202. Comparison of abnormalities on thoracic CT-scans in subtypes of ANCA-associated vasculitis
Creators: name: Rai1, Abdallah El
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background:</strong> Pulmonary manifestations are common in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Computed tomography of the chest is a sensitive method to detect pulmonary manifestations. Pulmonary abnormalities visible on CT scans in granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) have been described earlier, but studies comparing thoracic CT findings in GPA and MPA to EGPA are lacking. The aim of this study was to analyze chest CT scans from patients with GPA, MPA and EGPA using a standardized methodology. <strong>Methods:</strong> Patients with GPA (N = 132), MPA (N = 54) and EGPA (N = 26) who were followed at a tertiary vasculitis referral center and had received at least one chest CT scan between 2005 and 2021 were included. All CT scans were retrospectively re-analyzed by an independent radiologist using a predefined protocol using a predefined protocol based on the Guidelines of the Fleischner Society. <strong>Results: </strong>The most common pulmonary changes in GPA detected by CT were pulmonary nodules, ground glass opacities, and pulmonary emphysema (table). With the exception of one patient with EGPA, nodules with cavitation were found only in patients with GPA. Reticulation, bronchial wall thickening, and lymphadenopathy were slightly less common. Honeycombing was not observed in GPA, but was seen in a subset of patients MPA who displayed also other signs of interstitial lung disease. Consolidations and reticulations were primarily found in GPA and EGPA. The tree in bud-sign was found in similar frequencies between GPA, MPA and EGPA. Both NSIP and UIP Pattern are almost specific for MPA. Also a noticeable frequent association emerges between pulmonary venous congestion and MPA, while pericardial effusion is more common in MPA and EGPA. <strong>Conclusions:</strong> Pulmonary manifestations in AAV are frequently detected on chest CT. Analysis of this large cohort shows that subtypes of AAV are characterized by individual patterns of pulmonary findings on CT. <strong>Disclosures: </strong>none <strong>Table. </strong>Thoracic CT findings in patients with AAV according to type of diagnosis. Values are N (%). CT findings GPA n= 132 MPA n= 54 EGPA n= 26 <em>P</em> GPA vs. MPA <em>P</em> GPA vs. EGPA <em>P</em> MPA vs. EGPA <em>Parenchymal involvement</em> Nodules 73 (0,55) 13 (0,24) 11 (0,42) 5,0E-05 * 1,3E-01 3,8E-02 Nodules with cavitation 26 (0,20) 0 (0,00) 1 (0,04) 8,7E-13 5,2E-02 ! Consolidation 15 (0,11) 1 (0,02) 3 (0,12) 4,3E-02 7,3E-01 1,4E-02 Ground glass opacities 60 (0,45) 26 (0,48) 15 (0,58) 8,2E-01 2,7E-01 1,6E-01 Reticulation, peripheral 43 (0,33) 18 (0,33) 4 (0,15) 8,4E-01 1,0E-01 9,2E-02 Honeycombing 0 (0,00) 8 (0,15) 0 (0,00) 1,1E-06 ! 4,9E-03 Bronchiectasis 11 (0,08) 8 (0,15) 2 (0,08) 1,3E-01 7,1E-01 8,7E-02 Peribronchovascular thickening 39 (0,30) 13 (0,24) 14 (0,54) 3,7E-01 3,1E-02 8,0E-04 Bronchial stenosis 8 (0,06) 5 (0,09) 11 (0,42) 4,4E-01 2,1E-07 5,4E-04 Emphysema 60 (0,45) 16 (0,30) 7 (0,27) 4,6E-02 8,0E-02 1,7E-01 <em>Other abnormalities</em> Lymph node enlargement 37 (0,28) 13 (0,24) 9 (0,35) 5,9E-01 3,0E-02 1,5E-01 Pleural effusion 11 (0,08) 6 (0,11) 2 (0,08) 5,5E-01 2,0E-01 6,3E-01 Pericardial effusion 3 (0,02) 6 (0,11) 7 (0,27) 3,4E-03 3,2E-07 7,3E-02 <em>Disease Patterns</em> Alveolar haemorrhage 4 (0,03) 5 (0,09) 3 (0,12) 7,2E-01 5,4E-02 7,5E-01 UIP** 1 (0,01) 7 (0,13) 0 (0,00) 2,0E-04 6,6E-01 5,5E-03 NSIP*** 0 (0,00) 9 (0,17) 0 (0,00) 1,5E-06 ! 2,7E-02 Other interstitial lung disease 7 (0,05) 1 (0,02) 3 (0,12) 2,9E-01 2,3E-01 6,3E-02 Scarring/ Reticulation 43 (0,33) 18 (0,33) 4 (0,15) 9,2E-01 8,0E-02 9,2E-02 Pulmonary venous congestion 2 (0,02) 6 (0,11) 0 (0,00) 3,4E-03 5,3E-01 7,7E-02 Normal CT 15 (0,11) 7 (0,13) 5 (0,19) 7,6E-01 5,6E-01 4,6E-01 * in Bold: p-value &lt; 0,05 **Usual interstitial pneumonia, *** nonspecific interstitial pneumonia <strong>Disclosures</strong>: None