Pulmonary Wegener's granulomatosis: changes at follow-up CT

Abstract

The objective of this study was to assess the reversibility of pulmonary lesions in Wegener's granulomatosis using serial CT. We reviewed the follow-up CT scans of ten treated patients with confirmed Wegener's granulomatosis. The delay between the first evaluation before treatment and the second, on patients in clinical and biological remission, ranged from 6 to 54 months (mean 20.5 months). Follow-up CT showed a decrease in the extent of disease in all cases. Lesions disappeared completely, without scarring, in 4 of 4 ground-glass opacities, 25 of 36 nodules, and 4 of 9 pulmonary consolidations; they disappeared with residual scarring in 8 of 8 masses, 3 of 9 pulmonary consolidations, and 2 of 36 nodules. The majority of lesions disappear without scarring. Residual fibrosis may follow the occurence of masses and pulmonary consolidation. Computed tomography permits assessment of cicatricial lesions.

Imaging findings of pulmonary granulomatosis with polyangiitis (Wegener’s granulomatosis): lesions invading the pulmonary fissure, pleura or diaphragm mimicking malignancy

“…Bronchial wall thickening and bronchiectasis may present in distal airway involvement. Similar to the study of Attali et al [18], bronchiectasis was detected in 16 % of our patients. Lobar or segmental atelectasis was detected in 20 % of our patients.…”

Imaging Features of Granulomatosis with Polyangiitis (Wegener’s)

“…The size of the lesion and cavitation are two features of distinction that are diagnostically important. In fact, nodules with cavitation and masses measuring more than 3 cm tend to resolve with residual scarring, suggesting active lesions (Attali et al 1998;Komocsi et al 2003).The residual scarring can have two different appearances: linear opacities emanating from the hilum to the periphery with traction bronchiectasis and irregular fibrous lines without preferential orientation (Attali et al 1998) (Fig. 11).…”

“…Nodules resolve in response to treatment in approximately 50-70% of cases, mainly without scarring. In other cases they diminish in size or remain unchanged (Attali et al 1998;Reuter et al 1998). The size of the lesion and cavitation are two features of distinction that are diagnostically important.…”

“…Interlobular septal thickening is relatively more frequent in patients with active pulmonary disease than in those with past pulmonary involvement, but high-resolution CT cannot distinguish active inflammatory infiltration or cicatricial changes (Attali et al 1998;Komocsi et al 2003;Reuter et al 1998).…”

Edge Detection in Biomedical Images Using Self-Organizing Maps

“…Up to now, all analysis of CT images with GPA expressions have been done using manual measurements and subsequent statistical evaluation [1,3,10,12,14]. It has been based on the experience of a radiologist who can find abnormalities in the CT scan and who is able to classify types of the finding.…”