Lung vascular changes as biomarkers of severity in systemic sclerosis–associated interstitial lung disease

Abstract

Objectives Lung vascular and parenchymal changes can be recently assessed quantitatively in thoracic computed tomography (CT) images using automated software tools. We investigated the vessel parameters of patients with Systemic Sclerosis (SSc), quantified by CT imaging, and correlated them with the interstitial lung disease (ILD) features. Methods SSc patients undergoing standard of care pulmonary function testing and CT evaluation were retrospectively evaluated. CT images were analyzed for ILD patterns and total pulmonary vascular volume (PVV) extents with Imbio LTA. Vascular analysis (volumes, numbers, and densities of vessels, separating arteries and veins) was performed with an in-house developed software. A threshold of 5% ILD extent was chosen to define the presence of ILD, and commonly used cut-offs of lung function were adopted. Results 79 patients (52 women, 40 ILD, age 56.2 ± 14.2 years, total ILD extent 9.5 ± 10.7%, PVV/LV% 2.8%) were enrolled. Vascular parameters for total and separated PVV significantly correlated with functional parameters and ILD pattern extents. SSc-ILD patients presented with an increased number and volume of arterial vessels, in particular those between 2–4 mm of diameter, and with a higher density of arteries and veins of < 8 mm in diameter. Considering radiological and functional criteria concomitantly, as well as the descriptive trends from the longitudinal evaluations, the normalized PVVs, vessel numbers and densities increased progressively with the increase/worsening of ILD extent and functional impairment. Conclusion In SSc patients CT vessel parameters increase in parallel with ILD extent and functional impairment and may represent a biomarker of SSc-ILD severity.

Potential angiogenic, immunomodulatory, and antifibrotic effects of mesenchymal stem cell-derived extracellular vesicles in systemic sclerosis

“…The characteristics of MSC-EVs can influence pathological changes in vascular-rich tissue, similar to Raynaud's phenomenon, which affects over 95% of SSc patients and comprises occasional color changes in the extremities in cold environments (81). SSc-associated interstitial lung disease (SSc-ILD), one of the causes of death, is chiefly caused by damage to the alveolar epithelium and blood vessels in the lung region (82).…”

O papel da imagem quantitativa na avaliação da doença pulmonar obstrutiva crônica

“…Muitos são os benefícios que a avaliação quantitativa das imagens pode proporcionar. Em outros contextos, como no câncer de pulmão, é possível se valer de ferramentas de extração de dados derivados das informações básicas (análise radiômica), melhorando a correlação com os tipos histológicos (7) ; no contexto da hipertensão pulmonar é possível demonstrar, de forma mais precisa, a redistribuição da trama vascular pulmonar (8) , conhecendo sua correlação com a perda de função pulmonar e a extensão de acometimento por doença intersticial na esclerose sistêmica (9) .…”

The role of quantitative imaging in chronic obstructive pulmonary disease

“…The quantitative evaluation of images can provide many benefits. In other contexts, such as lung cancer, it is possible to use data extraction tools derived from basic information (radiomic analysis), thus improving the correlation with the histological type ( 7 ) ; in the context of pulmonary hypertension, it is possible to demonstrate, more precisely, the redistribution of the pulmonary vascular network ( 8 ) , allowing us to correlate that with the loss of pulmonary function and to determine the extent of involvement by interstitial disease in systemic sclerosis ( 9 ) .…”