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Chinese Journal of Lung Diseases(Electronic Edition) ›› 2024, Vol. 17 ›› Issue (05): 744-749. doi: 10.3877/cma.j.issn.1674-6902.2024.05.013

• Original articles • Previous Articles    

Chest CT and clinical features of antineutrophil cytoplasmic antibody-associated vasculitis

Liu Yang1, Jia Chen1, Yajuan Sun1, Jiao Chen1, Mingchao Tan1, Mingfu Gong1,()   

  1. 1.Department of Radiology, Xinqiao Hospital,Army Military Medical University, Chongqing 400037, China
  • Received:2024-04-17 Online:2024-10-25 Published:2024-12-03
  • Contact: Mingfu Gong

Abstract:

Objective

To analyze the chest CT and clinical characteristics of antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) with different target antigen types.

Methods

A retrospective analysis was conducted on the clinical and chest CT imaging data of 355 AAV patients who were treated at the Second Affiliated Hospital of Army Medical University from January 2015 to December 2023.Based on the different specific target antigens present in the serum, the patients were classified into two groups:myeloperoxidase (MPO) antineutrophil cytoplasmic antibodies (MPO-ANCA) and proteinase 3 (PR3)antineutrophil cytoplasmic antibodies (PR3-ANCA). Among them,311 patients were positive for MPO-ANCA,and 44 patients were positive for PR3-ANCA. The two subtypes were compared in terms of age,affected organs,and different imaging manifestations.

Results

Among the 355 AAV patients, the mean age of 311 cases MPOANCA-positive patients was (61.26±13.29) years,while the mean age of 44 cases PR3-ANCA-positive patients was (47.75±15.07) years. The mean age of MPO-ANCA-positive patients was significantly higher than that of PR3-ANCA-positive patients (P<0.001). The main affected organs in AAV patients were the kidneys and lungs, with 247 cases (69.58%) involving the kidneys and 125 cases (35.21%) involving the lungs. The proportion of renal involvement in MPO-ANCA-positive patients 225 cases(72.34%) was also significantly higher than that in PR3-ANCA-positive patients 22 cases(50.00%) (P<0.05). The imaging manifestations of lung involvement in AAV patients were diverse, with 172 cases (48.45%) showing ground-glass opacity, 162 cases (45.63%) showing interstitial changes, 135 cases (38.03%) showing nodules or masses, and 96 cases(9.58%) showing emphysema and bullae. Among them, MPO-ANCA-positive patients had a higher proportion of interstitial lung changes (48.55% vs. 25.00%, P<0.05) and emphysema and bullae (28.94% vs. 13.64%,P<0.05) compared with PR3-ANCA-positive patients. In contrast, PR3-ANCA-positive patients had a higher proportion of bilateral lung nodules or masses on chest CT (68.18% vs. 33.76%, P<0.005) compared with MPO-ANCA-positive patients.

Conclusion

Patients with AAV predominantly present with renal and lung involvement. The main imaging manifestations on chest CT are ground-glass opacity, interstitial changes,nodules, or masses. There are some differences in the chest CT imaging characteristics of AAV with different target antigens, which are of significance for auxiliary early diagnosis.

Key words: Antineutrophil cytoplasmic antibody-associated vasculitis, Lung injury, Kidney injury, Chest imaging manifestations, Clinical features

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