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1 From the Department of Diagnostic Radiology, Christian-Albrechts-University, Kiel, Germany
2 From the Department of Clinical Rheumatology, Medical University of Lübeck and Rheumaklinik Bad Bramstedt, Bad Bramstedt, Germany
3 From the Department of Internal Medicine, Christian-Albrechts-University, Kiel, Germany
M. Reuter, MD, Department of Diagnostic Radiology, Christian-Albrechts-University, Arnold-Heller-Str. 9, D-24105 Kiel, Germany
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, BAL, 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.
Key Words: lung • lung, CT • lung, diseases • lung, nodule • Wegener's granulomatosis
Submitted on September 17, 1997
Accepted on February 23, 1998
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