High-resolution Computed Tomography Abnormalities Research Articles

Circulating Biomarkers and Disease Activity in Systemic Sclerosis-Associated Interstitial Lung Disease

Background: Systemic sclerosis-associated interstitial lung disease (SSc-ILD) is a major cause of death in SSc patients. Several studies have reported that serum anti-Scl-70, Krebs von Lungren-6 (KL-6), and surfactant protein D (SP-D) levels are associated with the presence and progression of ILD in SSc patients. Objective: To examine the correlation between levels of these serum biomarkers and disease severity determined by baseline dyspnea index (BDI), high-resolution computed tomography (HRCT) score, and pulmonary function tests. Materials and Methods: The present study was a single-center, cross-sectional study. Serum anti-Scl-70, KL-6, and SP-D from 20 SSc-ILD patients and five non-ILD subjects were measured. The BDI, HRCT score, and pulmonary function tests were used to assess the severity of ILD in SSc-ILD patients. HRCT abnormalities, including ground-glass opacity (GGO), fibrosis, and honeycombing, were scored by using the semi-quantitative scoring system. Results: Serum anti-Scl-70, KL-6, and SP-D in SSc-ILD patients were significantly higher than those in non-ILD subjects. There was a moderate correlation between diffusing capacity for carbon monoxide (DLCO) and serum KL-6 levels (r=–0.551, p=0.022), while the pulmonary fibrosis (PF) score exhibited a strong correlation with serum KL-6 levels (r=0.630, p=0.003). The PF score had a moderate negative correlation with forced vital capacity (FVC) (r=–0.515, p=0.034) and a strong negative correlation with total lung capacity (TLC) and DLCO (r=–0.625, p=0.007, and r=–0.762, p<0.001, respectively). Conclusion: The levels of serum KL-6, and SP-D are elevated in SSc-ILD patients. Serum KL-6 may be a useful non-invasive biomarker for the disease severity, as determined by DLCO and the extent of fibrosis on HRCT, in patients with SSc-ILD. Trial registration: Thai Clinical Trials Registry, TCTR20200314001, registered 13 March 2020, retrospectively registered at http://www.thaiclinicaltrials.org/show/TCTR20200314001 Keywords: Scleroderma; Systemic sclerosis; Interstitial pneumonia; Interstitial lung disease; Fibrosis; Biomarker

Lung Ultrasound and High-Resolution Computed Tomography in Suspected COVID-19 Patients Admitted to the Emergency Department: A Comparison.

To analyze the diagnostic accuracy of lung ultrasonography (LUS) and high-resolution computed tomography (HRCT), to detect COVID-19. This study recruited all patients admitted to the emergency medicine unit, due to a suspected COVID-19 infection, during the first wave of the COVID-19 pandemic. These patients also who underwent a standardized LUS examination and a chest HRCT. The signs detected by both LUS and HRCT were reported, as well as the sensitivity, specificity, positive predictive value, and negative predictive value for LUS and HRCT. This cohort included 159 patients, 101 (63%) were diagnosed with COVID-19. COVID-19 patients showed more often confluent subpleural consolidations and parenchymal consolidations in lower lung regions of LUS. They also had "ground glass" opacities and "crazy paving" on HRCT, while pleural effusion and pulmonary consolidations were more common in non-COVID-19 patients. LUS had a sensitivity of 0.97 (95% CI 0.92-0.99) and a specificity of 0.24 (95% CI 0.07-0.5) for COVID-19 lung infections. HRCT abnormalities resulted in a 0.98 sensitivity (95% CI 0.92-0.99) and 0.1 specificity (95% CI 0.04-0.23) for COVID-19 lung infections. In this cohort, LUS proved to be a noninvasive, diagnostic tool with high sensitivity for lung abnormalities that were likewise detected by HRCT. Furthermore, LUS, despite its lower specificity, has a high sensitivity for COVID-19, which could prove to be as effective as HRCT in excluding a COVID-19 lung infection.

Abatacept in rheumatoid arthritis-associated interstitial lung disease: short-term outcomes and predictors of progression

