Chest
Volume 123, Issue 4, April 2003, Pages 1096-1103
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Clinical Investigations
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Nonspecific Interstitial Pneumonia Associated With Polymyositis and Dermatomyositis: Serial High-Resolution CT Findings and Functional Correlation

https://doi.org/10.1378/chest.123.4.1096Get rights and content

Study objectives:

We described the features seen on serial high-resolution CT scans of nonspecific interstitial pneumonia (NSIP) that was associated with polymyositis (PM) and dermatomyositis (DM), and we correlated the changes in the CT scan findings with those of pulmonary function test results.

Design, setting and patients:

Serial CT scans of 14 patients with histologically proven NSIP and PM/DM from two university hospitals were evaluated retrospectively (follow-up period, 3 to 61 months; mean follow-up period, 27.6 months). Using initial and follow-up CT scan findings, the extent of each type of opacity and the total area of increased opacity were calculated and correlated with the results of pulmonary function tests.

Measurements and results:

The predominant findings on the initial CT scans were of reticular and/or ground-glass opacities with or without consolidation. Reticular and ground-glass opacities predominated in the lower zone of each lung, and consolidation predominated at the lung periphery. Thirteen patients showed significant improvement of the total area of increased opacity (p < 0.05), and this decrease in extent inversely correlated with changes in FVC (r = −0.650; p = 0.031). Ground-glass and reticular opacities also were improved significantly in 11 and 13 patients, respectively. The decrease in the extent of ground-glass opacity correlated inversely with the changes in FVC (r = −0.758; p = 0.0119) and diffusion capacity for carbon monoxide (r = −0.669; p = 0.0448). In one patient, ground-glass opacity progressed, and death occurred after 3 months. Traction bronchiectasis was seen in 12 patients, and it improved in four patients after treatment. Honeycomb lung was not noted in any patient during follow-up.

Conclusions:

With treatment, serial CT scans of PM/DM patients with NSIP showed significant improvement in the abnormal opacities, and radiographic progression of lung fibrosis was limited. The CT scan features and clinical course of NSIP in PM/DM patients were relatively uniform, and this constitutes a subset of NSIP.

Section snippets

Patient Selection

Between April 1996 and July 2001, 22 patients with either PM or DM underwent video-assisted thoracoscopic surgery for their pulmonary disease in our two university hospitals. The lung tissue was initially examined by a pathologist at each of our hospitals, and the findings were confirmed by consultation with an experienced pulmonary pathologist. Of the 22 patients, the histologic diagnosis included NSIP in 18 patients, UIP in 2 patients, BOOP with DAD in 1 patient, and unclassifiable diffuse

Results

The frequency and distribution of each abnormal opacity on the initial and follow-up high-resolution CT scans are indicated in Table 1. On the initial high-resolution CT scans, ground-glass opacity was the most frequent abnormality (13 patients) [Fig 1, top], followed by the presence of intralobular reticular opacity (12 patients) and traction bronchiectasis (12 patients) [Fig 2, top]. Septal line thickening was seen in 11 patients. When septal line thickening and intralobular reticular opacity

Discussion

High-resolution CT features of NSIP have been reported previously as patchy ground-glass opacity with or without consolidation.1617 However, in a study13 of 50 patients with idiopathic NSIP, a wide variety of high-resolution CT scan findings was reported including ground-glass opacity (76% of the cases), reticular opacity (46% of the cases), honeycomb lung (30% of the cases), consolidation (16% of the cases), and nodules (14% of the cases). In our patients with NSIP and PM/DM, the most common

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