The role of chest CT in deciphering interstitial lung involvement: systemic sclerosis versus COVID-19

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  • Martina Orlandi
    Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence
  • Nicholas Landini
    Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence—AOUC, Florence
  • Gianluca Sambataro
    Regional Referral Centre for Rare Lung Diseases, A. O. U. ‘Policlinico G. Rodolico—San Marco’ Department of Clinical and Experimental Medicine, University of Catania
  • Cosimo Nardi
    Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence—AOUC, Florence
  • Lorenzo Tofani
    Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence
  • Cosimo Bruni
    Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence
  • Silvia Bellando-Randone
    Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence
  • Jelena Blagojevic
    Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence
  • Daniela Melchiorre
    Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence
  • Michael Hughes
    Department of Rheumatology, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
  • Christopher P Denton
    University College London Division of Medicine, Centre for Rheumatology and Connective Tissue Diseases, London, UK
  • Fabrizio Luppi
    Respiratory Unit, University of Milano-Bicocca, S. Gerardo Hospital, Monza
  • Barbara Ruaro
    Department of Pulmonology, University Hospital of Cattinara, Trieste
  • Francesca della Casa
    Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences, University of Naples Federico II, Napoli
  • Francesca W Rossi
    Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences, University of Naples Federico II, Napoli
  • Giacomo De Luca
    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano
  • Corrado Campochiaro
    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano
  • Michele Spinicci
    Department of Experimental and Clinical Medicine, University of Florence, and Infectious and Tropical Diseases Unit, AOUC
  • Lorenzo Zammarchi
    Department of Experimental and Clinical Medicine, University of Florence, and Infectious and Tropical Diseases Unit, AOUC
  • Sara Tomassetti
    Department of Clinical and Experimental Medicine, University of Florence, Florence
  • Antonella Caminati
    U.O. di Pneumologia, Ospedale San Giuseppe MultiMedica, IRCCS, Milano
  • Edoardo Cavigli
    Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence
  • Marco Albanesi
    Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence
  • Fabio Melchiorre
    Department of Radiology, Sant’Andrea Hospital Vercelli, ASLVC
  • Stefano Palmucci
    Radiodiagnostic and Radiotherapy Unit, Department of Medical Surgical Sciences and Advanced Technologies ‘GF Ingrassia’, University of Catania
  • Virginia Vegni
    Radiology Unit, Rugani Hospital, Siena
  • Serena Guiducci
    Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence
  • Alberto Moggi-Pignone
    Department of Experimental and Clinical Medicine, AOU Careggi Hospital, University of Florence Medical School, Florence, Italy
  • Yannick Allanore
    Department of Rheumatology A, Descartes University, APHP, Cochin Hospital, Paris, France
  • Alessandro Bartoloni
    Department of Experimental and Clinical Medicine, University of Florence, and Infectious and Tropical Diseases Unit, AOUC
  • Marco Confalonieri
    Department of Pulmonology, University Hospital of Cattinara, Trieste
  • Lorenzo Dagna
    Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milano
  • Francesco DeCobelli
    Department of Radiology IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University
  • Amato dePaulis
    Division of Autoimmune & Allergic Diseases, Department of Translational Medical Sciences, University of Naples Federico II, Napoli
  • Sergio Harari
    U.O. di Pneumologia, Ospedale San Giuseppe MultiMedica, IRCCS, Milano
  • Dinesh Khanna
    Department of Medicine, University of Michigan, Ann Arbor, MI, USA
  • Masataka Kuwana
    Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
  • Gloria Taliani
    Department of Translational and Precision Medicine, Sapienza University, Rome, Italy
  • Federico Lavorini
    Department of Clinical and Experimental Medicine, University of Florence, Florence
  • Vittorio Miele
    Department of Radiology, Azienda Ospedaliero-Universitaria Careggi, Florence
  • Giovanni Morana
    Department of Radiology, Ca’ Foncello General Hospital, Treviso
  • Alberto Pesci
    Respiratory Unit, University of Milano-Bicocca, S. Gerardo Hospital, Monza
  • Carlo Vancheri
    Regional Referral Centre for Rare Lung Diseases, A. O. U. ‘Policlinico G. Rodolico—San Marco’ Department of Clinical and Experimental Medicine, University of Catania
  • Stefano Colagrande
    Department of Experimental and Clinical Biomedical Sciences, Radiodiagnostic Unit n. 2, University of Florence—AOUC, Florence
  • Marco Matucci-Cerinic
    Division of Rheumatology AOUC, Department of Clinical and Experimental Medicine, University of Florence, University of Florence

Abstract

<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Objective</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>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 &lt; 0.0001) and signs of fibrosis in GGOs in the lower lobes (P &lt; 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).</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion</jats:title> <jats:p>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.</jats:p> </jats:sec>

Journal

  • Rheumatology

    Rheumatology 61 (4), 1600-1609, 2021-07-28

    Oxford University Press (OUP)

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