M, Myers JL, et al.. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline (2018) — https://www.thoracic.org/statements/resources/interstitial-lung-disease/diagnosis-IPF-full-length.pdf · Raghu et al. 2018 official guideline, DOI 10.1164/rccm.201807-1255ST, Table 4 UIP column and diagnostic recommendations; Raghu et al. 2022, PMC9851481, UIP can occur in HP, CTD or exposure-related ILD and updated diagnostic algorithm; Ryerson et al. 2025, DOI 10.1183/13993003.00158-2025, multidisciplinary pattern context.
- **probable-uip**: Raghu G, Remy-Jardin M, Myers JL, et al.. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline (2018) — https://www.thoracic.org/statements/resources/interstitial-lung-disease/diagnosis-IPF-full-length.pdf · Raghu et al. 2018, DOI 10.1164/rccm.201807-1255ST, Table 4 probable-UIP column and pp e49-e50; Raghu et al. 2022, DOI 10.1164/rccm.202202-0399ST, PMC9851481, probable-UIP diagnostic pathway and no-biopsy-in-appropriate-context update.
- **indeterminate**: Raghu G, Remy-Jardin M, Myers JL, et al.. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline (2018) — https://www.thoracic.org/statements/resources/interstitial-lung-disease/diagnosis-IPF-full-length.pdf · Raghu et al. 2018, DOI 10.1164/rccm.201807-1255ST, Table 4 and indeterminate-for-UIP section including prone confirmation of subtle dependent subpleural opacity; Raghu et al. 2022, PMC9851481, diagnostic combinations and TBLC boundary.
- **alternative**: Raghu G, Remy-Jardin M, Myers JL, et al.. Diagnosis of Idiopathic Pulmonary Fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline (2018) — https://www.thoracic.org/statements/resources/interstitial-lung-disease/diagnosis-IPF-full-length.pdf · Raghu et al. 2018, DOI 10.1164/rccm.201807-1255ST, Table 4 alternative-diagnosis column and examples; Raghu et al. 2022, PMC9851481, radiographic UIP and etiologic boundary; Ryerson et al. 2025, DOI 10.1183/13993003.00158-2025.

## Referências cruzadas
- _fronteira compartilhada_ → [RSNA COVID — RSNA chest CT reporting categories for acute COVID-19 pneumonia](https://radcommons.laudos.ai/systems/rsna-covid.md) — UIP categories describe a chronic fibrotic background; RSNA COVID categories describe acute pneumonia typicality. New ground-glass opacity can be an acute overlay, and neither system may be translated into the other.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2025-12-04 | revised | The current ERS/ATS interstitial-pneumonia statement expanded multidisciplinary pattern terminology beyond idiopathic disease and emphasized diagnostic confidence without converting UIP morphology into a single etiology. | confirmed |
| 2022-05-01 | revised | The ATS/ERS/JRS/ALAT update retained the four HRCT patterns, allowed probable UIP to support an IPF diagnosis without biopsy in the appropriate multidisciplinary clinical setting, and conditionally accepted TBLC as an SLB alternative in experienced centers. | confirmed |
| 2018-09-01 | published | 2018 ATS/ERS/JRS/ALAT clinical practice guideline for the diagnosis of idiopathic pulmonary fibrosis published, refining the HRCT pattern categories. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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