Rheumatological Clinic, Ospedale "Carlo Urbani", Università Politecnica delle Marche, Via Aldo Moro, 25, 60035, Jesi, Ancona, Italy.
Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy.
Radiol Med. 2018 Sep;123(9):655-663. doi: 10.1007/s11547-018-0894-3. Epub 2018 Apr 23.
Oesophageal dilatation (OD) has been implicated in the pathogenesis of interstitial lung disease (ILD) in systemic sclerosis (SSc). The aims of this study were to explore the association of the OD and SSc-ILD on chest high-resolution computed tomography (HRCT), and to establish a cutoff point for the OD suggestive for the presence of a significant lung involvement.
The widest oesophageal diameter (WOD) was obtained on axial HRCT images. The parenchymal abnormalities on HRCT were coded and scored according to Warrick method. Patient-centred measures, pulmonary function tests and the single breath carbon monoxide diffusing capacity of the lung (DLco) were also obtained. Multivariate regression analysis was performed to identify factors associated with oesophageal diameter.
126 subjects with SSc were included. The mean (± SD) WOD was 13.5 (± 4.2) mm, and in 76 (60.3%) participants WOD was ≥ 11 mm. SSc patients with ILD had larger oesophageal diameters than those without lung disease (19.4 vs. 14.1 mm, p < 0.001). We observed a high correlation between WOD and gastro-oesophageal reflux disease questionnaire (GerdQ) (r = 0.886, p < 0.001), Borg score (r = 0.705, p < 0.001), and Warrick score (r = 0.614, p < 0.001). WOD negatively correlated with DLco (r = - 0.508, p < 0.001). Multivariate analysis demonstrated positive associations between WOD and GerdQ (p < 0.0001), Borg score (p < 0.0005), and total Warrick score (p = 0.019).
An increased oesophageal diameter (> 11 mm) on chest HRCT is associated with pulmonary and oesophageal symptoms, more severe ILD, and lower DLco.
食管扩张（OD）被认为与系统性硬化症（SSc）中的间质性肺病（ILD）发病机制有关。本研究的目的是探讨 OD 与 SSc-ILD 在胸部高分辨率计算机断层扫描（HRCT）上的关联，并确定提示存在显著肺部受累的 OD 截断点。
在轴向 HRCT 图像上获取最宽食管直径（WOD）。根据 Warrick 方法对 HRCT 上的实质异常进行编码和评分。还获得了以患者为中心的测量、肺功能测试和单肺一氧化碳弥散量（DLco）。进行多变量回归分析以确定与食管直径相关的因素。
共纳入 126 例 SSc 患者。平均（±SD）WOD 为 13.5（±4.2）mm，76 例（60.3%）患者的 WOD≥11mm。ILD 的 SSc 患者的食管直径大于无肺部疾病的患者（19.4 与 14.1mm，p<0.001）。我们观察到 WOD 与胃食管反流病问卷（GerdQ）（r=0.886，p<0.001）、Borg 评分（r=0.705，p<0.001）和 Warrick 评分（r=0.614，p<0.001）之间具有高度相关性。WOD 与 DLco 呈负相关（r=-0.508，p<0.001）。多变量分析表明 WOD 与 GerdQ（p<0.0001）、Borg 评分（p<0.0005）和总 Warrick 评分（p=0.019）呈正相关。
胸部 HRCT 上食管直径增加（>11mm）与肺部和食管症状、更严重的 ILD 和更低的 DLco 相关。
