Wells A U
Interstitial Lung Disease Unit, Royal Brompton Hospital, Chelsea, London, UK.
Rheumatology (Oxford). 2008 Oct;47 Suppl 5:v59-61. doi: 10.1093/rheumatology/ken271.
High-resolution CT has now become an important part of the routine detection and evaluation of interstitial lung disease in SSc. CT now has a central role in the detection of interstitial disease, largely because other modalities have been unsatisfactory in this regard. Historically, CT has also been used to identify a high likelihood of reversible inflammatory disease in SSc, based upon studies in other diffuse lung diseases. However, accumulated evidence indicates that ground-glass attenuation on CT is not a reliable indicator of underlying alveolitis. Ground-glass attenuation on CT is common in SSc but reversible disease is found at surgical biopsy in a minority of cases, and is rare when ground glass is associated with reticular abnormalities or traction bronchiectasis. Furthermore, ground glass regresses inconsistently on serial CT evaluation, with or without treatment. CT is more useful in the staging of disease extent. Although formal CT scoring is not realistic in routine practice, rapid semi-quantitative estimation of disease extent on CT in combination with a forced vital capacity threshold has been used to stage disease as limited or extensive. The distinction between a higher and lower risk of progression of lung disease, made using this system, has important implications for both routine practice and the enrolment of higher risk patients in therapeutic studies.
高分辨率CT现已成为系统性硬化症（SSc）间质性肺疾病常规检测和评估的重要组成部分。CT目前在间质性疾病的检测中发挥着核心作用，这主要是因为其他检查方式在这方面并不令人满意。从历史上看，基于对其他弥漫性肺疾病的研究，CT也被用于识别SSc中可逆性炎症性疾病的高可能性。然而，越来越多的证据表明，CT上的磨玻璃影并非潜在肺泡炎的可靠指标。CT上的磨玻璃影在SSc中很常见，但在少数病例的外科活检中发现可逆性疾病，当磨玻璃影与网状异常或牵拉性支气管扩张相关时则很少见。此外，无论是否接受治疗，磨玻璃影在系列CT评估中消退情况不一致。CT在疾病范围分期方面更有用。虽然在常规实践中进行正式的CT评分不太现实，但结合用力肺活量阈值对CT上的疾病范围进行快速半定量评估已被用于将疾病分期为局限性或广泛性。使用该系统区分肺部疾病进展的高风险和低风险，对常规实践以及将高风险患者纳入治疗研究都具有重要意义。
