Longitudinal change during follow-up of systemic sclerosis: correlation between high-resolution computed tomography and pulmonary function tests

• Published in: Clinical rheumatology 2021, Vol.40 (1), p.213-219
• Main Authors: Carnevale, Aldo, Silva, Mario, Maietti, Elisa, Milanese, Gianluca, Saracco, Marta, Parisi, Simone, Bravi, Elena, De Gennaro, Fabio, Arrigoni, Eugenio, Bodini, Flavio Cesare, Fusaro, Enrico, Scirè, Carlo Alberto, Sverzellati, Nicola, Ariani, Alarico
• Format: Article
• Language: English
• Subjects: Brief Report; Chest; Computed tomography; Follow-Up Studies; Humans; Lung - diagnostic imaging; Lung diseases; Medicine; Medicine & Public Health; Respiratory function; Respiratory Function Tests; Retrospective Studies; Rheumatology; Scleroderma; Scleroderma, Systemic - complications; Scleroderma, Systemic - diagnostic imaging; Systemic sclerosis; Tomography, X-Ray Computed
• ISSN: 0770-3198; 1434-9949
• DOI: 10.1007/s10067-020-05375-y

The objective of this study was to determine the correlation between functional and radiological longitudinal change in patients with systemic sclerosis–associated interstitial lung disease (SSc-ILD), and to test the OMERACT definition of clinically meaningful progression of pulmonary function tests (PFTs) for the prediction of ILD radiological evolution. We retrospectively retrieved high-resolution computed tomography (HRCT) studies and PFTs including DLco, both available at two time-points and performed within 6 months of each other, in SSc patients. A subset of patients was selected using a 12–24-month clinically oriented interval ( n = 58). The extent of ILD at HRCT was scored according to a visual semi-quantitative method (SQCT). The correlation of absolute change ( Δ ) in the SQCT score with change in FVC and DLco was examined using Pearson’s correlation coefficient. The concordance between the OMERACT criteria (≥ 10% FVC relative decline; or 5–10% FVC and ≥ 15% DLco relative decline) and SQCT categorical change (5% and 10%) was investigated. A total of 129 patients were enrolled. During 12–24-month follow-up, ΔSQCT was negatively correlated with ΔFVC ( r = − 0.487, p = 0.0001) and ΔDLco ( r = − 0.298, p = 0.023). Ten patients demonstrated CT progression ΔSQCT > 5%, among whom 5 with ΔSQCT > 10%. OMERACT criteria identified 25 patients with progressive SSc-ILD, of whom only 5 presented ΔSQCT > 5 and 3 presented ΔSQCT > 10%. In conclusion, change in radiological extent of SSc-ILD was correlated to functional decline in a limited time-frame. Repeated HRCT after 12–24 months may be useful for the longitudinal characterization of ILD evolution in patients with stable pulmonary function. Conversely, functional changes are suggestive of a concurrent radiological progression only after this interval. Key Points • In SSc patients, chest HRCT performed every 12–24 months can detect minimal but significant changes in ILD extent, even in subjects with stable pulmonary function. • PFT changes in 12–24 months are related to the radiological ILD progression. • OMERACT criteria might overlook patients with radiological progression. • Repeated chest HRCT may be useful for monitoring SSc-ILD when performed within 12 to 24 months from baseline in order to promptly detect progression and possibly impact on prognosis.