ABSTRACT
ABSTRACT Objective: To investigate the correlation of HRCT findings with pulmonary metabolic activity in the corresponding regions using 18F-FDG PET/CT and inflammatory markers in patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD). Methods: This was a cross-sectional study involving 23 adult patients with SSc-associated ILD without other connective tissue diseases. The study also involved 18F-FDG PET/CT, HRCT, determination of serum chemokine levels, clinical data, and pulmonary function testing. Results: In this cohort of patients with long-term disease (disease duration, 11.8 ± 8.7 years), a nonspecific interstitial pneumonia pattern was found in 19 (82.6%). Honeycombing areas had higher median standardized uptake values (1.95; p = 0.85). Serum levels of soluble tumor necrosis factor receptor 1, soluble tumor necrosis factor receptor 2, C-C motif chemokine ligand 2 (CCL2), and C-X-C motif chemokine ligand 10 were higher in SSc patients than in controls. Serum levels of CCL2-a marker of fibroblast activity-were correlated with pure ground-glass opacity (GGO) areas on HRCT scans (p = 0.007). 18F-FDG PET/CT showed significant metabolic activity for all HRCT patterns. The correlation between serum CCL2 levels and GGO on HRCT scans suggests a central role of fibroblasts in these areas, adding new information towards the understanding of the mechanisms surrounding cellular and molecular elements and their expression on HRCT scans in patients with SSc-associated ILD. Conclusions: 18F-FDG PET/CT appears to be unable to differentiate the intensity of metabolic activity across HRCT patterns in chronic SSc patients. The association between CCL2 and GGO might be related to fibroblast activity in these areas; however, upregulated CCL2 expression in the lung tissue of SSc patients should be investigated in order to gain a better understanding of this association.
RESUMO Objetivo: Investigar a correlação entre achados de TCAR e a atividade metabólica pulmonar nas regiões correspondentes por meio de PET/TC com 18F-FDG e marcadores inflamatórios em pacientes com doença pulmonar intersticial (DPI) associada à esclerose sistêmica (ES). Métodos: Estudo transversal envolvendo 23 pacientes adultos com DPI associada à ES sem outras doenças do tecido conjuntivo. O estudo também envolveu PET/TC com 18F-FDG, TCAR, dosagem sérica de quimiocinas, dados clínicos e testes de função pulmonar. Resultados: Nessa coorte de pacientes com doença de longa duração (11,8 ± 8,7 anos), 19 (82,6%) apresentaram o padrão de pneumonia intersticial não específica. A mediana dos valores padronizados de captação foi maior nas áreas de faveolamento (1,95; p = 0,85). Os níveis séricos de soluble tumor necrosis factor receptor 1, soluble tumor necrosis factor receptor 2, C-C motif chemokine ligand 2 (CCL2) e C-X-C motif chemokine ligand 10 foram maiores nos pacientes com ES que nos controles. Os níveis séricos de CCL2 - um marcador de atividade fibroblástica - correlacionaram-se com áreas de opacidade em vidro fosco (OVF) pura na TCAR (p = 0,007). A PET/TC com 18F-FDG mostrou atividade metabólica significativa para todos os padrões de TCAR. A correlação entre níveis séricos de CCL2 e OVF na TCAR sugere que os fibroblastos desempenham um papel fundamental nessas áreas, acrescentando novas informações para a compreensão dos mecanismos que envolvem elementos celulares e moleculares e sua expressão na TCAR em pacientes com DPI associada à ES. Conclusões: A PET/TC com 18F-FDG aparentemente não consegue diferenciar a intensidade da atividade metabólica nos diferentes padrões de TCAR em pacientes com ES crônica. A associação entre CCL2 e OVF pode estar relacionada à atividade fibroblástica nessas áreas; entretanto, a expressão suprarregulada de CCL2 no tecido pulmonar de pacientes com ES deve ser investigada para que se compreenda melhor essa associação.
ABSTRACT
As alterações radiológicas pulmonares em pacientes com esquistossomose mansoni, forma hepatoesplênica, ocorrem em 75% dos casos. As alterações são vasculares e/ou parenquimatosas. As vasculares são mais freqüentes que as parenquimatosas, com retificação ou abaulamento do arco médio. As parenquimatosas consistem de micronódulos ou rosário, mais observadas no lobo inferior do pulmão direito.
The radiological pulmonary alterations evinced by 40 patients with the hepatoesplenic form of schistosomiasis mansoni are observed in 75% of the cases. These alterations are observed on the lung vasculature and/or at the pulmonary parenchyma. The lung vasculature alteration was more frequent than the the parenchymatous, with retification or buldging of the medium arch. The parenchymatous lessions consisted of intestitial nodulation or vascular nodulation, specially observed at the right inferior lobe.
Subject(s)
Humans , Schistosomiasis mansoni , LungABSTRACT
As alterações radiológicas torácicas na forma hepatointestinal da esquistossomose mansoni, observadas em 70 pacientes, estão principalmente localizadas no arco médio. Possuem freqüência semelhante quanto à retificação ou abaulamento do arco médio e expressam repercussões funcionais arteriolares pulmonares. São benignas merecendo atenção, entretanto, pelo potencial de lesão sobre o sistema cardiopulmonar.
The radiological pulmonary alterations shown by 70 patients with hepatointestinal form of schistosomiasis mansoni are observed specially at the medium arch, which is rectified or bulged. These abnormalities constitute expression of functional alterations of the pulmonary arteriolar vasculature. Though benign, they deserve special attention due to the potential evolution towards cardiopulmonar damage.
Subject(s)
Humans , Schistosomiasis mansoni , Liver/pathology , Intestines/pathology , Lung , BiopsyABSTRACT
É freqüente o acometimento pulmonar na esquistossomose mansoni aguda, toxêmica, expressão possível de fenômenos mecânicos e imunoalérgicos.
The pulmonary abnormalities on acute, toxemic, schistosomiasis in habitual. They are possibly related to mechanic and immunoallergic phenomena.
Subject(s)
Humans , Schistosomiasis mansoni , Lung , Acute DiseaseABSTRACT
Os autores comparam as alteraçöes radiológicas pulmonares observadas nas fases inicial e tardia da infecçäo esquistossomática nas formas aguda toxêmica (46 pacientes), hepatointestinal (70 pacientes) e hepatoesplênica (40 pacientes).
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Radiology/instrumentation , Schistosomiasis mansoni , Lung , Intestines , Spleen , LiverABSTRACT
The post-treatment pulmonary alterations were evaluated in patients (Study 1) and in mice (Study 2) infected with Schistosoma mansoni. Study 1: the patients were examined pre and post-treatment (with ora oxamniquine) and the following exams were performed: sputum for eosinophils and chest x-ray. Study 2: four groups of mice (total = 64) were studied; Group I (infected and treated with oxamniquine); II (infected and not treated); III (not infected and treated) and IV (not infected and not treated). All were x-rayed to check for pulmonary abnormalities pre and post-treatment and lung specimens were studied by optical microscopy and immunofluorescence. We have found abnormalities in the parameters checked in both studies and the results suggest an immunological reaction, probably due to deposition of immune complexes in the lungs, with subsequent activation of the complement system. The experimental study showed that the alterations are not dependent of the presence of eggs and/or worms of S. mansoni in the lungs, thus corroborating the hypothesis of deposition of circulating material.