Internal Medicine, Complejo hospitalario Ruber Juan Bravo, Universidad Europea (Madrid), Madrid, Spain.
Scienze Radiologiche, Dipartimento di Medicina e Chirurgia (DiMeC), University of Parma, Parma, Italy.
PLoS One. 2019 Nov 8;14(11):e0224772. doi: 10.1371/journal.pone.0224772. eCollection 2019.
Interstitial lung disease (ILD) is a frequent manifestation of Sjögren's syndrome (SS), an autoimmune disease of salivary and lacrimal glands, and affects approximately 20% of patients. No clinical or serological features appear to be useful to predict its presence, severity or progression, and chest high-resolution computed tomography (CT) remains the gold standard for diagnosis. Semiquantitative CT (SQCT) based on visual assessment (Goh and Taouli scoring) can estimate ILD extent, although it is burdened by relevant intra- and interobserver variability. Quantitative chest CT (QCT) is a promising alternative modality to assess ILD severity.
To determine whether QCT assessment can identify extensive or limited lung disease in patients with SS and ILD.
This multi-center, cross-sectional and retrospective study enrolled patients with SS and a chest CT scan. SQCT assessment was carried out in a blinded and centralized manner to calculate both Goh and Taouli scores. An operator-independent analysis of all CT scans with the open-source software platform Horos was used to evaluate the QCT indices. Patients were classified according to the extent of ILD and differences in QCT index distribution were investigated with non-parametric tests.
From a total of 102 consecutive patients with SS, the prevalence of ILD was 35.3% (36/102). There was a statistically significant difference in QCT index distribution between the SS with ILD and SS without ILD groups (p<0.001). Moreover, SS-ILD patients with ILD >20% (by Goh score) had a QCT index statistically different from those with limited ILD extent (p<0.001). Finally, QCT indices showed a moderate-to-good correlation with the Goh and Taouli scores (from 0.44 to 0.65; p<0.001).
QCT indices can identify patients with SS and ILD and discriminate those with lesser or greater lung disease.
间质性肺病（ILD）是干燥综合征（SS）的一种常见表现，SS 是一种唾液腺和泪腺的自身免疫性疾病，约影响 20%的患者。目前似乎没有临床或血清学特征可用于预测其存在、严重程度或进展，胸部高分辨率计算机断层扫描（CT）仍然是诊断的金标准。基于视觉评估的半定量 CT（SQCT）（Goh 和 Taouli 评分）可以估计ILD 程度，但存在明显的观察者内和观察者间变异性。定量胸部 CT（QCT）是评估ILD 严重程度的一种很有前途的替代方法。
确定 QCT 评估是否可以识别 SS 和ILD 患者的广泛或局限性肺病。
这项多中心、横断面和回顾性研究纳入了 SS 患者和胸部 CT 扫描。采用盲法和集中化方式进行 SQCT 评估，以计算 Goh 和 Taouli 评分。使用开源软件平台 Horos 对所有 CT 扫描进行独立于操作者的分析，以评估 QCT 指数。根据ILD 的范围对患者进行分类，并通过非参数检验研究 QCT 指数分布的差异。
从总共 102 例连续的 SS 患者中，ILD 的患病率为 35.3%（36/102）。SS 伴ILD 和 SS 不伴ILD 两组的 QCT 指数分布存在统计学差异（p<0.001）。此外，SS-ILD 患者的ILD>20%（Goh 评分）与ILD 程度有限的患者相比，QCT 指数有统计学差异（p<0.001）。最后，QCT 指数与 Goh 和 Taouli 评分具有中度至良好的相关性（范围从 0.44 到 0.65；p<0.001）。
QCT 指数可识别 SS 和ILD 患者，并区分ILD 程度较轻或较重的患者。
