Session: (1862–1894) Imaging of Rheumatic Diseases Poster II
1884: Which Cell Pattern in Immunological Bronchoalveolar Lavage (BAL) Is Associated with a High-resolution Computer Tomography (HRCT) Pattern at the Onset of Inflammatory Rheumatic Disease with Interstitial Lung Disease?
tobias Hoffmann1, Martin Förster2, Peter Oelzner1, Claus Kroegel2, Ulf Teichgräber3, Diane Renz4, Joachim Böttcher1, Christian Schulze2, Gunter Wolf1, Marcus Franz2 and Alexander Pfeil1, 1Department of Internal Medicine III, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany, 2Department of Internal Medicine I, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany, 3Institute of Diagnostic and Interventional Radiology, Jena University Hospital – Friedrich Schiller University Jena, Jena, Germany, 4Institute of Diagnostic and Interventional Radiology, Department of Pediatric Radiology, Hannover Medical School, Hannover, Germany
Background/Purpose: Inflammatory rheumatic diseases (IRD) are associated with interstitial lung disease (ILD). High-resolution Computer Tomography (HRCT) is recommended as goldstandard in the detection of IRD-ILD. The main HRCT-pattern included ground-glass opacities (GGO), non-specific interstitial pneumonia (NSIP), usual interstitial pneumonia (UIP), granuloma and cryptogenic organizing pneumonia (COP). Further, bronchoalveolar lavage (BAL) can be used to evaluate pulmonal cell pattern. The aim of this study was to evaluate HRCT pattern at the onset of IRD-ILD and to correlate the HRCT pattern to immunological BAL pattern.
Methods: The study includes 61 patients (connective tissue disease n=39, myositis n=9, vasculitis n=10 and rheumatoid arthritis n=3) with newly diagnosed IRD and evidence of ILD on HRCT. In addition to HRCT, immunological BAL was performed. The American Thoracic Society Clinical Practice Guideline were used to define BAL pattern with lymphocytic cellular pattern ( >15% lymphocytes), neutrophilic cellular pattern ( > 3% neutrophils), eosinophilic cellular pattern ( >1% eosinophils) and unspecific cellular pattern. No patient received any immunosuppressive therapy.
Results: For the total study cohort, the main HRCT pattern were NSIP (44.3%) and GGO (31.3%), followed by UIP (14.8%), granuloma (4.9%) and COP (3.3%). BAL pattern showed the following distribution: 37.7% lymphocytic cellular pattern, 27.9% neutrophilic cellular pattern, 18.0% eosinophilic cellular pattern and 16.4% unspecific cellular pattern. Concerning GGO, the main BAL pattern was lymphocytic cellular pattern (47.4%), whereas neutrophilic cellular pattern (37.0%) and lymphocytic cellular pattern (25.9%) were the dominant pattern in NSIP. UIP revealed the following BAL pattern: lymphocytic cellular pattern 55.6%, neutrophilic cellular pattern 33.3% and unspecific cellular pattern 11.1%.
Conclusion: GGO in HRCT is associated with the occurrence of a lymphocytic pattern in BAL, whereas in NSIP and UIP pattern the lymphocytic and neutophilic pattern is equally expressed. Based on the data, a further leading evaluation should be made with regard to the therapeutic options (anti-inflammatory and / or anti-fibrotic therapy) as well as the prognosis of IRD-ILD.
t. Hoffmann: None; M. Förster: None; P. Oelzner: None; C. Kroegel: None; U. Teichgräber: None; D. Renz: None; J. Böttcher: None; C. Schulze: None; G. Wolf: None; M. Franz: None; A. Pfeil: None.