IntroductionInterstitial lung disease in rheumatoid arthritis (RA-ILD) is an extra-articular involvement that impairs the prognosis and for which there is still no well-coded treatment. The aim of this study was to evaluate abatacept (ABA) effectiveness and safety in patients with RA-ILD.MethodsRA-ILD patients who started ABA treatment were consecutively enrolled. Chest high-resolution computed tomography (HRCT), clinical, laboratory and respiratory function variables were collected at baseline and after 18 months of ABA treatment. HRCT abnormalities were evaluated using a computer-aided method (CaM). ABA response was established based on the change in the percentage of fibrosis evaluated at HRCT-CaM, dividing patients into “worsened” (progression ≥ 15%), “improved” (reduction ≥ 15%), and “stable” (changes within the 15% range). The multivariate regression model was used to assess the associations between RA characteristics and ABA response.ResultsForty-four patients (81% women, mean age 59.1 ± 8.0, mean disease duration of 7.5 ± 3.1 years) were studied. Five patients (11.4%) showed RA-ILD progression, 32 patients (72.6%) were considered stable, and 7 patients (16.0%) showed an RA-ILD improvement. The proportion of current smokers was significantly different between “worsened” patients, respect to those defined as "improved/stable” (p = 0.01). Current smoking habit (p = 0.005) and concomitant methotrexate treatment (p = 0.0078) were the two variables related to RA-ILD progression in multivariate regression analysis.ConclusionTreatment with ABA is associated with a RA-ILD stability or improvement in the 88.6% of patients. Current smoking habit and concomitant treatment with methotrexate are the modifiable factors associated with RA-ILD worsening.Key Points• Abatacept plays a favourable role in the control of RA-ILD, with a significant worsening in only 11.4% of patients during a 18-month follow-up period.• The predictive variables related to RA-ILD progression during abatacept therapy are the concomitant treatment with methotrexate and current smoking habit.

Guillian--Barre' Syndrome in Patients with SARS-CoV-2: A Multicentric Study from Maharashtra, India.

Background:Guillian--Barre' Syndrome (GBS) has been shown to be associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. The aim of our study was to study the clinical profile and outcomes of GBS in COVID-19 from the Western region of India, the State of Maharashtra.Methods:This was a retrospective, multicenter observation study from different hospitals in Maharashtra beginning from March 2020 until November 2020.Results:We report 42 patients with COVID-19 GBS. Mean age was 59 years (range, 24--85 years). 31/42 (73.8%) were men. GBS was the presenting symptom in 14/42 (33%), while six of them remained asymptomatic for COVID-19 despite positive SARS-CoV-2 on nasopharyngeal swab reverse transcriptase polymerase chain reaction. The median interval between COVID-19 and GBS was 14 days (SD + 11), with minimum of 1 and maximum 40 days. Clinical presentation was like that of typical GBS. Electrophysiological studies showed a predominant demyelinating pattern in 25/42 (59.5%). Inflammatory markers were elevated in 35/42 (83.3%) and 38/42 (90.5%) had an Abnormal high-resolution CT (HRCT) chest. 14/42 (33.3%) patients required a ventilator, with nine deaths. Intravenous immunoglobulin was the mainstay of treatment for GBS. Majority had a good outcome and were walking independently or with minimal support at discharge. In subgroup analysis, the postinfectious group had a better outcome than the parainfectious group.Conclusion:GBS in COVID-19 occurs as both parainfectious and postinfectious GBS. Parainfectious GBS needs more rigorous monitoring and may benefit from COVID-19 specific treatment. Routine screening for SARS-CoV-2 should be implemented in patients with GBS in view of the ongoing pandemic.

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae

BackgroundCOVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected. Research questionWe conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/or abnormalities in pulmonary function tests (PFT) or in lung imaging. Study designand methods: This is a single center cohort study including COVID-19 survivors who underwent a three-month follow-up with clinical evaluation, PFT and lung high-resolution computed tomography (HRCT). All clinical, functional, and radiological data were centrally reviewed. Multiple linear regression analysis was performed to identify factors associated with residual lesions on HRCT. ResultsFull clinical evaluation, PFT and lung HRCT were available for central review in 126, 122 and 107 patients, respectively. At follow-up, 25% of patients complained from dyspnea and 35% from fatigue, lung diffusion capacity (DLCO) was decreased in 45%, 17% had HRCT abnormalities affecting more than 5% of their lung parenchyma while signs of fibrosis were found in 21%. In multiple linear regression model, number of days in ICU were related to the extent of persisting lesions on HRCT, while intubation was associated with signs of fibrosis at follow-up (P = 0.0005, Fisher's exact test). In contrast, the severity of lung imaging or PFT changes were not predictive of fatigue and dyspnea. InterpretationAlthough most hospitalized COVID-19 patients recover, a substantial proportion complains from persisting dyspnea and fatigue. Impairment of DLCO and signs suggestive of fibrosis are common but are not strictly related to long-lasting symptoms.

Pulmonary findings on high-resolution computed tomography in Takayasu arteritis.

