CT Features of Lung Disease in Patients with Systemic Sclerosis: Comparison with Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia

Desai, Sujal R.; Veeraraghavan, Srihari; Hansell, David M.; Nikolakopolou, Ageliki; Goh, Nicole; Nicholson, Andrew G.; Colby, Thomas V.; Denton, Christopher P.; Black, Carol M.; Bois, Roland M. du; Wells, Athol U.

doi:10.1148/radiol.2322031223

Cited by 342 publications

(257 citation statements)

References 36 publications

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“…Firstly, our study focused on quantification of total disease extent, and no pattern-based analysis of the CT examinations was performed. However, the disease extent was concordantly shown in this and in previous series to be a strong predictor of functional pulmonary impairment and therefore the stage of pulmonary disease, which is an important prerequisite for evaluation of a CAD tool [13,14]. An issue that needs consideration for optimization of the CAD tool is the overlap of attenuation values of ILD and pulmonary vasculature, leading to inclusion of small pulmonary vessels, which are likely to have resulted in an overestimation of disease extent.…”

Section: Discussionsupporting

confidence: 77%

“…Formal scoring of disease extent on HRCT in patients with ILD associated with CVD has been performed by several investigators [13][14][15][16]. The extent of disease on HRCT has been found to be inversely correlated to arterial oxygen levels at rest, and extensive pulmonary fibrosis correlates with the presence of neutrophilia on bronchoalveolar lavage [14,17].…”

Section: Discussionmentioning

confidence: 99%

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Interstitial lung disease associated with collagen vascular disorders: disease quantification using a computer-aided diagnosis tool

Marten¹,

Dicken

Kneitz

et al. 2008

Eur Radiol

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Interstitial lung disease associated with collagen vascular disorders: disease quantification using a computer-aided diagnosis tool

Marten¹,

Dicken

Kneitz

et al. 2008

Eur Radiol

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“…However, BAL neutrophil content does not provide useful insights in this regard. In SSc-ILD, although there is a high prevalence of neutrophilia and/or eosinophilia on BAL, fibrotic histology predominates on lung biopsy (30,31), and fibrotic appearances predominate on HRCT (11). The current findings indicate that neutrophilia on BAL reflects more extensive disease, rather than denoting interstitial inflammation.…”

Section: Discussionmentioning

confidence: 53%

Bronchoalveolar lavage cellular profiles in patients with systemic sclerosis–associated interstitial lung disease are not predictive of disease progression

Goh

Veeraraghavan

Desai

et al. 2007

Arthritis & Rheumatism

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153

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Objective. To evaluate the prognostic value of bronchoalveolar lavage (BAL) cellular profiles in patients with systemic sclerosis-associated interstitial lung disease (SSc-ILD).Methods. BAL cellularity was examined in relation to mortality (n ‫؍‬ 141), serial pulmonary function findings (n ‫؍‬ 134), and "progression-free survival" (n ‫؍‬ 134), by proportional hazards analysis. Baseline severity was quantified according to the extent of disease on high-resolution computed tomography, the diffusing capacity for carbon monoxide, and the presence or absence of pulmonary hypertension. Mortality was subclassified into overall mortality (during 10 years of followup), early mortality (occurring within 2 years of presentation), and late mortality (occurring 2-10 years after presentation).Results. Overall mortality was associated with neutrophilia on BAL (hazard ratio 2.23 [95% confidence interval 1.20-4.14], P ‫؍‬ 0.01), but this effect was lost when disease severity was taken into account. Early mortality was associated with neutrophilia on BAL (hazard ratio 8.40 [95% confidence interval 1.91-36.95], P ‫؍‬ 0.005), independent of disease severity. Late mortality was not associated with neutrophilia on BAL. The presence of neutrophilia on BAL was not associated with time to decline in pulmonary function or progressionfree survival. Neither eosinophilia nor lymphocytosis on BAL was associated with mortality, rapidity of functional deterioration, or progression-free survival. These findings were unaltered when treatment status was taken into account.Conclusion. BAL findings provide only limited prognostic information in SSc-ILD. Neutrophilia on BAL is linked to early mortality, but BAL findings are not linked to long-term survival or the rapidity of progression of lung disease. The usefulness of BAL to define alveolitis in SSc is questionable.

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“…130 -132 The HRCT patterns of lung disease in patients with SSc were compared to those with idiopathic NSIP or IPF. 133 Patients with SSc exhibited disease that was less extensive and less coarse (P > 0.001) but showed a greater proportion of GGO (P<0.001) than patients with IPF. The CT features closely resembled those visualized in patients with idiopathic NSIP.…”

Section: Histopathologymentioning

confidence: 89%

Spectrum of Fibrosing Diffuse Parenchymal Lung Disease

Morgenthau

Padilla

2009

Mount Sinai J Medicine

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The interstitial lung diseases are a heterogeneous group of disorders characterized by inflammation and/or fibrosis of the pulmonary interstitium. In 2002, the American Thoracic Society and the European Respiratory Society revised the classification of interstitial lung diseases and introduced the term diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are a subtype of diffuse parenchymal lung disease. The idiopathic interstitial pneumonias are subdivided into usual interstitial pneumonia (with its clinical counterpart idiopathic interstitial pneumonia), nonspecific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, and lymphocytic pneumonia. Sarcoidosis and hypersensitivity pneumonitis are the 2 most common granulomatous diffuse parenchymal lung diseases. Rheumatoid arthritis, systemic sclerosis, and dermatomyositis/polymyositis (causing antisynthetase syndrome) are diffuse parenchymal lung diseases of known association because these conditions are associated with connective tissue disease. Hermansky‐Pudlak syndrome is a rare genetic diffuse parenchymal lung disease characterized by the clinical triad of pulmonary disease, oculocutaneous albinism, and bleeding diathesis. This review provides an overview of the chronic fibrosing diffuse parenchymal lung diseases. Its primary objective is to illuminate the clinical challenges encountered by clinicians who manage the diffuse parenchymal lung diseases regularly and to offer potential solutions to those challenges. Treatment for the diffuse parenchymal lung diseases is limited, and for many patients with end‐stage disease, lung transplantation remains the best option. Although much has been learned about the diffuse parenchymal lung diseases during the past decade, research in these diseases is urgently needed. Mt Sinai J Med 76:2–23, © 2009 Mount Sinai School of Medicine

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CT Features of Lung Disease in Patients with Systemic Sclerosis: Comparison with Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia

Cited by 342 publications

References 36 publications

Interstitial lung disease associated with collagen vascular disorders: disease quantification using a computer-aided diagnosis tool

Interstitial lung disease associated with collagen vascular disorders: disease quantification using a computer-aided diagnosis tool

Bronchoalveolar lavage cellular profiles in patients with systemic sclerosis–associated interstitial lung disease are not predictive of disease progression

Spectrum of Fibrosing Diffuse Parenchymal Lung Disease

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