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Demographic and Physiological Differences Between Fibrotic and Nonfibrotic CT Subtypes of Sarcoidosis
Ruchi Yadav1, Wren L Lippitt2, Kum Ju Chae3
1Diagnostic Institute, Department of Radiology, Cleveland Clinic, Cleveland, OH.
Background:
One approach to categorizing patients using chest CT imaging manifestations of pulmonary sarcoidosis is to use 3 classifications: fibrotic, nonfibrotic, or no parenchymal abnormality. This study aimed to evaluate the relationships between these imaging subtypes and demographic and physiological variables in a large group of patients with sarcoidosis with chest CT imaging.
Research Question:
Do individuals with fibrotic sarcoidosis have more severe physiological impairment than those with nonfibrotic sarcoidosis and those with no parenchymal abnormality, and are there CT subtypes of fibrosis that are associated with different physiological subtypes?
Study Design And Methods:
The study included individuals with sarcoidosis from 2 large medical centers who were seen between 2008 and 2018 and from the Genomic Research in Alpha-1 Antitrypsin Deficiency and Sarcoidosis (GRADS) consortium and who received high-resolution CT imaging and spirometry and lung diffusing capacity within 180 days (N = 932). Pulmonary function phenotypes were characterized based on spirometry findings and lung diffusing capacity. CT patterns were systematically classified as fibrotic, nonfibrotic, or no parenchymal abnormality based on standardized visual assessment. Multinomial logistic regression analyzed the relationship between pulmonary function and CT categories.
Results:
Among the 942 patients, 353 (38%) had fibrosis, 380 (41%) had nonfibrotic abnormalities, and 199 (21%) had no parenchymal abnormality. Individuals with fibrotic abnormalities were older and had a longer time since diagnosis, more impaired spirometry and diffusing capacity, and larger pulmonary artery diameter than those without (all, P < .001). Among participants with fibrosis, those with a conglomerate mass were 9 times more likely to have a mixed pattern of spirometric impairment (P < .01).
Interpretation:
Our results show that individuals with fibrotic pulmonary sarcoidosis display distinct demographic and spirometric differences. Subtypes of fibrosis exhibit different lung function abnormalities.