This study aimed to describe pulmonary high-resolution CT (HRCT) findings in Takayasu arteritis (TA) and to determine possible causes. A total of 243 TA patients were enrolled from a prospective cohort after excluding patients with other pulmonary disorders or incomplete data. Patients were divided into two groups: those with normal lung HRCT and those with abnormal lung HRCT. Clinical characteristics were compared between groups and binary logistic regression analysis was applied to identify possible causes of the lung lesions. Follow-up HRCT (obtained in 64 patients) was analysed to study changes in pulmonary lesions after treatment. Of the 243 patients, 107 (44.0%) had normal lung HRCT while 136 (56.0%) had abnormal lung HRCT, including stripe opacity (60.3%), nodules (44.9%), patchy opacity (25.0%), pleural thickening (15.4%), pleural effusion (10.3%), ground-glass opacity (8.1%), pulmonary infarction (6.6%), mosaic attenuation (4.4%), bronchiectasis (3.7%) and pulmonary oedema (2.2%). Patients with abnormal HRCT were significantly more likely to have type II arterial involvement (25% vs 12.2%, P = 0.04), pulmonary arterial involvement (PAI; 21.3% vs 5.6%, P < 0.001), pulmonary hypertension (20.6% vs 8.4%, P = 0.01) and abnormal heart function (27.9% vs 7.6%, P < 0.001). Logistic regression analysis demonstrated that PAI, worsened heart function and age were associated with presence of pulmonary lesions. Pulmonary infarction, pleural effusion and patchy opacities improved partially after treatment. Pulmonary lesions are not rare in patients with TA. Age, PAI and worsened heart function are potential risk factors for presence of pulmonary lesions in TA.

Rheumatoid arthritis patients with interstitial lung disease: Clinical, radiological and laboratory characteristics

BackgroundRheumatoid arthritis associated interstitial lung disease (RA-ILD) has a significant burden of morbidity and mortality. Aim of the workTo analyze clinical, radiological and laboratory characteristics of RA-ILD in an Egyptian cohort. Patients and methodsThe study included 160 RA patients. Detailed medical history, disease activity score (DAS28) and joint damage (Sharp score) were carefully recorded. Chest x-ray, high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs) were done and patients were sub-grouped as RA-ILD (HRCT or PFTs abnormalities) and RA without ILD. ResultsPatients were 136 (85%) females and 24 (15%) males with a mean age of 37.8 ± 11.3 years and disease duration of 4.98 ± 5.53 years. 50% of patients had chest manifestations suggestive of ILD. 60% demonstrated abnormalities in PFT and 63.75% in HRCT. The most common HRCT findings were reticulation (66.6%) and ground glass appearance (64.7%), followed by bronchiectasis (50.9%) and honey combing (46%). usual interstitial pneumonia (UIP) was the most common HRCT subtype (49%). RA-ILD patients were significantly older (p < 0.001), had longer disease duration (p < 0.001), more frequent arthritis (p = 0.002), higher DAS28 (p < 0.001) and Sharp score (p < 0.001), significantly positive rheumatoid factor (RF) (p = 0.007) and anti-citrullinated protein antibody (ACPA) (p < 0.001). ConclusionA high frequency of ILD among Egyptian patients is recorded due to careful evaluation of respiratory symptoms and valuable assessment by PFTs and HRCT chest. UIP is the most common radiologic pattern of RA-ILD. RA patients with ILD are significantly older with longer disease duration, delayed age at onset, high disease activity with arthritis and positive RF and ACPA.

Association between number and type of different ACPA fine specificities with lung abnormalities in early, untreated rheumatoid arthritis

BackgroundRheumatoid arthritis (RA)-associated anticitrullinated protein/peptide antibodies (ACPA) might originate at mucosal sites such as the lungs. We aimed to examine the relationship between the ACPA repertoire and lung abnormalities on...

Identification of Subclinical Lung Involvement in ACPA-Positive Subjects through Functional Assessment and Serum Biomarkers.

