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Screening for interstitial lung disease in systemic sclerosis: performance of high-resolution CT with limited number of slices: a prospective study
  1. Thomas Frauenfelder1,
  2. Anna Winklehner1,
  3. Thi Dan Linh Nguyen1,
  4. Rucsandra Dobrota2,3,
  5. Stephan Baumueller1,
  6. Britta Maurer2,
  7. Oliver Distler2
  1. 1Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
  2. 2Division of Rheumatology, University Hospital Zurich, Zurich, Switzerland
  3. 3Department of Internal Medicine and Rheumatology, Dr. I. Cantacuzino Hospital, Bucharest, Romania
  1. Correspondence to Dr Oliver Distler, Division of Rheumatology, University Hospital Zurich, Gloriastr. 25, Zürich 8091, Switzerland; Oliver.Distler{at}usz.ch

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.

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

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