Background/Purpose:

Interstitial Lung Disease (ILD) in patients with Idiopathic Inflammatory Myopathies (IIM) is associated to high mortality and morbidity. The study of pleural irregularities (PI) with lung ultrasound (US) and quantitative automated scoring of high resolution computed tomography (HRCT) have been recently proposed as a method for assessing the ILD. Purpose of our study is to compare the US assessment of PI and HRCT semi-quantitative and quantitative analysis of ILD.

Methods:

Forty-five IIM patients (30 F, 15M, mean age 64±12), 44 diagnosed according to Bohan and Peter (23 PM, 22 DM) and 1 IBM according to Griggs criteria, with a disease duration of 54±86 months, were enrolled. Lung US was performed in 53 anterior and posterior intercostal spaces with 8-18 MHz linear probe, assigning a PI score ranging from 0 to 2 0 (no PI), 1 (mild PI – 3-5mm), 2 (severe PI > 5 mm) and calculating the total PI score (PIS). In a subset of patients to assess reliability and reproducibility of the PIS, the lung ultrasounds were also repeated by the same operator after two days and by a second operator.

HRCTs were assessed by an expert radiologist to obtain a semiquantitative score – Warrick score (WS) and 26 HRCTs were also evaluated with a quantitative analysis by a volumetric texture and local volumetric histogram feature-based analysis software (CALIPER). With CALIPER were quantified lung involvement as a percent of interstitial lung abnormalities (ILD%): a combination of percent of areas of ground glass, reticulation and honeycombing. Analysis of the vascular involvement was obtained as percent of pulmonary vessel volume (PVRS %).

Results:

PI were present in all patients with a mean PIS of 25 ±14. At HRCT, the semiquantitative analysis of CT data, identified ILD in 32 patients with a mean WS of 7.2±7.0. CALIPER software quantified a mean ILD% of 2.90±5.72 and a mean PVRS% of 2.56±1.29.

A good correlation was identified between PIS and WS (r=0.716 p<0.001) and with PIS and ILD% and PVRS% (r=0.559 p=0.003 and r=0.615 p<0.001 respectively). Additionally, a good correlation was identified among WS and ILD% and PVRS% (r=0.693 p<0.001 and r=0.651 p<0.001 respectively).

The PIS score was repeatable (inter-reader reliability: α= 0.916) and reproducible (intra-reader reliability: α= 0.945).

Conclusion:

The evaluation of ILD with innovative techniques may allow a more precise grading of ILD in IIM patients. Our study suggests a possible role for both PI and CALIPER in the evaluation of ILD in clinical practice and for RCTs, as PI US may be useful for the initial screening of ILD and the automatic software CALIPER could make ILD assessment easier and more reproducible.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/innovative-approaches-for-the-assessment-of-interstitial-lung-disease-in-idiopathic-inflammatory-myopathies-ultrasound-evaluation-of-pleural-irregularities-and-semiquantitative-and-quantitative-analy/