Lung involvement is related to the natural history of anti-citrullinated proteins antibodies (ACPA)-positive rheumatoid arthritis (RA), both during the pathogenesis of the disease and as a site of disease-related injury. Increasing evidence suggests that there is a subclinical, early lung involvement during the course of the disease, even before the onset of articular manifestations, which can potentially progress to a symptomatic interstitial lung disease. To date, reliable, non-invasive markers of subclinical lung involvement are still lacking in clinical practice. The aim of this study is to evaluate the diagnostic potential of functional assessment and serum biomarkers in the identification of subclinical lung involvement in ACPA-positive subjects. Fifty ACPA-positive subjects with or without confirmed diagnosis of RA (2010 ARC-EULAR criteria) were consecutively enrolled. Each subject underwent clinical evaluation, pulmonary function testing (PFT) with assessment of diffusion lung capacity for carbon monoxide (DLCO), cardiopulmonary exercise testing (CPET), surfactant protein D (SPD) serum levels dosage and high-resolution computed tomography (HRCT) of the chest. The cohort was composed of 21 ACPA-positive subjects without arthritis (ND), 10 early (disease duration < 6 months, treatment-naïve) RA (ERA) and 17 long-standing (disease duration < 36 months, on treatment) RA (LSRA). LSRA patients had a significantly higher frequency of overall HRCT abnormalities compared to the other groups (p = 0.001). SPD serum levels were significantly higher in ACPA-positive subjects compared with healthy controls (158.5 ± 132.3 ng/mL vs 61.27 ± 34.11 ng/mL; p < 0.0001) and showed an increasing trend from ND subjects to LSRD patients (p = 0.004). Patients with HRCT abnormalities showed significantly lower values of DLCO (74.19 ± 13.2% pred. vs 131.7 ± 93% pred.; p = 0.009), evidence of ventilatory inefficiency at CPET and significantly higher SPD serum levels compared with subjects with no HRCT abnormalities (213.5 ± 157.2 ng/mL vs 117.7 ± 157.3 ng/mL; p = 0.018). Abnormal CPET responses and higher SPD levels were also associated with specific radiological findings. Impaired DLCO and increased SPD serum levels were independently associated with the presence of HRCT abnormalities. Subclinical lung abnormalities occur early in RA-associated autoimmunity. The presence of subclinical HRCT abnormalities is associated with several functional abnormalities and increased SPD serum levels of SPD. Functional evaluation through PFT and CPET, together with SPD assessment, may have a diagnostic potential in ACPA-positive subjects, contributing to the identification of those patients to be referred to HRCT scan.

Transthoracic ultrasonographic features of typical high-resolution computed tomography signs of interstitial lung diseases

Objective: To investigate the accuracy of bedside transthoracic lung ultrasonography (TLU) in different typical high resolution computed tomography (HRCT) signs of interstitial lung diseases (ILDs). Methods: Fifty patients first diagnosed with ILDs were enrolled from January 2016 to December 2018. There were 21 males and 29 females. The mean age was (56±14) years(rang 42-73 years). TLU was performed in inspiration for the characters of A-lines and B-lines as well as pleural at anterior, lateral and dorsal chest walls, respectively. HRCT was selected at three levels according to the upper, middle, and lower lung fields. The range of each level needing to be evaluated corresponded to the TLU scanning field one by one, and recording the signs of HRCT. Early change of ILDs was definite as the HRCT score was no more than 1 and no honeycomb was present. The correlation between A-lines, B-lines, pleural abnormal and HRCT signs was evaluted. Spearman's correlation coefficient was used to evaluate the relationship between B-lines and HRCT score. Results: The sensitivity and specificity of A-lines for HRCT normality were 83.9% and 84.9%, respectively. Coincidence rate was 84.6%. The sensitivity and specificity of B-lines for HRCT abnormality were 84.9% and 83.9%, respectively. Coincidence rate was 84.6%. Interlobular septal thickening shadow had fewer B-lines and narrower interval than other HRCT signs, while the other HRCT signs had no differences in B-lines. And the sensitivity and specificity of B-lines for detection the early change of HRCT in ILDs were 89.5% and 89.2%, respectively. Coincidence rate was 89.3%. A positive correlation was found between the number of B-lines and HRCT scores (R=0.827, P<0.001), and the width of B-lines and HRCT score (R=0.951, P<0.001). Meanwhile, a negative correlation was found between the interval of B-lines and HRCT score (R=-0.831, P<0.001). The sensitivity and specificity of TLU for HRCT pleural abnormality were 100.0% and 90.0%, respectively. Coincidence rate was 93.6%. Conclusions: TLU showed high sensitivity and specificity in finding interstitial changes of the lung. It gives a new view on the diagnostic possibilities of ILDs and may be used to evaluate the severity and the therapeutic effect of treatment. However, TLU could not differentiate HRCT signs of ILDs.

Clinical features and high resolution CT imaging evolution of coronavirus disease 2019

