HRCT Features of Dermatomyositis-/Polymyositis- Associated Interstitial Lung Disease
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摘要:
目的:探讨皮肌炎(DM)/多发性肌炎(PM)相关间质性肺病(ILD)的高分辨率CT(HRCT)特征。方法:回顾性分析2014年1月至2019年12月间141例合并ILD的DM/PM患者的胸部HRCT征象。结果:DM/PM-ILD的HRCT表现主要包括:磨玻璃影(87.2%,123/141)、小叶间隔增厚(78.0%,110/141)、小叶内间质增厚(63.8%,90/141)、实变(29.0%,41/141)、胸膜下线(26.2%,37/141)、牵拉性支气管扩张(19.9%,28/141)、蜂窝征(3.5%,5/141);其他合并表现还包括纵隔气肿(3例)、胸腔积液(15例)及心包积液(18例);主要的影像分型为非特异性间质性肺炎(NSIP),其次为机化性肺炎(OP)。结论:尽管DM/PM-ILD病变类型复杂,但其影像学表现仍具有一定的特征性,掌握其HRCT主要特征及影像分型有助于该病的早期识别和及时诊治。
Abstract:Objective: To evaluate high-resolution computed tomography (HRCT) features of dermatomyositis-/polymyositis- associated interstitial lung disease (DM/PM-ILD). Methods: We retrospectively reviewed the HRCT images of 148 patients with DM/PM-ILD at the First Affiliated Hospital of Xi’an Jiaotong University between Jan. 1, 2014, and Dec. 31, 2019. Results: The HRCT features of DM/PM-ILD were characterized by ground-glass opacities (GGO) (87.2%, 123/141), interlobular septal thickening (78.0%, 110/141), intralobular interstitial thickening (63.8%, 90/141), consolidation (29.1%, 41/141), subpleural lines (26.2%, 37/141), traction bronchiectasis (19.9%, 28/141), and honeycombing (3.5%, 5/141). Pneumomediastinum (3), pleural effusion (15), and pericardial effusion (18) were also observed. The two main radiological patterns were non-specific interstitial pneumonia (NSIP) and organism pneumonia (OP). Conclusion: HRCT features of DM/PM-ILD are heterogeneous, with various radiological patterns. Mastering the main characteristics of HRCT manifestation and the radiological patterns of DM/PM-ILD will be helpful for early identification and timely treatment.
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表 1 DM/PM-ILD患者HRCT基本特征
Table 1 The basic HRCT features of DM/PM-ILD patients
项目 HRCT特征 例数 占比/% 总例数 141 100.0 基本特征 GGO 123 87.2 实变 41 29.1 小叶间隔增厚 110 78.0 小叶内间质增厚 90 63.8 胸膜下线 37 26.2 牵拉性支气管扩张 28 19.9 蜂窝影 5 3.5 伴随征象 纵隔气肿 3 2.1 胸腔积液 15 10.6 心包积液 18 12.8 病灶轴向分布 中央分布 0 0.0 周围分布 108 76.6 弥漫或随机分布 33 23.4 病灶纵向分布 上肺 0 0.0 下肺 52 36.9 弥漫或随机分布 89 63.1 表 2 DM/PM-ILD患者HRCT影像分型
Table 2 The radiological pattern of DM/PM-ILD patients on HRCT
影像分型 例数 占比/% 总例数 141 100.0 NSIP 53 37.6 OP 39 27.7 NSIP+OP 32 22.7 DAD 8 5.7 UIP/可能UIP 5/4 3.5/2.8 -
[1] 王亚飞, 李红霞, 吴振彪. 肌炎相关间质性肺病的治疗进展[J]. 中华风湿病学杂志, 2022, 26(7): 480−485. DOI: 10.3760/cma.j.cn141217-20210927-00392. WANG Y F, LI H X, WU Z B. Progress in the treatment of myositis-related interstitial lung disease[J]. Chinese Journal of Rheumatology, 2022, 26(7): 480−485. DOI: 10.3760/cma.j.cn141217-20210927-00392. (in Chinese).
[2] PALMUCCI S, Di MARI A, CANCEMI G, et al. Clinical and radiological features of interstitial Lung diseases associated with polymyositis and dermatomyositis[J]. Medicina (Kaunas), 2022, 58(12): 1757. DOI: 10.3390/medicina58121757.
[3] 吴京波, 时新杰, 郭丽娟, 等. 以间质性肺病为首发表现的抗Jo-1抗体综合征1例[J]. 国际医药卫生导报, 2021, 27(8): 1240−1243. DOI: 10.3760/cma.j.issn.1007-1245.2021.08.034. WU J B, SHI X J, GUO L J, et al. One case of anti-Jo-1 syndrome with interstitial lung disease as the initial symptom[J]. International Medicine and Health Guidance News, 2021, 27(8): 1240−1243. DOI: 10.3760/cma.j.issn.1007-1245.2021.08.034. (in Chinese).
[4] SUGIYAMA Y, YOSHIMI R, TAMURA M, et al. The predictive prognostic factors for polymyositis/dermatomyositis-associated interstitial lung disease[J]. Arthritis Research & Therapy, 2018, 20(1): 7. DOI: 10.1186/s13075-017-1506-7.
[5] GULER S A, CORTE T J. Interstitial lung disease in 2020: A history of progress[J]. Clinics in Chest Medicine, 2021, 42(2): 229−239. DOI: 10.1016/j.ccm.2021.03.001.
