High resolution computed tomography in systemic sclerosis. Real diagnostic utilities in the assessment of pulmonary involvement and comparison with other modalities of lung investigation

Abstract

The real utility of high resolution computed tomography (HRCT) for early detection of lung involvement was investigated in eighteen patients affected with systemic sclerosis (SSc). The results obtained from HRCT have been compared with traditional (chest radiographs, pulmonary function tests (PFT)) and nontraditional (ventilation and perfusion scintiscan) modalities of lung investigation. A significant statistical correlation (p < 0.001) between HRCT scans and chest radiographs was observed. Moreover, HRCT was more sensitive in the detection of early pulmonary interstitial involvement and more accurate in the assessment of interstitial fibrosis in cases with severe lung involvement. A statistical correlation (P < 0.001) between HRCT and the modalities of investigation of alveolo-capillary membrane--as PFT and ventilation scintiscan--was also observed. These results indicate that in SSc HRCT may be a useful technique for assessing early pulmonary involvement and for complementing other methodologies of investigation of lung function.

Regional differences in bronchoalveolar lavage and thoracic high‐resolution computed tomography results in dyspneic patients with systemic sclerosis

“…In the absence of associated airway changes (such as traction bronchiectasis or bronchiolectasis), groundglass opacification of the lung identified on HRCT corresponds to histologic evidence of alveolar inflammation in patients with chronic diffuse infiltrative lung disease (12,29). In this setting, ground-glass opacification seems to precede the HRCT appearance of honeycombing, supporting the notion that alveolitis precedes irreversible fibrosis.…”

“…HRCT is more sensitive in detecting the pulmonary parenchymal changes of ILD than is projectional chest radiography (29)(30)(31). HRCT evidence of ILD is present in up to 91% of SSc patients, similar to the percentage of patients with SSc who have pulmonary fibrosis on postmortem examination (12,31).…”

“…Typical interstitial abnormalities identified on HRCT include thickened interlobular septa, subpleural lines and parenchymal bands, architectural distortion, subpleural cysts, and honeycomb lung formation. Additional findings include subpleural micronodules, small airway ectasia (bronchiectasis and bronchiolectasis), and ground-glass opacification (12,25,29).…”

High Resolution Computed Tomography Scoring Systems for Evaluating Interstitial Lung Disease in Systemic Sclerosis Patients

“…Semi-quantitative scores were not used to evaluate progression in this case [27]. Variations of this method also used by Pignone et al [2]; Davas et al [10]; Shahin et al [11]; Giacomelli et al [12]; Shah et al [13]; Gohari Moghadam [14]. …”

“…It is a much more sensitive diagnostic test than traditional chest radiograph, especially for detection of early or mild disease [2,3]. The most common radiologic pattern of lung disease in SSc is diffuse parenchymal lung disease characterized by prominent ground-glass opacities and fine interstitial reticular markings with lower lung predominance.…”