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CT Features of Lung Disease in Patients with Systemic Sclerosis: Comparison with Idiopathic Pulmonary Fibrosis and Nonspecific Interstitial Pneumonia¹

¹ From the Department of Radiology, King’s College Hospital, Denmark Hill, London SE5 9RS, England (S.R.D.); Interstitial Lung Disease Unit (S.V., A.N., N.S.L.G., R.M.d.B., A.U.W.) and Departments of Radiology (D.M.H.) and Pathology (A.G.N.), Royal Brompton Hospital, London, England; Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, Ariz (T.V.C.); and Centre for Rheumatology, Royal Free and University College Medical School, London, England (C.P.D., C.M.B.). Received August 1, 2003; revision requested October 14; revision received November 24; accepted January 5, 2004. Address correspondence to S.R.D. (e-mail: sujal.desai@kingsch.nhs.uk).

PURPOSE: To evaluate computed tomographic (CT) patterns of lung disease in patients with systemic sclerosis (SSc) and compare them with CT appearance in patients with biopsy-proved idiopathic pulmonary fibrosis (IPF) and idiopathic nonspecific interstitial pneumonia (NSIP).

MATERIALS AND METHODS: The CT features of consecutive patients with SSc (n = 225; male patients, 44; female patients, 181; median age, 47 years; age range, 16–78 years), IPF (n = 40; men, 26; women, 14; median age, 54.5 years; age range, 36–77 years) and NSIP (n = 27; men, 18; women, nine; median age, 53 years; age range, 32–68 years) were quantified separately by two observers. The extent of interstitial lung disease, ground-glass opacification, emphysema, and the coarseness of a reticular pattern were quantified. Group comparisons were made nonparametrically with the Wilcoxon rank sum test. Differences in CT features were identified with multiple logistic regression analysis.

RESULTS: The coarseness of fibrosis was similar in patients with SSc and idiopathic NSIP but strikingly different between patients with SSc (median coarseness score, 5.5; range, 0.0–13.3) and IPF (median coarseness score, 8.8; range, 2.5–15.0) (P < .001). The proportion of ground-glass opacification at CT was similar in patients with SSc and idiopathic NSIP but differed significantly between patients with SSc (median proportion, 49.9%; range, 0.0%–100.0%) and IPF (median proportion, 23.5%; range, 0.0%–97.2%) (P < .001). At logistic regression analysis, there were no differences in the CT features between patients with SSc and those with NSIP after controlling for age, disease extent, and the percentage predicted forced vital capacity and carbon monoxide diffusing capacity.

CONCLUSION: Interstitial lung disease in patients with SSc is less extensive, less coarse, and characterized by a greater proportion of ground-glass opacification than that in patients with IPF. The CT features of lung disease in patients with SSc closely resemble those in patients with idiopathic NSIP.

© RSNA, 2004

Index terms: Lung, CT, 68.1211 • Lung, diseases, 60.6113, 60.613, 60.917 • Lung, fibrosis, 60.6113, 60.613 • Lung, interstitial disease, 60.613, 60.917 • Scleroderma, 60.613 • Pneumonia, usual interstitial, 60.6113 • Pneumonia, nonschedule interstitial and fibrosis, 60.6113

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