Objective: To identify the main computed tomography (CT) features that may help distinguishing a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc) from COVID-19 pneumonia. Methods: This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study. Results: Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p < 0.0001) and signs of fibrosis in GGO in the lower lobes (p < 0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. A predictive score was created which resulted positively associated with the COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity). Conclusion: The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination the proposed score and the radiologic expertise. The presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.
The role of chest CT in deciphering interstitial lung involvement: systemic sclerosis versus COVID-19 / M. Orlandi, N. Landini, G. Sambataro, C. Nardi, L. Tofani, C. Bruni, S. Bellando-Randone, J. Blagojevic, D. Melchiorre, M. Hughes, C.P. Denton, F. Luppi, B. Ruaro, F. Della Casa, F.W. Rossi, G. De Luca, C. Campochiaro, M. Spinicci, L. Zammarchi, S. Tomassetti, A. Caminati, E. Cavigli, M. Albanesi, F. Melchiorre, S. Palmucci, V. Vegni, S. Guiducci, A. Moggi-Pignone, Y. Allanore, A. Bartoloni, M. Confalonieri, L. Dagna, F. De Cobelli, A. De Paulis, S. Harari, D. Khanna, M. Kuwana, G. Taliani, F. Lavorini, V. Miele, G. Morana, A. Pesci, C. Vancheri, S. Colagrande, M. Matucci-Cerinic. - In: RHEUMATOLOGY. - ISSN 1462-0324. - 61:4(2022 Apr 22), pp. 1600-1609. [10.1093/rheumatology/keab615]
The role of chest CT in deciphering interstitial lung involvement: systemic sclerosis versus COVID-19
G. De Luca;F. Melchiorre;S. Harari;
2022
Abstract
Objective: To identify the main computed tomography (CT) features that may help distinguishing a progression of interstitial lung disease (ILD) secondary to Systemic sclerosis (SSc) from COVID-19 pneumonia. Methods: This multicentric study included 22 international readers divided in the radiologist group (RAD) and non-radiologist group (nRAD). A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study. Results: Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT features most frequently associated with SSc-ILD. The CT features most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p < 0.0001) and signs of fibrosis in GGO in the lower lobes (p < 0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. A predictive score was created which resulted positively associated with the COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity). Conclusion: The CT differential diagnosis between COVID-19 pneumonia and SSc-ILD is possible through the combination the proposed score and the radiologic expertise. The presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.File | Dimensione | Formato | |
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