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High Resolution Computed Tomography in Fibrosing Alveolitis Associated with Systemic Sclerosis
DAVID LAUNAY, MARTINE REMY-JARDIN, ULRIQUE MICHON-PASTUREL, IOANA MASTORA, ERIC HACHULLA, MARC LAMBERT, VALERIE DELANNOY, VIVIANE QUEYREL, ALAIN DUHAMEL, REGIS MATRAN, PASCAL DE GROOTE, and PIERRE-YVES HATRON ABSTRACT. Objective. To investigate the use of high resolution computed tomography (HRCT) in diagnosis of patients with fibrosing alveolitis associated with systemic sclerosis (FA-SSc), and to determine predictors of disease progression. Methods. We retrospectively studied 90 patients with SSc who had undergone an initial (Time 1) and followup (Time 2) clinical and HRCT evaluation, with a mean ± SD interval of 5.14 ± 2.98 years between T1 and T2. Results. At T1, HRCT was normal in 40 patients; at T2, 34/40 (85%) continued to have a normal HRCT. For the 50 patients with FA-SSc on HRCT scan at T1, the overall disease progression comprised extension of lung changes toward the apices with worsening of lung fibrosis at T2. Among the 37 patients who had areas of isolated ground-glass opacities at T1, 25 (68%) had progression of lung fibrosis at T2. These 25 patients were mostly men, who showed a more marked decrease of diffusing capacity and a longer interval between T1 and T2. Conclusion. The results emphasize the good longterm prognosis indicated by a normal initial HRCT in SSc. Patients with FA-SSc with abnormal HRCT experienced progressive replacement of ground-glass opacities by honeycombing and/or traction bronchiectasis/bronchiolectasis. Ground-glass opacity is probably the first step of lung fibrosis in SSc, and treatment should be discussed even at this early stage. (J Rheumatol 2006;33:1789–801) Key Indexing Terms:
SYSTEMIC SCLEROSIS
From the Department of Internal Medicine, Claude-Huriez Hospital, National Center for Vascular Manifestations of Scleroderma; Department of Radiology and Department of Pulmonary Function Tests, Albert-Calmette Hospital; Department of Medical Statistical Analysis (CERIM), University of Lille; and Department of Cardiology, Regional University Hospital of Lille, Lille, France. D. Launay, MD; U. Michon-Pasturel, MD; E. Hachulla, MD, PhD; M. Lambert, MD, PhD; V. Queyrel, MD; P-Y. Hatron, MD, Department of Internal Medicine, Claude-Huriez Hospital, National Center for Vascular Manifestations of Scleroderma; M. Rémy-Jardin, MD; I. Mastora, MD, Department of Radiology, Albert-Calmette Hospital; V. Delannoy, MD; A. Duhamel, MD, Department of Medical Statistical Analysis (CERIM), University of Lille; R. Matran, MD, PhD, Department of Pulmonary Function Tests, Albert-Calmette Hospital; P. De Groote, MD, Department of Cardiology, Regional University Hospital of Lille. Address reprint requests to Prof. M. Rémy-Jardin, Department of Radiology, Albert-Calmette Hospital, Boulevard Leclercq 59037, Lille Cedex, France. E-mail: mremy-jardin@chru-lille.fr Accepted for publication March 16, 2006.
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