High-resolution computed tomography characterization of interstitial lung diseases in polymyositis/dermatomyositis.
OBJECTIVE
Interstitial lung disease (ILD) associated with polymyositis (PM) and dermatomyositis (DM) sometimes progresses rapidly and is resistant to therapy. Clinical features that forecast the prognosis of the disease remain to be elucidated. Our aim was to assess if selected clinical features and high-resolution computed tomography (HRCT) findings can assist in predicting the clinical course of ILD in PM/DM.


METHODS
We examined HRCT findings retrospectively for ILD identified in 17 patients with PM and 16 with DM. Radiological patterns and clinical features are analyzed in comparison with clinical course.


RESULTS
Mortality rates were 12% and 44% for ILD associated with PM and DM, respectively. Most patients with DM died of rapidly progressive lung deterioration. No patient in the PM group died of respiratory failure. In the DM group, all patients with fatal ILD had ground-glass attenuation and reticular opacity as the principal radiological findings. Consolidation was recognized frequently as the principal pattern in nonfatal cases. Radiological patterns were categorized into 3 groups; A: consolidation dominant, B: ground-glass attenuation/reticular opacity dominant without chronic fibrosing process, and C: ground-glass attenuation/reticular opacity dominant with chronic fibrosing process. Occurrences of fatal disease were 0%, 83%, and 20%, in groups A, B, and C.


CONCLUSIONS
The prognosis of ILD associated with DM differs from that with PM. The former can be classified into 3 subgroups on the basis of radiological findings, which are closely associated with clinical course.
Hayashi
Shinichiro
S
Department of Pulmonary Medicine, Saga University School of Medicine, Nabeshma, Saga 849-8501, Japan. hayashs@cc.saga-u.ac.jp
Tanaka
Masahide
M
Kobayashi
Hiromi
H
Nakazono
Takahiko
T
Satoh
Toshimi
T
Fukuno
Yuji
Y
Aragane
Naoko
N
Tada
Yoshifumi
Y
Koarada
Shuichi
S
Ohta
Akihide
A
Nagasawa
Kohei
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003882:Dermatomyositis / Q000150:complications*; D018450:Disease Progression; D005260:Female; D006651:Histocytochemistry; D006801:Humans; D053208:Kaplan-Meier Estimate; D017563:Lung Diseases, Interstitial / Q000150:complications* / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed