HRCT and scleroderma: semiquantitative evaluation of lung damage and functional abnormalities.
OBJECTIVE
This study sought to validate the Warrick score in the assessment of lung involvement in systemic sclerosis (SSc) and correlate the results with functional abnormalities. In addition, we propose the use of high resolution computed tomography (HRCT) indices of alveolitis and fibrosis to discriminate between different stages of the disease.


METHODS
Thirty-one patients with SSc (16 with the diffuse form and 15 with the limited form) underwent functional and HRCT evaluations of the lung. The semiquantitative evaluation of radiological involvement, as proposed by Warrick, provides a score for each lesion based on the severity and the extent of the pulmonary damage. In addition to the total score, indices for alveolitis and fibrosis were created. The association between each score and functional abnormalities was tested.


RESULTS
The total Warrick score was 16+/-7.7 [mean+/-standard deviation (SD)]. The total score correlated inversely with total lung capacity (TLC) (percentage of predicted TLC) (r=-0.38; p=0.04), diffusion lung capacity for carbon monoxide (DLCO) (percentage of predicted DLCO) (r=-0.43; p=0.02) and with forced expiratory volume in 1 second (FEV1) (percentage of predicted FEV1) (r=-0.36; p=0.05). The alveolitis and fibrosis indices were 1.9+/-1.1 and 14.2+/-7.4, respectively. The alveolitis index correlated significantly with percentage of predicted DLCO (r=-0.46; p=0.01) but not with percentage of predicted TLC (r=-0.28; p=0.13). The fibrosis index correlated both with percentage of predicted DLCO (r=-0.38; p=0.04) and with percentage of predicted TLC (r=-0.35; p=0.05).


CONCLUSIONS
Our findings confirm the diagnostic role of HRCT in assessing the extent of lung damage in SSc. Furthermore, the two indices (alveolitis and fibrosis) provide new tools for evaluating the relationship between pulmonary involvement and systemic impairment in SSc.
Bellia
M
M
Dipartimento di Biotecnologie e Medicina Legale, Sezione di Scienze Radiologiche, Università di Palermo, Palermo, Italy. maria.bellia@libero.it
Cannizzaro
F
F
Scichilone
N
N
Riili
M
M
Triolo
G
G
Midiri
M
M
Lagalla
R
R
D000328:Adult; D000368:Aged; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging; D005541:Forced Expiratory Volume; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011650:Pulmonary Alveoli / Q000000981:diagnostic imaging; D012129:Respiratory Function Tests; D045743:Scleroderma, Diffuse / Q000000981:diagnostic imaging; D045745:Scleroderma, Limited / Q000000981:diagnostic imaging; D012595:Scleroderma, Systemic / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014109:Total Lung Capacity