Lung fibrosis - semiquantitative grading by Warrick et al.

Warrick classification of lung involvement in interstitial lung disease is a quantitative scoring method of disease extent and severity. The grading involves the following features of the disease:

Feature Grading
Global disease extent Estimated to the nearest 5%
Extent of reticulation Proportion of total disease extent
Extent of ground-glass Proportion of total disease extent
Coarseness of reticulation
  • normal: 0
  • fine intralobular fibrosis: 1
  • microcystic honeycombing: 2
  • macrocystic honeycombing: 3

The features are assessed at five levels:

  1. Origin of the great vessels
  2. Main carina
  3. Pulmonary venous confuence
  4. Halfway between levels 3 and 5
  5. Immediately above the right hemidiaphragm

Total disease extent corresponds to the mean of the percentage of disease at each level.

References:

1. Warrick JH, Bhalla M, Schabel SI, Silver RM. High resolution computed
tomography in early scleroderma lung disease. J Rheumatol 1991;18:1520-28.
2. Assayag D., Kaduri S., Hudson M., Hirsch A., Barton M. High Resolution Computed Tomography Scoring Systems for Evaluating Interstitial Lung Disease in Systemic Sclerosis Patients. Rheumatology 2012;S1:003.
3. Sterclova M., Vasakova M. Quantification of parenchymal involvement in patients with fibrosing interstitial lung diseases. Ces Radiol 2013;67(3):204-208.

Updated 30/10/2013 14:17 by Lambert