High-resolution computed tomography of the chest for the screening, re-screening and follow-up of systemic sclerosis-associated interstitial lung disease: a EUSTAR-SCTC survey
High-resolution computed tomography of the chest for the screening, re-screening and follow-up of systemic sclerosis-associated interstitial lung disease: a EUSTAR-SCTC survey
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DOI：
10.55563/clinexprheumatol/7ry6zz
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发表时间：
2022-10-01
影响因子：
3.7
通讯作者：
Distler, O.
中科院分区：
文献类型：
--
作者：
Bruni, C.;Chung, L.;Distler, O.
目的胸部高分辨率CT(HRCT)是诊断间质性肺疾病的金标准。先前的一项调查报告，只有不到60%的治疗SSc的风湿科医生要求对新诊断的SSc患者进行ILD筛查的HRCT。从那时起，开始努力提高对人权CT作为一种筛查工具的认识。方法欧洲硬皮病试验和研究(EUSTAR)和硬皮病临床试验联合会(SCTC)成员回答了一项关于HRCT在诊断中的使用、基线HRCT阴性的患者的重新筛查以及HRCT阳性的SSC-ILD患者的随访的调查。结果205名内科应答者中，95.6%会在SSC诊断时进行HRCT检查：64.9%作为ILD的常规筛查(65.4%为SSC转诊医生，63.6%为非转诊医生)，30.7%为临床怀疑(95.2%为听诊爆裂)。在非筛查医生中，临床和伦理方面的担忧是不订购HRCT的主要驱动因素。在随访期间，79.0%的应答者会在基线阴性病例中重复进行HRCT：14.1%作为常规筛查，64.9%用于诊断目的。最后，93.2%的应答者会在SSc-ILD诊断后再次进行胸部HRCT检查：36.6%为年度常规检查，56.6%为临床评估。结论基线HRCT在SSc-ILD筛查中的使用略有增加，但应调整宣传方案，以进一步提高认识。HRCT在重新筛查和随访中的应用可能受益于经过验证的算法。
Objective High-resolution computed tomography (HRCT) of the chest is the gold standard to diagnose interstitial lung disease (ILD). A prior survey reported that fewer than 60% of SSc-treating rheumatologists order an HRCT for ILD screening in newly diagnosed SSc patients. Since then, efforts were initiated to increase awareness of HRCT as a screening tool. The aim of the present study was to assess efficacy of these awareness programmes.Methods European Scleroderma Trials and Research (EUSTAR) and Scleroderma Clinical Trials Consortium (SCTC) members answered a survey about the use of HRCT at diagnosis, the re-screening of patients with a negative baseline HRCT, and the follow-up of HRCT positive SSc-ILD patients. When HRCT was not routinely requested, additional details were collected.Results Among 205 physician responders, 95.6% would perform an HRCT at SSc diagnosis: 64.9% as routine screening for ILD (65.4% of SSc referral and 63.6% of non-referral physicians) and 30.7% upon clinical suspicion (95.2% in case of crackles on auscultation). Among non-screening physicians, clinical and ethical concerns were major driving factors for not ordering HRCTs. During follow-up, 79.0% of responders would repeat HRCTs in baseline negative cases: 14.1% as routine screening and 64.9% for diagnostic purposes. Finally, 93.2% of responders would repeat a chest HRCT after SSc-ILD diagnosis: 36.6% as yearly routine and 56.6% according to clinical evaluation.Conclusion The use of baseline HRCT for the screening of SSc-ILD has slightly increased, but awareness programmes should be adapted for further improvement. HRCT use in re-screening and follow-up may benefit from validated algorithms.