Quantitative chest computed tomography predicts mortality in systemic sclerosis: A longitudinal study

Area of Science:

• Radiology
• Pulmonology
• Rheumatology

Background:

• Systemic sclerosis (SSc) is associated with interstitial lung disease (ILD), a major cause of mortality.
• Quantitative computed tomography (qCT) offers objective measures of lung abnormalities.
• Predicting mortality in SSc-ILD patients remains a clinical challenge.

Purpose of the Study:

• To investigate if qCT measures can predict 5-year mortality in patients with SSc.
• To evaluate the association between specific qCT parameters and survival outcomes.
• To compare qCT findings with traditional semiquantitative analysis.

Main Methods:

• Retrospective analysis of SSc patients with high-resolution CTs (HRCTs) and pulmonary function tests (PFTs).
• Evaluation of ground glass opacities, reticular pattern, honeycombing, and pulmonary vascular volume using Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER).
• Kaplan-Meier survival analysis and multivariate models to identify mortality predictors.

Main Results:

• A higher reticular pattern on baseline qCT independently predicted mortality (Exp 2.70).
• Worse survival was observed with ILD extent ≥ 6.32%, reticular pattern ≥ 1.41%, and forced vital capacity (FVC) < 70% at baseline.
• Absolute FVC decline ≥ 5% at follow-up was a significant predictor of mortality (Exp 15.01).

Conclusions:

• Baseline qCT assessment of the reticular pattern is a valuable tool for predicting mortality in SSc patients.
• qCT provides objective and reproducible measures of lung damage in SSc-ILD.
• Integrating qCT into clinical practice can improve risk stratification for SSc patients with ILD.