title: Quantitative chest CT analysis in patients with systemic sclerosis before and after autologous stem cell transplantation: comparison of results with those of pulmonary function tests and clinical tests.
abstract: OBJECTIVE
  The aim of this study was to evaluate the course of SSc-related pulmonary abnormalities following high-dose chemotherapy with autologous stem cell transplantation (SCT) by quantitative chest CT analysis and compare the results with those of pulmonary function tests and the response of cutaneous involvement.
  
  
  METHODS
  Chest CT quantification was performed before, directly after [0.49 years (sd 0.20)] and at a mean of 2.2 years (sd 2.1) following autologous SCT in 26 consecutive patients with SSc between March 2001 and March 2015. Quantitative CT used fully automated software to calculate inspiratory total lung volume, mean lung density, high attenuation value and their pulmonary distribution (core vs peel). All patients underwent pulmonary function tests. We additionally analysed parallels in the response of associated skin changes by using the modified Rodnan skin score (mRSS).
  
  
  RESULTS
  The forced vital capacity (FVC) course at 6 months was used to classify patients into responders [n = 20 (76.9%)] and non-responders [n = 6 (23.1%)]. FVC, forced expiratory volume in 1 s, vital capacity (VC) as well as single-breath diffusion capacity for carbon monoxide significantly improved (P = 0.03, 0.001, 0.001 and 0.013, respectively) in responders. At quantitative CT, total lung volume increased (P = 0.018), whereas mean lung density (P = 0.026) and high attenuation value decreased (P = 0.020) after autologous SCT in responders. Correspondingly, mRSS improved from 27.35 (sd 9.25) before to 10.81 (sd 8.64) after autologous SCT (P = 0.003) in responders. Changes in mRSS before autologous SCT and thereafter correlated significantly with those 24 months after autologous SCT (r = 0.575; P = 0.031).
  
  
  CONCLUSIONS
  CT quantification of lung volume and parenchymal attenuation in SSc patients presenting with alveolitis and fibrosis that undergo autologous SCT yields parameters that match well with those of pulmonary function and even clinical tests. It might therefore be used as a substitute marker in patients who are unable to adequately perform lung function tests.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen christopher.kloth@med.uni-tuebingen.de.
authors.forename: Christopher
authors.initials: C
authors.lastname: Kloth
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maximilian Thaiss
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen.
authors.forename: Heike
authors.initials: H
authors.lastname: Preibsch
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen.
authors.forename: Klemens
authors.initials: K
authors.lastname: Mark
authors.affiliation: Department of Rheumatology, Clinical Immunology and Nephrology, Asklepios Klinik Hamburg Altona, Hamburg.
authors.forename: Ina
authors.initials: I
authors.lastname: Kötter
authors.affiliation: Department of Internal Medicine II, Eberhard Karls University, Tübingen, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hetzel
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen.
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.affiliation: Department of Internal Medicine II, Eberhard Karls University, Tübingen, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Henes
authors.affiliation: Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tübingen.
authors.forename: Marius
authors.initials: M
authors.lastname: Horger
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D017563:Lung Diseases, Interstitial / Q000000981:diagnostic imaging* / Q000628:therapy; D008176:Lung Volume Measurements; D008875:Middle Aged; D011247:Pregnancy; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging* / Q000628:therapy; D012189:Retrospective Studies; D012595:Scleroderma, Systemic / Q000000981:diagnostic imaging* / Q000628:therapy; D033581:Stem Cell Transplantation / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014184:Transplantation, Homologous; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: CT scan; HRCT; autologous stem cell; computed tomography densitometry; computer-assisted image interpretation; interstitial lung disease; lung fibrosis; pulmonary function test; radiology; scleroderma