gms | German Medical Science

Introduction: Pulmonary manifestations such as the interstitial pneumonia (IP) in patients suffering from connective tissue diseases are associated with a severe course of disease and potentially life-threatining complications. The diagnostic procedures are basing on pulmonary functions tests, 6-min go testing, bronchoalveolar lavage, and capillary blood gas analysis. However, radiographic imaging preferentially using high resolution computed tomography (HRCT) of the lung has to be considered obligatory for the primary diagnosis as well as for the follow-up during the course of disease.

Objective: In front of the background of cumulative radiation exposure we have performed in two patients with CTD-ILD the HRCT and the MRI to compare the findings of IP as previously reported [1].

Methods: Two patients underwent HRCT and MRI of the lung within of 9 days. Patient 1 was a 31-year old woman with Sharp syndrome sincee 4 months showing severe Raynaud`s phenomenon and mild dyspnoe (NYHA I equivalent). Patient 2 was a 27-year old woman with myalgia, arthritis and increasing dyspnoe (NYHA III equivalent) as symptoms of interstital pneumonia with autoimmune features (IPAF). Both of the patients showed typical NSIP pattern in the HRCT (in multiplanar technique of slices in the thickness of 1, 3, and 10 millimeters). The MRI was performed with contrast agent supported imaging in T2-HASTE, TRUFI, T1-VIBE and T2-TIRM technique each in transversal and coronal alignment as previously published [2].

Results: The HRCT (patient 1) demonstrates in the dorsal area tender and predominatly planar reticulations whereas the ventrolateral area only showed singular peripheral reticulations. In the MRI the dorsal planar reticulations could be shown comparable with HRCT, but the tender peripheral reticulation in the ventrolateral area could not be presented in a sufficient quality.

The HRCT (patient 2) showed reticulations preferentially in the subpleural area as well as peripheral moderate bronchiectasis, whereas the MRI could not represent the area with peripheral reticulations. This area appears only blurred as milky glass and without any indication of bronchiectasis.

Conclusion: In both patients with CTD-ILD the IP NSIP pattern and planar reticulations as well as milky glass infiltrations could be demonstrated in HRCT as well as in MRI of the lung, however, the resolution of imaging was higher in the HRCT. Tender reticulations especially in the peripheral area of lung could not be shown in MRI of the lung, but in HRCT. Comparing the imaging of HRCT and MRI of the lung in the two patients with CTD-ILD the MRI seems to be inferior to HRCT detecting tender reticulations particularly in the peripheral lung area.

Disclosures: G. Aßmann: 2020-2021 regelmäßige Vortragstätigkeit für Pfizer, Novartis, BMS und Boehringer-Ingelheim. Die übrigen Autoren geben an, dass kein Interessenkonflikt besteht.

Figure 1 [Fig. 1]