Objective: To investigate the clinical manifestations of the clinical characteristics of 141 patients with coronavirus disease 2019 (COVID-19) and the imaging evolution characteristics of High Resolution CT (HRCT) in the chest. Methods: From January 20, 2020 to February 8, 141 COVID-19 patients in Renmin Hospital of Wuhan University, 77 males and 64 females, with a median age of 49 (9,87) , were retrospectively analyzed. The clinical features, laboratory examination indexes and HRCT evolution findings of 141 COVID-19 patients were analyzed. Results: Laboratory examinations of 141 COVID-19 patients showed a decrease in white blood cell count and lymphocyte ratio. Among the 141 patients with COVID-19, fever (>37.5℃) was the most common clinical manifestation in 139 cases (98.58%) , and occasionally non-respiratory symptoms such as diarrhea in 4 cases (2.84%) . 141 patients with COVID-19had abnormal HRCT. 52 (36.88%) chest HRCT images showed ground-glass opacity (GGO) , mainly under pleural; 23 (16.31%) GGO with focal consolidation; 27 (19.15%) small flaky shadows; 20 cases (14.18%) large flaky consolidation shadows; 48 cases (34.04%) bronchovascular bundle thickening and vascular penetrating signs; 5 cases (3.55%) had air bronchial signs; 7 cases (4.96%) of small nodule shadows; 5 cases (3.55%) of fibrosis, grid shadows or strand shadows.135 cases (95.74%) were positive for the first time nucleic acid test, 6 cases (4.26%) were negative, and 71 cases (50.35%) of common type, 47 cases (33.33%) of severe type and 23 cases (16.31%) of critical type were found during the same period. The average time from onset of each type to the first CT examination was: (2.51±1.32) , (5.02±2.01) , and (5.91±1.76) days; 19 (19/47, 40.43%) of which were severe for the first time CT classification worsened at the second examination and lessened at the third examination. 141 cases (100%) were positive for the second nucleic acid test, and the HRCT results for the same period were 44 cases (31.21%) of common type, 53 cases (37.59%) of severe type, and 44 cases (31.21%) of critical type; the average interval time was (3.32±1.61) , (3.93±1.84) , (4.15±1.57) days;the third nucleic acid test were positive among 113 cases and 28 cases were negative, HRCT results of the same period were 79 cases (56.03%) of common type, 46 cases (32.62%) of severe type, and 16 cases (11.35%) of critical type;the average interval from the first CT examination were: (5.59±1.83) , (7.32±1.37) , (7.55±1.78) days. The differences in CT typing at different time were statistically significant (P<0.05) . Conclusion: The clinical features of COVID-19 and HRCT images are diverse, extensive GGO and infiltrates in both lungs are typical. Viral nucleic acid tests usually occur earlier or at the same time as the CT examination positive, and there are false negatives in nucleic acid tests. In some epidemiological backgrounds, CT imaging manifestations and evolutionary characteristics are of great significance for early warning of lung injury, assessment of disease severity, and assistance in clinical typing and post-treatment follow-up.

SAT0101 ABATACEPT IN RHEUMATOID ARTHRITIS ASSOCIATED-INTERSTITIAL LUNG DISEASE: SHORT TERM OUTCOME AND PROGNOSTIC FACTORS

Background:The prevalence of interstitial lung disease (ILD) in rheumatoid arthritis (RA) varies in the medical literature from 1% to 67% and is a major cause of mortality. Previous works have identified increased age, smoking and anticytrullinated protein antibodies (ACPA) titre as risk factors for RA-ILD (RA-ILD). Conventional treatments for RA may lead to a new onset or worsening of RA-ILD, so treatment should be identified to prevent the onset or exacerbation of RA-ILD. Studies have shown that abatacept (ABA) may improve the outcome of RA-ILD.Objectives:The aim of our study is to evaluate ABA effectiveness and safety in patients with RA-ILD.Methods:We enrolled RA-ILD patients who started treatment with ABA. All patients underwent thoracic high-resolution computed tomography (HRCT) at the beginning of ABA treatment and after 18 months of therapy. HRCT abnormalities were evaluated using a a computer-aided method (CaM). At each visit clinical, laboratory and respiratory function characteristics were collected and the Clinical Disease Activity Index (CDAI) and the Health Assessment Questionnaire Disability Index (HAQ-DI) for disease activity and functional disability were measured. The cohort was divided into three groups based on the CaM-HRCT results: patients with a lung fibrosis progression of 15% or more were defined as “worsened”, those with a reduction of 15% or more were defined as “improved”, all other patients were defined as “stable”. The 15% threshold of change, derived from the CaM assessment, results from the determination of the standard deviation of the mean value change after 18 months of follow-up of the cohort. The multivariate regression model was used to assess the strength of the association between RA characteristics and HRCT response to ABA.Results:Forty-four patients (81% women) with a mean age of 59.1±8.0 years and a mean duration of the disease of 7.5±3.1 years were recruited. Twenty-three (52.3%) patients were positive for ACPA and 28 (63.6%) for rheumatoid factor. Five patients (11.4%) showed deterioration of ILD, 31 (70.6%) were in the “stable” group, and 7 patients (16.0%) experienced improvement over a mean follow-up period of 18 months. The factors related to ILD deterioration were use of methotrexate (MTX) (p=0.0078), and current smoking habit (p=0.0054), according to multivariate regression analysis (Table).Conclusion:Treatment with ABA is associated with an RA-ILD stability or improvement rate of 86.6% of patients, while the worsening rate is 11.4%. Concomitant treatment with MTX and current smoking habit are factors associated with RA-ILD worsening. MTX discontinuation and smoking cessation should be strongly promoted in patients with RA-ILD.