[6] BOHAN A, PETER J B. Polymyositis and dermatomyositis (first of two parts)[J]. The New England Journal of Medicine, 1975, 292(7): 344−347. DOI: 10.1056/NEJM197502132920706.
[7] OLIVEIRA D S, ARAÚJO FILHO J A, PAIVA A, et al. Idiopathic interstitial pneumonias: Review of the latest American Thoracic Society/European Respiratory Society classification[J]. Radiologia Brasileira, 2018, 51(5): 321−327. DOI: 10.1590/0100-3984.2016.0134.
[8] HANSELL D M, BANKIER A A, MACMAHON H, et al. Fleischner Society: Glossary of terms for thoracic imaging[J]. Radiology, 2008, 246(3): 697−722. DOI: 10.1148/radiol.2462070712.
[9] GUAN C S, LV Z B, YAN S, et al. Imaging features of coronavirus disease 2019 (COVID-19): Evaluation on thin-section CT[J]. Academic Radiology, 2020, 27(5): 609−613. DOI: 10.1016/j.acra.2020.03.002.
[10] EGASHIRA R. High-resolution CT findings of myositis-related interstitial lung disease[J]. Medicina (Kaunas), 2021, 57(7): 692. DOI: 10.3390/medicina57070692.
[11] KIM G, TASHKIN D P, LO P, et al. Using transitional changes on high-resolution computed tomography to monitor the impact of cyclophosphamide or mycophenolate mofetil on systemic sclerosis-related interstitial lung disease[J]. Arthritis & Rheumatology, 2020, 72(2): 316−325. DOI: 10.1002/art.41085.
[12] GOLDIN J G, KIM G, TSENG C H, et al. Longitudinal changes in quantitative interstitial lung disease on computed tomography after immunosuppression in the scleroderma lung study II[J]. Annals of the American Thoracic Society, 2018, 15(11): 1286−1295. DOI: 10.1513/AnnalsATS.201802-079OC.
[13] KISHABA T. Acute exacerbation of idiopathic pulmonary fibrosis[J]. Medicina (Kaunas), 2019, 55(3): 70. DOI: 10.3390/medicina55030070.
[14] 毛萌萌, 郭炳鹏, 韩茜. 《成人特发性肺纤维化(更新)和进展性肺纤维化: ATS/ERS/JRS/ALAT临床实践指南(2022版)》解读(一): 进展性肺纤维化识别与治疗[J]. 国际呼吸杂志, 2023, 43(11): 1245−1250. DOI: 10.3760/cma.j.cn131368-20231013-00247. MAO M M, GUO B P, HAN Q. Interpretation of “Idiopathic pulmonary fibrosis (an Update) and progressive pulmonary fibrosis in adults: An official ATS/ERS/JRS/ALAT clinical practice guideline (2022 Edition)”: Identification and treatment of progressive pulmonary fibrosis[J]. International Journal of Respiration, 2023, 43(11): 1245−1250. DOI: 10.3760/cma.j.cn131368-20231013-00247. (in Chinese).
[15] HAYASHI S, TANAKA M, KOBAYASHI H, et al. High-resolution computed tomography characterization of interstitial lung diseases in polymyositis/dermatomyositis[J]. The Journal of Rheumatology, 2008, 35(2): 260−269.
[16] SINGH D, KUMAR S, STEAD T S, et al. Spontaneous mediastinal emphysema[J]. Cureus, 2018, 10(3): e2369. DOI: 10.7759/cureus.2369.
[17] YEUNG T W, CHEONG K N, LAU Y L, et al. Adolescent-onset anti-MDA5 antibody-positive juvenile dermatomyositis with rapidly progressive interstitial lung disease and spontaneous pneumomediastinum: A case report and literature review[J]. Pediatric Rheumatology Online Journal, 2021, 19(1): 103. DOI: 10.1186/s12969-021-00595-1.
[18] 郭子维, 王燕, 胡伟, 等. 皮肌炎合并纵隔气肿患者的临床特点及血清学特征[J]. 中华风湿病学杂志, 2015, 19(9): 592−597. DOI: 10.3760/cma.j.issn.1007-7480.2015.09.004. GUO Z W, WANG Y, HU W, et al. Clinical and serological features of patients with dermatomyositis complicated by spontaneous pneumomediastinum[J]. Chinese Journal of Rheumatology, 2015, 19(9): 592−597. DOI: 10.3760/cma.j.issn.1007-7480.2015.09.004. (in Chinese).
[19] YOO H, HINO T, HAN J, et al. Connective tissue disease-related interstitial lung disease (CTD-ILD) and interstitial lung abnormality (ILA): Evolving concept of CT findings, pathology and management[J]. European Journal of Radiology Open, 2021, 8: 100311. DOI: 10.1016/j.ejro.2020.100311.
[20] DOUGLAS W W, TAZELAAR H D, HARTMAN T E, et al. Polymyositis-dermatomyositis-associated interstitial lung disease[J]. American Journal of Respiratory and Critical Care Medicine, 2001, 164(7): 1182−1185. DOI: 10.1164/ajrccm.164.7.2103110.
[21] JOY G M, ARBIV O A, WONG C K, et al. Prevalence, imaging patterns and risk factors of interstitial lung disease in connective tissue disease: A systematic review and meta-analysis[J]. European Respiratory Review: An Official Journal of the European Respiratory Society, 2023, 32(167). DOI: 10.1183/16000617.0210-2022.