In suspected interstitial lung disease, which imaging modality provides the greatest sensitivity?

• A. High-resolution CT (HRCT) of the chest
• B. Chest radiography
• C. MRI of the chest
• D. Ultrasound of the chest

Answer: (A)

Detecting interstitial lung disease relies on visualizing subtle changes in the lung parenchyma. High-resolution CT uses very thin slices and high spatial resolution, allowing it to pick up early and small interstitial abnormalities—such as reticulation, ground-glass opacity, and early honeycombing—that chest radiographs often miss. MRI isn’t ideal for lung parenchyma because air-tissue interfaces give poor signal and motion/artifact limits quality, and ultrasound cannot assess the air-filled lungs effectively. So, the imaging modality with the greatest sensitivity for suspected ILD is high-resolution CT of the chest.