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Lung CT Densitometry in Systemic Sclerosis^*

Correlation With Lung Function, Exercise Testing, and Quality of Life

^* From the Respiratory Medicine Unit, Department of Critical Care (Drs. Camiciottoli, Meoni, and Pistolesi); Radiodiagnostic Section, Department of Clinical Physiopathology (Drs. Orlandi, Bartolucci, Barcaroli, and Mascalchi); Rheumatology Unit, Department of Internal Medicine (Drs. Conforti and Matucci-Cerinic); and Department of Electronics and Telecommunications (Dr. Diciotti), University of Florence, Florence, Italy.

Correspondence to: Gianna Camiciottoli, MD, Respiratory Medicine Unit, Department of Critical Care, Università degli Studi di Firenze, Viale Morgagni 85, Firenze, Italy; e-mail: g.camiciottoli{at}dac.unifi.it

Abstract

Background: To ascertain if analysis of lung density histograms in thin-section CT was more reproducible than visual assessment of lung changes in systemic sclerosis (SSc), and if such density histogram parameters as mean lung attenuation (MLA), skewness, and kurtosis could more closely reflect pulmonary function as well as exercise and quality of life impairment.

Methods: The intraoperator and interoperator reproducibility of visual and densitometric lung CT analysis in 48 SSc patients examined with CT were evaluated by means of weighted statistics. Univariate and multivariate regression analyses were applied to evaluate the relationship of visual and densitometric CT measurements with functional parameters including functional residual capacity (FRC), FVC, FEV₁, diffusion capacity of the lung for carbon monoxide (DLCO), 6-min walking testing (6MWT), and health-related quality of life questionnaire (QLQ) parameters.

Results: The intraoperator and interoperator reproducibility of MLA (intraobserver weighted = 0.97; interobserver weighted = 0.96), skewness (intraobserver weighted = 0.89; interobserver weighted = 0.88), and kurtosis (intraobserver weighted = 0.89; interobserver weighted = 0.88) were higher than those of visual assessment (intraobserver weighted = 0.71; interobserver weighted = 0.69). In univariate analysis, only densitometric measurements were correlated with some exercise and QLQ parameters. In multivariate analysis, MLA (square regression coefficient corrected [R²c] = 0.70), skewness (R²c = 0.78), and kurtosis (R²c = 0.77) were predicted by FRC, FVC, DLCO, 6MWT, and QLQ parameters, while visual assessment was associated only with FRC and FVC (R²c = 0.40).

Conclusions: In SSc, densitometric analysis is more reproducible than visual assessment of lung changes in thin-section CT and more closely correlated to pulmonary function testing, 6MWT, and QLQ. Density histogram parameters may be useful for cross-sectional and longitudinal studies of lung involvement in SSc.

Key Words: CT • densitometry • histogram analysis • pulmonary function tests • systemic sclerosis

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