Chest
Volume 114, Issue 2, August 1998, Pages 500-506
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Clinical Investigations: Idiopathic Disease
Pulmonary Wegener's Granulomatosis: Correlation Between High-Resolution CT Findings and Clinical Scoring of Disease Activity

https://doi.org/10.1378/chest.114.2.500Get rights and content

Study objective

To evaluate the usefulness of high-resolution CT (HRCT) for monitoring pulmonary disease activity in Wegener's granulomatosis (WG).

Design

Prospective study of CT and clinical data.

Setting

Main referral hospital for rheumatic diseases and department of diagnostic radiology of collaborating university hospital.

Patients

Seventy-three patients with WG underwent 98 staging examinations using HRCT. The status of pulmonary disease activity at the time of examination was scored according to clinical, bronchoscopic, RAL, and radiographic findings as follows: activity (n=25, group 1), past activity (n=45, group 2) and lack of any pulmonary disease (n=28, group 3). HRCT findings were correlated with the clinical scoring of pulmonary disease activity.

Results

Of 98 staging examinations 78 (79.6%) revealed abnormal CT scans showing the following main abnormalities: (a) nodules or masses (group 1: 16 [60.4%], group 2: 9 [20%]); (b) parenchymal bands (group 1: 12 [48%], group 2: 27 [60%], group 3: 6 [21.5%]); (c) septal thickening (group 1: 8 [32%], group 2: 6 [13.3%]); (d) parenchymal opacification (group 1: 7 [28%], group 2: 4 [8.9%]); and (e) pleural irregularity (group 1: 14 [56%], group 2: 22 [49%], group 3: 9 [32%]). Nodules/masses and areas of parenchymal opacification were significantly associated with florid disease activity of the lungs. Parenchymal bands and septal thickening were observed in both groups with pulmonary involvement, but statistical analysis revealed no significant difference. Pleural irregularities were nonspecific.

Conclusion

HRCT may be a useful adjunct to clinical scoring of pulmonary disease activity in patients with WG and suspected lung involvement.

Section snippets

Patients

Seventy-three patients with WG (30 female, 43 male; mean age, 48.3 years; range, 34 to 71 years) underwent 98 staging examinations (1 examination each in 58 patients, 2 examinations in 8 patients, and ≥3 examinations in 7 patients). In the majority of enrolled patients, staging was performed for reevaluation after treatment (n=80 staging examinations). The diagnosis of WG was established in accordance to the 1990 American College of Rheumatology Criteria19 and the Chapel Hill criteria20 and it

Results

Correlations between HRCT findings and pulmonary status are presented in Table 2. HRCT detected nodules and masses in group 1 (active pulmonary disease) and group 2 (past pulmonary disease) only (Fig 1). There were significantly more patients with nodules/masses in group 1 (16/25 patients) compared with group 2 (9/45 patients) (p<0.001). The probability to have active lung disease is significantly increased in the event of nodules/masses (odds ratio 8.1, 95% confidence interval 2.7 to 27.9).

Discussion

Our study of 98 examinations in 73 patients with differing status of pulmonary disease documents a broad spectrum of radiologic signs. The classic pulmonary nodules and masses are found in merely 25% of examinations, which represents an incidence considerably lower compared with the literature.1, 10, 13, 14, 15, 17, 22 This discrepancy may be traced back to inclusion of patients with no overt pulmonary symptoms, subacute disease manifestation, and the chronic course of patients receiving

Acknowledgments

The authors thank Claus-C. Gluer, PhD (Section of Medical Physics, Department of Diagnostic Radiology) for his assistance with the statistical analysis.

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