This HRCT protocol is important for diagnosing systemic sclerosis related interstitial lung disease. And can be used for one off scanning or sequential scanning over time. It can help guide treatment decisions.
HRCT is considered the most sensitive non-invasive means for facilitating the diagnosis of systemic sclerosis related interstitial lung disease, and can be used to protect the future course of lung disease and therapeutical response. To confirm the target area, first set the HRCT scanner parameters as outlined in the table, while giving breathing instructions to the patient. Take a deep breath in and blow it out.
Take another deep breath in, and blow it out. Acquire a volumetric exploratory metric scan from the lung apices to the lung base. Next, acquire a sequential supine exploratory scan with 10 to 20 millimeter gaps from two centimeters below the lung apices to the lung base, followed by a sequential prone inspiratory optional with 10 to 20 millimeter gaps from the carina for the lung base.
For optimal quality volumetric scans, obtain less than two millimeter images with a high spatial resolution reconstruction. Review each scan image immediately after acquisition. And repeat the scan if motion artifacts are present, or if an inadequate inspiration has occurred.
When all of the scans have been acquired, prepare an interpretive report, and share the report and images with the patient's care team and medical records. Key features of SSc-ILD as assessed by HRCT commonly include a nonspecific interstitial pneumonia pattern with peripheral ground glass opacities and extensive traction bronchiectasis. As observed in these images, central predominance or peripheral distribution with subpleural sparing is highly suggestive of nonspecific interstitial pneumonia.
Typically, traction bronchiectasis and traction bronchiectasis are often the predominant features of systemic sclerosis related interstitial lung disease. Additional findings may include honeycombing, which is observed more commonly in diffuse forms of systemic sclerosis, and a dilated air-filled esophagus. A pulmonary artery size greater than the adjacent ascending aorta suggests a coexistence, pulmonary hypertension, even in patients without fibrotic lung disease.
Here are two sets of axial and coronal chest HRCT images taken 10 years apart in a patient with systemic sclerosis associated interstitial lung disease can be observed. The initial axial and coronal images demonstrate a basilar predominant ground glass opacity and reticulation with mild traction bronchiectasis and subpleural sparing consistent with nonspecific interstitial pneumonia. In the images obtained 10 years later, an increased reticulation and traction bronchiectasis at the lung bases with a decrease in the ground glass opacity that is consistent with a mild worsening of pulmonary fibrosis, can be observed.
Be sure to acquire supine inspiration, crone inspiration, and expiration images without motion artifact using thin reconstruction or acquisition slice thickness. Asking patients to take two or three breaths can be beneficial, forced vital capacity assessments, can reform in correlation with HRCT to assess a patient's disease stage per the ghost agent system. And it can be helpful in making treatment decisions.