Progressive lung fibrosis and mortality can occur in early systemic sclerosis patients without pulmonary abnormalities at baseline assessment.

In systemic sclerosis, baseline extent of radiological involvement is an important outcome predictor and baseline absence of radiological involvement suggests a more favourable prognosis. As current predictive models are based on cohorts with variable disease duration, we aim to assess disease dynamics in early disease. Patients were included from the prospective longitudinal Belgian Systemic Sclerosis Cohort. We included patients with a disease duration < = 36months at baseline with available baseline thoracic high-resolution computed tomography (HRCT) images and longitudinal pulmonary function test (PFT) results until 42months of follow-up. Fifty-two patients were included; 50% were male and 44% suffered from diffuse cutaneous systemic sclerosis. A total of 46% carried anti-topoisomerase 1 antibodies. The mean disease duration at baseline visit was 11months. At baseline visit, 40.4% (21/52) patients had HRCT abnormalities. Patients with abnormal HRCT findings more frequently suffered from diffuse cutaneous systemic sclerosis (p < 0.05) and less frequently carried anti-centromere antibodies (p < 0.05). Patients without CT abnormalities at baseline had a shorter disease duration (9 ± 7months versus 14 ± 12months). After 42months, 8/52 patients, including 3 patients with normal HRCT findings at baseline, died due to SSc-related manifestations. Progression of lung fibrosis occurred in 16 patients at month 42, including 7 patients with normal CT at baseline. No clear predictors of progression could be identified. In early SSc patients, the disease dynamics differ from the large published cohorts. Progressive lung fibrosis and mortality can also occur in patients without radiological abnormalities at baseline. Key Points • Disease dynamics in early SSc differ from more established SSc. • In early SSc, progressive pulmonary fibrosis can occur in patients without CT abnormalities at baseline. • In early SSc, more stringent pulmonary follow-up is warranted both in lcSSc and dcSSc.

High-resolution CT features distinguishing usual interstitial pneumonia pattern in chronic hypersensitivity pneumonitis from those with idiopathic pulmonary fibrosis.

Radiologic diagnosis of chronic hypersensitivity pneumonitis (CHP) presenting a usual interstitial pneumonia (UIP) pattern is challenging. The aim of this study was to identify the high-resolution CT (HRCT) findings which are useful to discriminate CHP-UIP from idiopathic pulmonary fibrosis (IPF). This study included 49 patients with well-established bird-related CHP-UIP, histologically confirmed, and 49 patients with IPF. Two groups of observers independently assessed HRCT, evaluated the extent of each abnormal HRCT finding. When their radiological diagnosis was CHP-UIP, they noted the HRCT findings inconsistent with IPF. Correct CT diagnoses were made in 79% of CHP-UIP and 53% of IPF. Although no apparent difference was seen in the extent of each HRCT finding, upper or mid-lung predominance, extensive ground-glass abnormality, and profuse micronodules were more frequently pointed out as inconsistent findings in CHP-UIP than IPF (p = 0.007, 0.010, 0.001, respectively). On regression analysis, profuse micronodules [OR 13.34 (2.85-62.37); p = 0.001] and upper or mid-lung predominance of findings [OR 2.86 (1.16-7.01); p = 0.022] remained as variables in the equation. In this cohort, some IPF cases were misdiagnosed as CHP-UIP. Profuse micronodules and upper or mid-lung predominance are important clues for the differentiation of CHP-UIP from IPF.

Computed tomography assessment of evolution of interstitial lung disease in systemic sclerosis: Comparison of two scoring systems

BackgroundThe aim of this study was to evaluate and compare the internal and external responsiveness of a computed-aided method (CaM) with a conventional visual reader-based score (CoVR) to measure interstitial lung disease (ILD) in patients with systemic sclerosis (SSc) on high resolution computed tomography (HRCT). MethodsForty-five patients were evaluated in this retrospective cohort. HRCTs were collected at baseline and after 1 year. HRCT abnormalities were evaluated according to a CoVR (Warrick's method) and a quantitative CaM. Internal 1-year responsiveness was tested with a standardized mean response (SRM). Analyses of the receiver operating characteristic curves (ROCs) evaluated the sensitivity and specificity of the two methods to discriminate between clinically relevant progression and no relevant progression, using expert judgment as the gold standard (external responsiveness). ResultsIn one year, lung involvement was stable/improved in 17 of the 45 patients (37.8%) and worsened in 28 patients (62.2%). HRCT scores changed moderately over the follow-up period. Using SFM, CaM was significantly more responsive in detecting changes due to treatment than the CoVR method. Likewise, in the analysis of the ROC curve, CaM scores showed the highest performance (AUC ROC CaM vs. CoVR, 0.951 vs. 0.807; p = 0.0065). ConclusionQuantitative analysis of CaM was more responsive than the CoVR method to accurately evaluate and monitor SSc-ILD progression or response to therapy.

