Pulmonary Wegener's granulomatosis: correlation between high-resolution CT findings and clinical scoring of disease activity.

STUDY OBJECTIVE

To evaluate the usefulness of high-resolution CT (HRCT) for monitoring pulmonary disease activity in Wegener's granulomatosis (WG).

DESIGN

Prospective study of CT and clinical data.

SETTING

Main referral hospital for rheumatic diseases and department of diagnostic radiology of collaborating university hospital.

PATIENTS

Seventy-three patients with WG underwent 98 staging examinations using HRCT. The status of pulmonary disease activity at the time of examination was scored according to clinical, bronchoscopic, BAL, and radiographic findings as follows: activity (n=25, group 1), past activity (n=45, group 2) and lack of any pulmonary disease (n=28, group 3). HRCT findings were correlated with the clinical scoring of pulmonary disease activity.

RESULTS

Of 98 staging examinations 78 (79.6%) revealed abnormal CT scans showing the following main abnormalities: (a) nodules or masses (group 1: 16 [60.4%], group 2: 9 [20%]); (b) parenchymal bands (group 1: 12 [48%], group 2: 27 [60%], group 3: 6 [21.5%]); (c) septal thickening (group 1: 8 [32%], group 2: 6 [13.3%]); (d) parenchymal opacification (group 1: 7 [28%], group 2: 4 [8.9%]); and (e) pleural irregularity (group 1: 14 [56%], group 2: 22 [49%], group 3: 9 [32%]). Nodules/masses and areas of parenchymal opacification were significantly associated with florid disease activity of the lungs. Parenchymal bands and septal thickening were observed in both groups with pulmonary involvement, but statistical analysis revealed no significant difference. Pleural irregularities were nonspecific.

CONCLUSION

HRCT may be a useful adjunct to clinical scoring of pulmonary disease activity in patients with WG and suspected lung involvement.