The role of chest CT in deciphering interstitial lung involvement: systemic sclerosis versus COVID-19

Abstract

Objective To identify the main computed tomography (CT) features that may help distinguishing a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc) from COVID-19 pneumonia. Methods This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study. Results Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p < 0.0001) and signs of fibrosis in GGO in the lower lobes (p < 0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. A predictive score was created which resulted positively associated with the COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity). Conclusion The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination the proposed score and the radiologic expertise. The presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.

High-Resolution Computed Tomography: Lights and Shadows in Improving Care for SSc-ILD Patients

“…However, if subtle ground-glass opacities or fine reticulations are present on supine images, a second acquisition, with the patient in a prone position, can be acquired to differentiate gravity-related interstitial alterations in dependent areas of the lung from disease-related alterations (Figure 2). As systemic sclerosis typically affects the posterior and basal portions of the lungs, this is of particular importance [46,[54][55][56]. This acquisition can be volumetric or sequential and can be limited to the lower lobes [56].…”

Laser Speckle Contrast Analysis: Functional Evaluation of Microvascular Damage in Connective Tissue Diseases. Is There Evidence of Correlations With Organ Involvement, Such as Pulmonary Damage?

“…Microvascular damage and dysfunction are the earliest morphological and functional markers of several connective tissue diseases, including SSc and SLE (Cutolo et al, 2014(Cutolo et al, , 2018Soulaidopoulos et al, 2017;Pauling et al, 2019;Perelas et al, 2020;Orlandi et al, 2021;Ruaro et al, 2021). This makes morphological and functional assessment of the peripheral microvasculature a must for the diagnosis, prognosis and evaluation of specific therapeutic effects in patients with connective tissue disorders (Cutolo et al, 2014(Cutolo et al, , 2018Soulaidopoulos et al, 2017;Pauling et al, 2019;Perelas et al, 2020;Orlandi et al, 2021;Ruaro et al, 2021).…”

“…Microvascular damage and dysfunction are the earliest morphological and functional markers of several connective tissue diseases, including SSc and SLE (Cutolo et al, 2014(Cutolo et al, , 2018Soulaidopoulos et al, 2017;Pauling et al, 2019;Perelas et al, 2020;Orlandi et al, 2021;Ruaro et al, 2021). This makes morphological and functional assessment of the peripheral microvasculature a must for the diagnosis, prognosis and evaluation of specific therapeutic effects in patients with connective tissue disorders (Cutolo et al, 2014(Cutolo et al, , 2018Soulaidopoulos et al, 2017;Pauling et al, 2019;Perelas et al, 2020;Orlandi et al, 2021;Ruaro et al, 2021). Indeed, laser speckle technique is able to detect significant reductions in PBP in connective tissue diseases patients, where PBP is specifically impaired in those areas typically affected by Raynaud's phenomenon, i.e., the fingertips, periungual and palm areas, with early complications such as DU (Ruaro et al, 2015;Barsotti et al, 2020), correlated to a more advanced microvascular anatomical damage (Ruaro et al, 2014).…”

High-Resolution Computed Tomography and Lung Ultrasound in Patients with Systemic Sclerosis: Which One to Choose?

“…Systemic sclerosis (SSc) is an autoimmune disease that affects multiple organ systems, including the lungs [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Interstitial lung disease (ILD) is a common manifestation in systemic sclerosis (SSc) and, despite continuous advances in treatment, remains the major cause of death in SSc patients [ 1 , 2 , 3 , 4 ].…”

“…It is of utmost importance to detect ILD in its very early stages so as to be able to choose the correct treatment regimen [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Imaging plays a central role in the management of systemic sclerosis-associated interstitial lung disease (SSc-ILD), and chest high-resolution computed tomography (HRCT) is currently considered the ‘gold standard’ for establishing an ILD diagnosis [ 14 , 15 , 16 , 17 , 18 ]. In early-stage SSc, the most frequent HRCT pattern is nonspecific interstitial pneumonia (NSIP), with predominant ground-glass opacity (GGO) and reticular abnormality.…”