Revisiting HRCT Features of ABPA

Allergic bronchopulmonary aspergillosis (ABPA) is an abnormal immune response (hyper-sensitivity) mounted against Aspergillus fumigatus in predisposed immunocompetent hosts. This entity is commonly seen in individuals with bronchial asthma and rarely in cystic fibrosis. Serological and radiological tests help to confirm the diagnosis. High resolution computed tomography (HRCT) is the radiological modality of choice for investigating ABPA subjects. The subjects with ABPA may present variably with no HRCT abnormalities, bronchiectasis, high attenuation mucus (HAM) and chronic fibrotic lung changes. The presence of HAM represents immunological severity and also indicates higher chances of relapse. HAM is pathognomonic for ABPA. HRCT findings of ABPA are reviewed in this article.

The clinical analysis of chronic obstructive pulmonary disease patients complicated with nontuberculous mycobacterial pulmonary disease

Objectives: Long-term use of inhaled corticosteroids (ICS) was reported as a risk factor for patients with chronic obstructive pulmonary disease (COPD) complicated with nontuberculous mycobacterial lung disease (NTM-LD). But it was not reported often in China. Methods: We conducted a retrospective analysis of patients who were diagnosed with COPD and NTM-LD in our department from January 1(st) 2017 to December 31(th) 2018. Results: This study consisted of 10 male and 5 female patients with a mean age of (66±7) years. The detailed clinical data and radiological images were reviewed systemically. There were 4 current smokers (26.7%) and 6 past smokers (40%). All cases were current ICS users, with a mean duration of (27.3±9.7) months, ranging from 3 months to 61 months. Among them, 8 cases (53.3%) used inhaled fluticasone and 7 cases (46.7%) used inhaled budesonide. Aggravated coughing (15 cases, 100%), expectoration (15 cases, 100%) and dyspnea (10 cases, 66.7%) were the common clinical manifestations, although fever was only reported in 4 cases (26.7%). All cases showed normal white blood cell count and lymphocyte count, and some of them (7 cases, 46.7%) showed elevated erythrocyte sedimentation rate and C-reactive protein. Most of them (14 cases, 93.3%) had normal TB-SPOT results. Multiple focal bronchiectasis (9 cases, 60%) and significant emphysema (12 cases, 80%) were the common manifestations of basic high-resolution CT (HRCT) prior NTM infection. The occurrence of bronchiectasis (15 cases, 100%), "tree in bud" sign (12 cases, 80%) and tiny cavities (8 cases, 53.3%) were the common HRCT abnormalities for the NTM-LD cases. According to the 2007's NTM-LD diagnosis criteria, most of them (13 cases, 86.7%) were diagnosed with positive sputum samples at least twice, and 2 cases were diagnosed with positive CT-directed bronchial alveolar lavage fluid. NTM-PCR analysis was performed routinely for the isolated NTM samples to identify the NTM species. Mycobacterium avium complex (MAC) was the most common NTM species (8 cases, 53.3%). After treatment with proposed anti-NTM strategies, most cases improved (9 cases, 60%), and some of them (4 cases, 26.7%) were cured and a few cases (2 cases, 13.3%) relapsed. Conclusions: When COPD patients treated with ICS showed aggravated cough, expectation and/or dyspnea, and new occurrence of bronchiectasis and/or "tree in bud" sign in the recent HRCT, the differential diagnosis of NTM-LD should be considered. Respiratory samples should be arranged for NTM cultures and PCR analysis as soon as possible. Earlier antimicrobial strategies according to the identified NTM species would improve the clinical outcomes.

Interstitial lung abnormalities in patients with early rheumatoid arthritis: A pilot study evaluating prevalence and progression.

Pulmonary disease is a leading cause of morbidity and mortality in rheumatoid arthritis (RA). In this study, we investigated the prevalence and progression of interstitial lung abnormalities (ILA) in a prospective cohort study of 18 subjects with early RA. Eighteen adults diagnosed with anti-citrullinated protein-antibody-positive RA within the prior year underwent baseline high-resolution computed tomography (HRCT), symptom assessment, and pulmonary function and laboratory testing. The follow-up HRCT and clinical assessment were completed after 1 year. Seven of the 18 patients (39%) had baseline HRCT abnormalities including septal thickening, honeycombing, ground glass opacities, and/or traction bronchiectasis. At follow-up, 6 out of the 7 subjects (86%) with ILAs at baseline exhibited progression, while 10 out of 11 (91%) without ILAs at baseline remained stable. A higher Clinical Chronic Obstructive Pulmonary Disease Questionnaire score was associated with both the presence and progression of HRCT abnormalities (10 vs 2, p=0.045; 10 vs 2, p=0.009, respectively). C-reactive protein (CRP) trended higher in patients with radiologic abnormalities (3.5 mg/L vs 1.1 mg/L, p=0.08) and was significantly higher in those with progression (3.5 mg/L vs 1 mg/L, p=0.024). Smoking, pulmonary function, and autoantibodies were not associated with HRCT abnormalities. ILAs are prevalent in patients with early RA. If identified at baseline, radiographic progression of ILAs after 1 year is likely, while those without ILAs at baseline are unlikely to develop new ILAs. In addition, early respiratory symptoms and higher CRP levels may correlate with the presence and progression of underlying ILAs.

