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Ann Rheum Dis. 2014 Dec;73(12):2069-73. doi: 10.1136/annrheumdis-2014-205637. Epub 2014 Sep 30.

Screening for interstitial lung disease in systemic sclerosis: performance of high-resolution CT with limited number of slices: a prospective study.

Author information

1
Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
2
Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Hospital, Bucharest, Romania.
3
Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland.

Abstract

OBJECTIVES:

Early diagnosis of interstitial lung disease (ILD), currently the main cause of death in systemic sclerosis (SSc), is needed. The gold standard is high-resolution CT (HRCT) of the chest, but regular screening faces the risk of increased radiation exposure. We performed a prospective validation of a dedicated, 9-slice HRCT protocol with reduced radiation dose for the detection of ILD in patients with SSc.

METHODS:

We analysed 170/205 consecutive patients with SSc. Whole-chest HRCT, serving as standard of reference, and the reduced HRCT with nine slices allocated according to a basal-apical gradient were obtained. ILD presence, extent (> or <20%) and diagnostic confidence were assessed. The reduced HRCT was independently analysed by two blinded radiologists, who also evaluated image quality. Radiation dose parameters were calculated.

RESULTS:

Standard chest HRCT showed ILD in 77/170 patients. With the reduced HRCT, 68/77 cases with ILD were identified (sensitivity 88.3%, both readers). The accuracy (91.8%, reader 1; 94.7%, reader 2), diagnostic confidence (98.8%, reader 1; 95.3%, reader 2) and image quality rates were high. Minimal ILD was correctly quantified in 73.1% (reader 1)/71.2% (reader 2) and extensive ILD in 88% (reader 1)/100% (reader 2). Importantly, the reduced HRCT had a significantly lower radiation dose. The mean dose length product (effective dose) was only 5.66±4.46 mGycm (0.08±0.06 mSv) compared with the standard protocol dose of 149.00±95.90 mGycm (2.09±1.34 mSv).

CONCLUSIONS:

The above-described reduced chest HRCT protocol reliably detects even mild SSc-ILD in clinical practice, with the advantage of a much lower radiation dose compared with standard whole-chest HRCT.

KEYWORDS:

Multidisciplinary team-care; Outcomes research; Pulmonary Fibrosis; Systemic Sclerosis

PMID:
25269829
DOI:
10.1136/annrheumdis-2014-205637
[Indexed for MEDLINE]

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