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Enfermedad pulmonar intersticial en enfermedades reumáticas autoinmunes sistémicas: correlaciones radiológicas e
Aidan Pye1, Darya S Jalaledin2, Angela Chang1
1Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Rheumatology advances in practice
|February 11, 2026
Resumen
CT de alta resolución (HRCT) muestra acuerdo moderado con la patología explant en la artritis reumatoide (AR) -ILD y la esclerosis sistémica (SSc) -ILD, pero no en la miopatía inflamatoria idiopática (IIM) -ILD. Anti-MDA5+ IIM-ILD progresa rápidamente, destacando las limitaciones del HRCT.
Área de la Ciencia:
- Medicina Pulmonar La medicina pulmonar es el tratamiento de las enfermedades pulmonares.
- Reumatología Reumatología.
- Radiología Radiología.
Sus antecedentes:
- La TC de alta resolución (HRCT) es crucial para el diagnóstico de la enfermedad pulmonar intersticial (ILD) en las enfermedades reumáticas autoinmunes sistémicas (SARD).
- La confirmación histológica a través de la biopsia pulmonar se realiza con poca frecuencia en SARD-ILD.
- Evaluar el acuerdo entre los hallazgos de HRCT y la patología explant es esencial para comprender la precisión del diagnóstico.
Objetivo del estudio:
- Evaluar la concordancia entre las imágenes HRCT y la patología explant en pacientes con SARD-ILD que se han sometido a un trasplante de pulmón.
- Investigar las posibles diferencias en el acuerdo de la histología HRCT en diferentes subtipos de SARD, incluida la miopatía inflamatoria idiopática (IIM), la esclerosis sistémica (SSc) y la artritis reumatoide (RA).
Principales métodos:
- Análisis retrospectivo de 82 pacientes SARD-ILD que se sometieron a un trasplante de pulmón entre 2012 y 2024 en dos centros canadienses.
- El acuerdo HRCT-histología se cuantificó utilizando estadísticas ponderadas de kappa (κ).
- Se emplearon diagramas aluvionales para visualizar los resultados.
Principales resultados:
- La artritis reumatoide-ILD (RA-ILD) mostró una concordancia HRCT-histología moderada (κ = 0,46), mientras que la esclerosis sistémica-ILD (SSc-ILD) demostró un acuerdo justo y no significativo (κ = 0,31).
- La miopatía inflamatoria idiopática-ILD (IIM-ILD) no exhibió una correlación HRCT-histología significativa (κ=0.07) y una heterogeneidad histológica significativa.
- Los pacientes con anti-MDA5+ IIM experimentaron universalmente ILD rápidamente progresiva, a menudo con daño alveolar difuso o fibrosis en etapa terminal, independientemente de los hallazgos iniciales de HRCT.
Conclusiones:
- La correlación HRCT-histología es de moderada a moderada en SSc-ILD y RA-ILD, pero limitada en IIM-ILD debido a la marcada heterogeneidad histológica.
- HRCT puede no predecir con precisión la patología específica o la naturaleza agresiva de IIM-ILD, particularmente en los casos anti-MDA5-positivos.
- El estudio subraya las limitaciones de confiar únicamente en HRCT para diagnosticar y predecir el curso de IIM-ILD.
Palabras clave:
El HRCTT es el HRCT.la histología, la histología.enfermedad pulmonar intersticial.La miositis es una miositis.La artritis reumatoide también se conoce como artritis reumatoide.La esclerosis sistémica es una esclerosis sistémica.Más Videos Relacionados
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