High-resolution computed tomography of the lung in patients with rheumatoid arthritis

An international consensus for rheumatoid arthritis (RA) patients at risk of developing interstitial lung disease (ILD) is still lacking. The aims of study were to evaluate: the prevalence of ILD involvement in RA over high-resolution computed tomography (HRCT); the relationships between pulmonary function tests (PFTs), patient-centered measurements, and ILD; and the potential risk factors contributing to RA-ILD patients.Data regarding the clinical characteristics (age, sex, age at onset of RA), laboratory findings (rheumatoid factor [RF] and anti-citrullinated protein antibodies [ACPA]), respiratory functional assessment (forced vital capacity [FVC] and carbon monoxide diffusion capacity [DLCO]), patient-centred measures of dyspnea (PCMD), Health Assessment Questionnaire—Disability Index (HAQ-DI), and HRCT have collected retrospectively. HRCT abnormalities were evaluated using a conventional visual reader-based score (CoVR) and a computer-aided method (CaM). The relationships between the 2 HRCT scores—PFTs and PCMD—were calculated using Pearson correlation. The area under the receiving-operating characteristic (AUC-ROC) curve was calculated to determine the discriminatory performance of measurements between patients with and without ILD. The multivariate regression model was used to evaluate the association force between ILD and RA characteristics.In all, 151 patients (45 males and 106 females, mean age 53.4 ± 7.6 years) were included. ILD had been detected in 29 patients out of 151 (19.2%). Usual interstitial pneumonia was the most common HRCT. RA-ILD patients were older, and older at RA onset (both P < .01), with a higher HAQ-DI (P < .05) than patients without ILD. ACPA positivity and titer were higher in the RA-ILD group (P = .02). Extent and severity of ILD, and total CoVR and CaM score closely related to DLCO and PCMD (both P < .0001). A reduced DLCO was the most sensitive test for predicting the presence of ILD on HRCT (AUC-ROC 0.811 ± 0.037). Advanced age (P < .0001), age at RA onset (P = .025), ACPA titer (P = .004), and smoking (P = .008) were independent explanatory variables of HRCT damage in multivariate analysis.The RA-ILD is associated with age and older age of RA onset, smoking, and ACPA titer. DLCO seems to be the most sensitive parameter to predict ILD on HRCT, followed by PCMD.

Composition of airway bacterial community correlates with chest HRCT in adults with bronchiectasis.

In bronchiectasis (BE) not caused by cystic fibrosis, chronic, polymicrobial airway infection contributes to the underlying pathogenesis of disease. There is little information on whether bacterial community composition relates to clinical status. We determined the relationship between bacterial community composition, chest high-resolution computed tomography (HRCT) scores and clinical markers in BE. A subgroup of BE patients from a previous cross-sectional study were analysed. Spontaneously expectorated sputum was analysed using culture-independent sequencing on the Roche 454-FLX platform covering the V1-V3 region of the 16S rRNA marker gene. Chest HRCT scans, multiple breath washout, spirometry and blood inflammatory markers were collected. Spearman's rank (r) correlation coefficient was used to assess relationships. Data from 21 patients were analysed (mean (SD) age: 64.0 (7.7); female : male 14:7; mean (SD) forced expiratory volume in 1 s (FEV1 ): 76.5 (17.2)). All bacterial community composition metrics (bacterial richness, diversity, evenness and dominance) correlated with percentage BE score, with more severe HRCT abnormality relating to lower bacterial richness, evenness and diversity (range r = -0.47 to -0.66; P < 0.05). Inflammation (C-reactive protein and white cell count) was greater in patients with lower diversity and richness (range r = -0.44 to -0.47; P < 0.05). Bacterial community characteristics did not correlate with lung function. This is the first study to indicate a relationship between bacterial community characteristics by 16S rRNA marker gene sequencing, structural damage as determined by chest HRCT and clinical measures in BE. The association between loss of diversity and chest HRCT severity suggests that bacterial dominance with pathogenic bacteria may contribute to disease pathology.