Serial High-Resolution Computed Tomography Imaging in Patients with Wegener Granulomatosis: Differentiation Between Active Inflammatory and Chronic Fibrotic Lesions

• Published in: Acta radiologica (1987) 2005-08, Vol.46 (5), p.484-491
• Main Authors: Lohrmann, C., Uhl, M., Schaefer, O., Ghanem, N., Kotter, E., Langer, M.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Bronchoscopy; Chronic Disease; Diagnosis, Differential; Endoscopy; Female; Fibrosis - diagnosis; Follow-Up Studies; Granulomatosis with Polyangiitis - diagnosis; Humans; Inflammation - diagnosis; Investigative techniques, diagnostic techniques (general aspects); Lung - diagnostic imaging; Male; Medical sciences; Middle Aged; Observer Variation; Pneumology; Respiratory system : syndromes and miscellaneous diseases; Retrospective Studies; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Tomography, X-Ray Computed - methods
• ISSN: 0284-1851; 1600-0455
• DOI: 10.1080/02841850510021733

Purpose: To evaluate pulmonary pathologies in Wegener granulomatosis with sequential computed tomography (CT) in order to differentiate active inflammatory lesions from chronic fibrotic lesions. Material and Methods: Serial CT findings in 38 patients with Wegener granulomatosis were retrospectively analyzed (mean follow-up period, 21 months). The presence, extension, and distribution of the following findings were evaluated with CT: parenchymal nodules, masses, ground-glass attenuation, airspace consolidation, bronchial wall-thickening, bronchiectasis, linear areas of attenuation, pleural irregularities, pleural effusions, hilar and mediastinal lymphadenopathy. Results: Observed in 92% of patients, nodules were the most common CT pathology. Areas of ground-glass attenuation, consolidation, masses of linear attenuation, and tracheal bronchial wall-thickening were detected in 24%, 26%, 32%, 39%, and 68% of patients. At follow-up, the clearance of lesions was most consistent for areas of ground-glass attenuation (89%), masses (87%), and cavitated nodules (85%). In the follow-up scan, 58% of all nodules, 47% of pulmonary consolidations, and 66% of bronchial wall-thickening were completely resolved. Areas of bronchiectasis and septal non-septal lines remained stable in 70% and 71% of patients. Conclusion: The majority of the lesions decreased or resolved completely with or without areas of linear attenuation. Ground-glass attenuation, cavitated nodules and masses appear to represent active inflammatory lesions. In most probability, areas of bronchiectasis and septal non-septal lines more often represent chronic fibrotic changes rather than active inflammatory changes. In combination with clinical evaluation and bronchoscopy, CT assists in the assessment of disease activity.