Chest
Volume 145, Issue 1, January 2014, Pages 101-107
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Original Research
Diffuse Lung Disease
Accuracy of Individual Variables in the Monitoring of Long-term Change in Pulmonary Sarcoidosis as Judged by Serial High-Resolution CT Scan Data

https://doi.org/10.1378/chest.12-2479Get rights and content

Background

In pulmonary sarcoidosis, the optimal means of quantifying change is uncertain. The comparative usefulness of simple lung function trends and chest radiography remains unclear. We aimed to explore and contrast the disease-monitoring strategies of serial pulmonary function tests (PFTs) and chest radiography compared against morphologic change on high-resolution CT (HRCT) scan.

Methods

Seventy-three patients with sarcoidosis were identified who had two HRCT scans with concurrent chest radiography and PFTs. Chest radiography and HRCT scans were assessed by two radiologists for change in disease extent. Concordance between the scoring systems, as well as agreement between PFT trends (% change from baseline in FEV, FVC, and diffusing capacity of the lung for carbon monoxide [Dlco]), chest radiography, and chest HRCT scan change, were examined using the weighted κ coefficient of variation (Kw).

Results

There was fair agreement between change in extent of disease on chest radiograph and significant PFT trends (Kw = 0.35, P < .001) and moderate agreement between change in extent of disease on serial HRCT scan and significant PFT trends (Kw = 0.64, P < .0001). The integration of Dlco trends did not improve concordance between change on HRCT scan and PFT change. Change in gas transfer coefficient (ie, Dlco/alveolar volume) displayed no overall linkage with change in disease extent on chest radiograph (Kw = 0.07, P = .27) and only poor agreement with change in disease extent on HRCT scan (Kw = 0.17, P = .07).

Conclusions

Significant PFT trends correlate better with morphologic change as defined by serial HRCT scan than extent of disease on radiograph. Isolated change in gas transfer coefficient is more frequently discordant with change in disease extent on chest radiograph and HRCT scan and may suggest a pulmonary vascular component.

Section snippets

Materials and Methods

We reviewed data from 73 patients collected between January 1, 1993, and December 31, 2005, who met current clinical and histopathologic diagnostic criteria for pulmonary sarcoidosis.1 All patients had a baseline HRCT scan of the chest and a follow-up scan. Clinical data were extracted from case records (Table 1). As the aim of the study was to reconcile change in chest HRCT scan with changes in PFT indices and/or chest radiography, treatment effects were not specifically evaluated.

The

Chest Radiographic and HRCT Scan Change

There was good interobserver agreement for change in chest radiographic extent (weighted κ coefficient of variation [Kw] = 0.79, P < .0001) and for change in HRCT scan extent (Kw = 0.75, P < .0001). As shown in Table 2, change in disease extent was seen more frequently on HRCT scan (63 of 73, 86%) than on chest radiography (53 of 73, 73%) (P < .05). There was only moderate agreement between change in radiographic extent and change in HRCT scan disease extent (Kw = 0.46, P < .0001). There was

Discussion

We report that in pulmonary sarcoidosis, a monitoring strategy of quantifying spirometric trends in isolation provides good agreement with morphologic change on serial HRCT scan but is not improved by the integration of gas transfer or chest radiographic data. Isolated or disproportionate gas transfer decline was frequent, did not correlate with morphologic change, and should be studied further as a possible precursor to the development of pulmonary hypertension.

No attempt was made in this

Acknowledgments

Author contributions: Dr Zappala is guarantor of the study.

Dr Zappala: contributed to data collection, statistics, and manuscript preparation.

Dr Desai: contributed to imaging assessment and manuscript review.

Dr Copley: contributed to imaging assessment and manuscript review.

Dr Spagnolo: contributed to patient selection and manuscript review.

Mr Cramer: contributed to clinical measurement supervision and manuscript review.

Ms Sen: contributed to data collection and manuscript review.

Dr Alam:

References (0)

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Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

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