Abstract
BackgroundInterstitial lung disease (ILD) and its rapid progression (RP) are the main contributors to unfavourable outcomes of patients with idiopathic inflammatory myopathy (IIM). This study aimed to identify the clinical value of PET/CT scans in IIM-ILD patients and to construct a predictive model for RP-ILD.MethodsAdult IIM-ILD patients who were hospitalized at four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZJU), from 1 January 2017 to 31 December 2020 were reviewed. PET/CT scans and other characteristics of patients who met the inclusion and exclusion criteria were collected and analysed.ResultsA total of 61 IIM-ILD patients were enrolled in this study. Twenty-one patients (34.4%) developed RP-ILD, and 24 patients (39.3%) died during follow-up. After false discovery rate (FDR) correction, the percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.014), bilateral lung mean standard uptake value (SUVmean, P = 0.014) and abnormal mediastinal lymph node (P = 0.045) were significantly different between the RP-ILD and non-RP-ILD groups. The subsequent univariate and multivariate logistic regression analyses verified our findings. A “DLM” model was established by including the above three values to predict RP-ILD with a cut-off value of ≥ 2 and an area under the curve (AUC) of 0.905. Higher bilateral lung SUVmean (P = 0.019) and spleen SUVmean (P = 0.011) were observed in IIM-ILD patients who died within 3 months, and a moderate correlation was recognized between the two values.ConclusionsElevated bilateral lung SUVmean, abnormal mediastinal lymph nodes and decreased DLCO% were significantly associated with RP-ILD in IIM-ILD patients. The “DLM” model was valuable in predicting RP-ILD and requires further validation.
Highlights
Interstitial lung disease (ILD) is a frequent complication in patients with idiopathic inflammatory myopathy, showing a predominantly non-specific interstitial pneumonia (NSIP) pattern in histopathological findings [1–3]
From 1 January 2017 to 31 December 2020, 274 adult idiopathic inflammatory myopathy (IIM)-ILD patients were admitted to the Qingchun, Chengzhan, Zhijiang and Yuhang divisions of FAHZJU
All of the rapid progression (RP)-ILD events were identified after taking PET/CT scans
Summary
Interstitial lung disease (ILD) is a frequent complication in patients with idiopathic inflammatory myopathy, showing a predominantly non-specific interstitial pneumonia (NSIP) pattern in histopathological findings [1–3]. Elevated pulmonary FDG uptake predicted the progression of SSc-ILD [13]. Two small-sample cohort studies found that FDG uptake (maximum standard uptake value, SUVmax) in the lung was correlated with ILD severity and might predict the occurrence of RP-ILD [15, 16]. A systemic evaluation of FDG uptake in IIM-ILD patients is necessary to acquire a broader view of the clinical value of PET/CT scans in IIM-ILD. Interstitial lung disease (ILD) and its rapid progression (RP) are the main contributors to unfavourable outcomes of patients with idiopathic inflammatory myopathy (IIM). This study aimed to identify the clinical value of PET/CT scans in IIM-ILD patients and to construct a predictive model for RP-ILD
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