Relationship Between Abnormalities on High-Resolution CT and Pulmonary Function in Systemic Sclerosis

¹ From the Groupe de Recherche Epithélium Respiratoire et Inflammation, Services de Médecine Interne B, CHU Bretonneau, 2 Boulevard Tonnellé, Tours Cedex, France
² From the Pneumologie, CHU Bretonneau, 2 Boulevard Tonnellé, Tours Cedex, France
³ From the Radiologie B, CHU Bretonneau, 2 Boulevard Tonnellé, Tours Cedex, France
⁴ From the Médecine Nucléaire In Vitro, CHU Bretonneau, 2 Boulevard Tonnellé, Tours Cedex, France

Patrice Diot, Service de Pneumologie, CHU Bretonneau, 2 bis Boulevard Tonnellé, 37044, Tours Cedex, France; e-mail: diot{at}med.univ-tours.fr

Study objectives: To determine the predictive value of abnormalities on high-resolution CT (HRCT) on pulmonary disease in systemic sclerosis.

Patients: Fifty-two patients suffering from systemic sclerosis.

Design: Pulmonary disease was defined by pulmonary function test abnormalities, ie, total lung capacity (TLC) <80% of predicted value and/or diffusion of carbon monoxide (DLCO) <75% of predicted value, without any pulmonary event other than systemic sclerosis in the medical history. Patients were divided in two groups, group A with pulmonary disease (29 patients) and group B without pulmonary disease (23 patients). HRCT abnormalities were scored on whole lungs. A decision matrix was constructed to determine sensitivity, specificity, positive and negative predictive values, and false-positive and false-negative rates. A receiver operating characteristic curve was constructed to determine the best compromise between sensitivity and specificity.

Results: HRCT total scores were higher in group A (9.0 ± 4.3) than in group B (5.0 ± 2.8) (p < 0.001) and they correlated with TLC (r = 0.39, p < 0.005) and DLCO (r = 0.50, p < 0.0002). An HRCT score of 7 corresponded to the best compromise between sensitivity (0.60) and specificity (0.83), with a positive predictive value of 0.82. Taking into account a value of 10 for the HRCT score increased specificity to 1 but decreased sensitivity to 0.41.

Conclusion: A minimum score of 7 would be required to consider HRCT abnormalities in systemic sclerosis as predictive of pulmonary disease. An HRCT score of 10 makes it possible to establish the diagnosis of lung involvement severe enough to impair pulmonary function.

Key Words: high-resolution computed tomography • lung systemic sclerosis • pulmonary function tests

Submitted on January 13, 1998
Accepted on June 10, 1998

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