Differentiating tracheobronchial involvement in granulomatosis with polyangiitis and relapsing polychondritis on chest CT: a cohort study.
Granulomatosis with polyangiitis
Multidetector computed tomography
Relapsing polychondritis
Respiratory tract diseases
Trachea
Journal
Arthritis research & therapy
ISSN: 1478-6362
Titre abrégé: Arthritis Res Ther
Pays: England
ID NLM: 101154438
Informations de publication
Date de publication:
28 10 2022
28 10 2022
Historique:
received:
27
06
2022
accepted:
30
09
2022
entrez:
29
10
2022
pubmed:
30
10
2022
medline:
2
11
2022
Statut:
epublish
Résumé
In patients with tracheobronchial involvement, the differential diagnosis between granulomatosis with polyangiitis (GPA) and relapsing polychondritis (RP) can be challenging. The aim of this study was to describe the characteristics of airway abnormalities on chest computed tomography (CT) in patients with GPA or RP and to determine whether specific imaging criteria could be used to differentiate them. GPA and RP patients with tracheobronchial involvement referred to a national referral center from 2008 to 2020 were evaluated. Their chest CT images were reviewed by two radiologists who were blinded to the final diagnosis in order to analyze the characteristics of airway involvement. The association between imaging features and a diagnosis of GPA rather than RP was analyzed using a generalized linear regression model. Chest CTs from 26 GPA and 19 RP patients were analyzed. Involvement of the subglottic trachea (odds ratio for GPA=28.56 [95% CI: 3.17; 847.63]; P=0.001) and extensive airway involvement (odds ratio for GPA=0.02 [95% CI: 0.00; 0.43]; P=0.008) were the two independent CT features that differentiated GPA from RP in multivariate analysis. Tracheal thickening sparing the posterior membrane was significantly associated to RP (odds ratio for GPA=0.09 [95% CI: 0.02; 0.39]; P=0.003) but only in the univariate analysis and suffered from only moderate interobserver agreement (kappa=0.55). Tracheal calcifications were also associated with RP only in the univariate analysis (odds ratio for GPA=0.21 [95% CI: 0.05; 0.78]; P=0.045). The presence of subglottic involvement and diffuse airway involvement are the two most relevant criteria in differentiating between GPA and RP on chest CT. Although generally considered to be a highly suggestive sign of RP, posterior tracheal membrane sparing is a nonspecific and an overly subjective sign.
Sections du résumé
BACKGROUND
In patients with tracheobronchial involvement, the differential diagnosis between granulomatosis with polyangiitis (GPA) and relapsing polychondritis (RP) can be challenging. The aim of this study was to describe the characteristics of airway abnormalities on chest computed tomography (CT) in patients with GPA or RP and to determine whether specific imaging criteria could be used to differentiate them.
METHODS
GPA and RP patients with tracheobronchial involvement referred to a national referral center from 2008 to 2020 were evaluated. Their chest CT images were reviewed by two radiologists who were blinded to the final diagnosis in order to analyze the characteristics of airway involvement. The association between imaging features and a diagnosis of GPA rather than RP was analyzed using a generalized linear regression model.
RESULTS
Chest CTs from 26 GPA and 19 RP patients were analyzed. Involvement of the subglottic trachea (odds ratio for GPA=28.56 [95% CI: 3.17; 847.63]; P=0.001) and extensive airway involvement (odds ratio for GPA=0.02 [95% CI: 0.00; 0.43]; P=0.008) were the two independent CT features that differentiated GPA from RP in multivariate analysis. Tracheal thickening sparing the posterior membrane was significantly associated to RP (odds ratio for GPA=0.09 [95% CI: 0.02; 0.39]; P=0.003) but only in the univariate analysis and suffered from only moderate interobserver agreement (kappa=0.55). Tracheal calcifications were also associated with RP only in the univariate analysis (odds ratio for GPA=0.21 [95% CI: 0.05; 0.78]; P=0.045).
CONCLUSION
The presence of subglottic involvement and diffuse airway involvement are the two most relevant criteria in differentiating between GPA and RP on chest CT. Although generally considered to be a highly suggestive sign of RP, posterior tracheal membrane sparing is a nonspecific and an overly subjective sign.
Identifiants
pubmed: 36307863
doi: 10.1186/s13075-022-02935-2
pii: 10.1186/s13075-022-02935-2
pmc: PMC9615207
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
241Informations de copyright
© 2022. The Author(s).
Références
Chest. 2022 Jan;161(1):257-265
pubmed: 34324839
Chest. 2002 May;121(5):1651-60
pubmed: 12006457
Arthritis Rheumatol. 2016 Dec;68(12):2992-3001
pubmed: 27331771
Acta Radiol. 2010 Jun;51(5):522-6
pubmed: 20350245
Arthritis Rheumatol. 2022 Mar;74(3):393-399
pubmed: 35106964
Radiology. 2006 Aug;240(2):565-73
pubmed: 16801364
Clin Radiol. 1998 Nov;53(11):809-15
pubmed: 9833783
Radiology. 2008 Mar;246(3):697-722
pubmed: 18195376
Autoimmun Rev. 2019 Sep;18(9):102353
pubmed: 31323366
Ann Intern Med. 1986 Jan;104(1):74-8
pubmed: 3484422
AJR Am J Roentgenol. 2002 Jan;178(1):173-7
pubmed: 11756115
Arthritis Rheum. 1990 Aug;33(8):1101-7
pubmed: 2202308
Rheumatology (Oxford). 2022 May 30;61(6):2464-2471
pubmed: 34542599
AJR Am J Roentgenol. 2009 Mar;192(3):676-82
pubmed: 19234263
Nat Rev Dis Primers. 2020 Aug 27;6(1):71
pubmed: 32855422
Curr Opin Rheumatol. 2004 Jan;16(1):56-61
pubmed: 14673390
Medicine (Baltimore). 2015 Aug;94(32):e1088
pubmed: 26266344
Semin Arthritis Rheum. 2021 Apr;51(2):339-346
pubmed: 33601189
Chest. 2009 Apr;135(4):1024-1030
pubmed: 19017885
Am J Pathol. 2012 May;180(5):2144-55
pubmed: 22449947
Ann Intern Med. 1998 Jul 15;129(2):114-22
pubmed: 9669970
Radiographics. 2012 Jan-Feb;32(1):51-69
pubmed: 22236893
Radiographics. 2002 Oct;22 Spec No:S215-30
pubmed: 12376612
Arthritis Rheum. 2013 Jan;65(1):1-11
pubmed: 23045170