The role of chest CT in deciphering interstitial lung involvement: systemic sclerosis versus COVID-19. (28th July 2021)

• Record Type: Journal Article
• Authors: Orlandi, Martina; Landini, Nicholas; Sambataro, Gianluca; Nardi, Cosimo; Tofani, Lorenzo; Bruni, Cosimo; Bellando-Randone, Silvia; Blagojevic, Jelena; Melchiorre, Daniela; Hughes, Michael; Denton, Christopher P; Luppi, Fabrizio; Ruaro, Barbara; della Casa, Francesca; Rossi, Francesca W; De Luca, Giacomo; Campochiaro, Corrado; Spinicci, Michele; Zammarchi, Lorenzo; Tomassetti, Sara; Caminati, Antonella; Cavigli, Edoardo; Albanesi, Marco; Melchiorre, Fabio; Palmucci, Stefano; Vegni, Virginia; Guiducci, Serena; Moggi-Pignone, Alberto; Allanore, Yannick; Bartoloni, Alessandro; Confalonieri, Marco; Dagna, Lorenzo; DeCobelli, Francesco; dePaulis, Amato; Harari, Sergio; Khanna, Dinesh; Kuwana, Masataka; Taliani, Gloria; Lavorini, Federico; Miele, Vittorio; Morana, Giovanni; Pesci, Alberto; Vancheri, Carlo; Colagrande, Stefano; Matucci-Cerinic, Marco;
• Is Part Of: Rheumatology. Volume 61:Number 4(2022)
• Page Start: 1600
• Page End: 1609
• Publication Date: 2021-07-28
• Subjects: COVID-19 -- COVID-19 pneumonia -- interstitial lung disease -- systemic sclerosis -- lung CT scan; Rheumatism -- Periodicals; Rheumatology -- Periodicals; 616.723005
• DOI: 10.1093/rheumatology/keab615
• Languages: English
• ISSNs: 1462-0324

Abstract

Abstract: Objective: The aim of this study was to identify the main CT features that may help in distinguishing a progression of interstitial lung disease (ILD) secondary to SSc from COVID-19 pneumonia. Methods: This multicentric study included 22 international readers grouped into a radiologist group (RADs) and a non-radiologist group (nRADs). 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 (GGOs) in the upper lobes; fibrosis in the lower lobe GGOs; 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 GGOs in the lower lobes ( P < 0.0001) remained independently associated with COVID-19 pneumonia and SSc-ILD, respectively. A predictive score was created that was positively associated with COVID-19 diagnosis (96.1% sensitivity and 83.3% specificity). Conclusion: CT diagnosis differentiating between COVID-19 pneumonia and SSc-ILD is possible through a combination of the proposed score and radiologic expertise. The presence of consolidation in the lower lobes may suggest COVID-19 pneumonia, while the presence of fibrosis inside GGOs may indicate SSc-ILD.