Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
Department of Radiology, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
PLoS One. 2024 Sep 27;19(9):e0310892. doi: 10.1371/journal.pone.0310892. eCollection 2024.
Quantitative chest computed tomography (qCT) methods are new tools that objectively measure parenchymal abnormalities and vascular features on CT images in patients with interstitial lung disease (ILD). We aimed to investigate whether the qCT measures are predictors of 5-year mortality in patients with systemic sclerosis (SSc).
Patients diagnosed with SSc were retrospectively selected from 2011 to 2022. Patients should have had volumetric high-resolution CTs (HRCTs) and pulmonary function tests (PFTs) performed at baseline and at 24 months of follow-up. The following parameters were evaluated in HRCTs using Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER): ground glass opacities, reticular pattern, honeycombing, and pulmonary vascular volume. Factors associated with death were evaluated by Kaplan‒Meier survival curves and multivariate analysis models. Semiquantitative analysis of the HRCTs images was also performed.
Seventy-one patients were included (mean age, 54.2 years). Eleven patients (15.49%) died during the follow-up, and all patients had ILD. As shown by Kaplan‒Meier curves, survival was worse among patients with an ILD extent (ground glass opacities + reticular pattern + honeycombing) ≥ 6.32%, a reticular pattern ≥ 1.41% and a forced vital capacity (FVC) < 70% at baseline. The independent predictors of mortality by multivariate analysis were a higher reticular pattern (Exp 2.70, 95%CI 1.26-5.82) on qCT at baseline, younger age (Exp 0.906, 95%CI 0.826-0.995), and absolute FVC decline ≥ 5% at follow-up (Exp 15.01, 95%CI 1.90-118.5), but not baseline FVC. Patients with extensive disease (>20% extension) by semiquantitative analysis according to Goh's staging system had higher disease extension on qCT at baseline and follow-up.
This study showed that the reticular pattern assessed by baseline qCT may be a useful tool in the clinical practice for assessing lung damage and predicting mortality in SSc.
定量胸部计算机断层扫描（qCT）方法是一种新的工具，可以客观地测量间质性肺疾病（ILD）患者 CT 图像上的实质异常和血管特征。我们旨在研究 qCT 测量值是否可预测系统性硬化症（SSc）患者的 5 年死亡率。
从 2011 年至 2022 年，回顾性选择诊断为 SSc 的患者。患者应在基线和 24 个月的随访时进行容积高分辨率 CT（HRCT）和肺功能检查（PFT）。使用计算机辅助肺病理评估和评分（CALIPER）在 HRCT 中评估以下参数：磨玻璃影、网状影、蜂窝肺和肺血管容积。通过 Kaplan-Meier 生存曲线和多变量分析模型评估与死亡相关的因素。还对 HRCT 图像进行了半定量分析。
共纳入 71 例患者（平均年龄 54.2 岁）。11 例患者（15.49%）在随访期间死亡，所有患者均患有ILD。Kaplan-Meier 曲线显示，ILD 程度（磨玻璃影+网状影+蜂窝肺）≥6.32%、基线时存在网状影≥1.41%和用力肺活量（FVC）<70%的患者生存较差。多变量分析的独立死亡预测因子是基线时 qCT 上更高的网状影（Exp 2.70，95%CI 1.26-5.82）、更年轻的年龄（Exp 0.906，95%CI 0.826-0.995）和随访时 FVC 绝对下降≥5%（Exp 15.01，95%CI 1.90-118.5），但基线 FVC 除外。根据 Goh 分期系统进行半定量分析，疾病广泛（>20%扩展）的患者基线和随访时 qCT 上的疾病扩展程度更高。
本研究表明，基线 qCT 评估的网状影可能是 SSc 患者评估肺损伤和预测死亡率的有用临床工具。
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