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Avoiding underdiagnosing of lung involvement in anca associated vasculitis patients – answer is in dedicated radiologist

INTRODUCTION: Lung involment in patients with ANCA associated vasculitis (AAV) can be non specific. High resolution computerized tomography (HRCT) allows timely and detailed analysis of lung involvement in AAV patients. We analysed differences in group of AAV patients with performed HRCT lung scan. METHODS: Our study included 108 AAV patients whom we preformed kidney biopsy, thus proving renal involment. Out of those 29 patients who had non specific respiratory simptoms had HRCT lung scan performed. HRCT lung scan was analysed by experienced radiologist. We analysed clinical and serological phenotypes of 29 AAV patients with HRCT lung scan. Categorical variables were analysed and compared usinsg Fischer Exact test. RESULTS: 108 patients with ANCA associated vasculitis have been analyzed, 61 females (55.6%) with median age of 61 (Interquartile range-IQR 51-70) years. According to clinical phenotype (microscopic polyangiitis (MPA), granulomatosis with polyangiitis (GPA), renal limited vasculitis (RLV), eosinophilic granulomatosis with polyangiitis) there were 66 (61.1%) patients with MPA, 20 (18.5%) with GPA, 20 (18.5%) with RLV and 2(1, 9%) with EGPA which were, due to small number, excluded from analysis. From the total number of patients 29 (26, 9%, MPA=20, GPA=9) had HRCT lung scan performed with various morphological changes detected in lung parenchyma. Morphological changes described on HRCT lung scan included: lung haemorrhage, consolidations, ground-glass infiltrations, nodules, cavitations, fibrosis. All of the patients had renal involvement with only 9/29 having serum creatinine levels lower than 350 umol/L. Average BVAS score including HRTC findings was 23 (IQR 13-33) and as shown in our earlier work without CT findings BVAS would be signiicantly lower. There was significant difference between clinical phenotypes in the scanned group in that there were more MPA patients with lung damage compared to GPA (p=0.008). Furthermore when analyzing serological phenotypes there was more MPO-ANCA patients with lung involvement compared to PR3-ANCA (p<0.001) and interestingly there were no ANCA negative patients, with clinical phenotype of either MPA or GPA, within scanned group (p<0.001). CONCLUSIONS: AAV patients can often have lung involvement underdiagnosed, especially in the absence of clinical signes and symptoms. Our data suggest that such underdiagnosing of lung involvement could possibly be more present in MPA patients. HRCT lung scan, performed by dedicated radiologist, can detect earliest signes of lung involment in these patients afecting assesment of disease severity as well as determening therapeutical approach to such patients.

lunganca-associated vasculitisradiologists

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