Servicio de Neumología, Hospital General Universitario Dr. Balmis, Alicante, Spain.
Servicio de Radiodiagnóstico, Hospital General Universitario Dr. Balmis, Alicante, Spain; Departamento de Patología y Cirugía, Universidad Miguel Hernández, Sant Joan d'Alacant, Alicante, Spain; Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain.
Radiologia (Engl Ed). 2024 Apr;66 Suppl 1:S10-S23. doi: 10.1016/j.rxeng.2023.03.006. Epub 2024 Feb 28.
To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes.
We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed.
We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate.
Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.
描述一系列间质性肺疾病（ILD）患者在开始使用抗纤维化药物前的 CT 扫描中出现的间质性肺异常（ILA）的患病率和特征，并确定早期 CT 扫描中出现的有助于预测结局的特征。
我们进行了一项回顾性观察性研究。原始队列包括在一家三级医院接受抗纤维化药物治疗的 101 名 ILD 患者。如果患者在治疗开始前至少进行了一次胸部 CT 扫描，则将其纳入研究。他们通过放射学分类为三组：无 ILA、有放射学 ILA 和广泛异常。ILA 分为胸膜下纤维化、胸膜下非纤维化和非胸膜下。对初始扫描和治疗前进行的最新 CT 扫描进行阅读以评估进展情况。分析纤维化的 CT 表现与放射学进展率和死亡率之间的关系。
我们纳入了 50 名患者。只有 1 名（2%）患者的 CT 扫描正常，25 名（50%）患者的 CT 扫描广泛异常，24 名（48%）患者有 ILA 的放射学标准，在开始使用抗纤维化药物前中位数为 98.2 个月，其中 18 名（75%）患者有胸膜下纤维化模式。下区明显支气管扩张和蜂窝状改变与生存期较短有关（p=0.04）。下区明显蜂窝状改变与更快的进展率也有显著相关性（p<0.05）。
在需要使用抗纤维化药物之前很久，临床上相关的 ILD 患者的远程 CT 扫描中就已经频繁出现纤维化的 ILA。即使在无症状患者中，最早扫描中出现牵拉性支气管扩张和蜂窝状改变也与死亡率和随后的进展有关。
