Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence.
Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence-AOUC, Florence.
Rheumatology (Oxford). 2022 Apr 11;61(4):1600-1609. doi: 10.1093/rheumatology/keab615.
The aim of this study was to identify the main CT features that may help in distinguishing a progression of interstitial lung disease (ILD) secondary to SSc from COVID-19 pneumonia.
This multicentric study included 22 international readers grouped into a radiologist group (RADs) and a non-radiologist group (nRADs). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study.
Fibrosis inside focal ground-glass opacities (GGOs) in the upper lobes; fibrosis in the lower lobe GGOs; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONs in the lower lobes (P < 0.0001) and signs of fibrosis in GGOs in the lower lobes (P < 0.0001) remained independently associated with COVID-19 pneumonia and SSc-ILD, respectively. A predictive score was created that was positively associated with COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity).
CT diagnosis differentiating between COVID-19 pneumonia and SSc-ILD is possible through a combination of the proposed score and radiologic expertise. The presence of consolidation in the lower lobes may suggest COVID-19 pneumonia, while the presence of fibrosis inside GGOs may indicate SSc-ILD.
本研究旨在确定有助于区分继发于 SSc 的间质性肺病 (ILD) 进展与 COVID-19 肺炎的主要 CT 特征。
这项多中心研究纳入了 22 名国际读者，分为放射科医生组 (RADs) 和非放射科医生组 (nRADs)。共纳入 99 例患者，其中 COVID-19 患者 52 例，SSc-ILD 患者 47 例。
上叶局灶性磨玻璃影 (GGO) 内纤维化；下叶 GGO 纤维化；下叶网状影（特别是双侧对称或伴有纤维化迹象）是与 SSc-ILD 最相关的 CT 特征。与 COVID-19 肺炎最相关的 CT 特征是：下叶实变 (CONS)，下叶 CONS 伴有周边（中央/周边或斑片状分布）、前、后 CONS 和下叶圆形 GGO。多变量分析后，下叶 CONS（P < 0.0001）和下叶 GGO 纤维化（P < 0.0001）的存在与 COVID-19 肺炎和 SSc-ILD 分别独立相关。创建了一个预测评分，与 COVID-19 诊断呈正相关（敏感性为 96.1%，特异性为 83.3%）。
通过提出的评分和放射学专业知识相结合，可以对 COVID-19 肺炎和 SSc-ILD 进行 CT 诊断区分。下叶 CONS 的存在可能提示 COVID-19 肺炎，而 GGO 内纤维化的存在可能提示 SSc-ILD。
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