Combined computed tomography (CT)/scintigraphy strategy may help in diagnostic dilemmas in interstitial lung disease (ILD)
With great interest, we read the recent article by Çetinçakmak et al. assessing the quantitative calculation of interstitial lung disease (ILD) severity by examining the lung volume of systemic sclerosis patients (1). They demonstrated that the percentage of lower lobe volume could be a quantitative index indicating damage in the lung of the patients (1).
To further expand this point, we would like to suggest that few scintigraphic studies in the management of ILD have been performed. We assessed the clinical significance of 99mTc-IgG and 99mTc-MIBI scintigraphy in the assessment of such patients in prospective cohort studies (2,3). We demonstrated that both lung scans can distinguish the severity of pulmonary involvement even in early views. Furthermore, we have seen several cases of ILD indicating assistance value of scintigraphy to high-resolution computed tomography (HRCT) and other diagnostic tests in our ongoing daily practice which has seen more than 100 cases to the present day. These findings depicted that lung scans can be used as a complement to other diagnostic and clinical examinations in terms of functional information in ILD. Therefore, based on these findings and clinical feedbacks, we believed that scintigraphy have an impact in the management of ILDs.
On other hand, ILDs 99mTc-MIBI scintigraphy results may vary according to the methods of acquisitions [early, delayed or both; planar or single-photon emission computerized tomography (SPECT)] and interpretations (equal, increased uptake or both). We observed that a lesion with increased uptake in early views can be considered an active lesion, and the sensitivity was high enough to discriminate inactive from active lung lesions observed and thus may explain the clinical benefit of a more potent drug regimen. Subsequent to the continuing evidence on the many-sided pathophysiology of ILD, there is a need for a realistic approach to training of medicine for the management of patients, particularly in intractable patients using the existing treatment (4).
Acknowledgements
None.
Footnote
Conflicts of Interest: The authors have no conflicts of interest to declare.
References
- Çetinçakmak MG, Göya C, Hamidi C, Tekbaş G, Abakay Ö, Batmaz İ, Hattapoğlu S, Yavuz A, Bilici A. Quantitative volumetric assessment of pulmonary involvement in patients with systemic sclerosis. Quant Imaging Med Surg 2016;6:50-6. [PubMed]
- Bahtouee M, Saberifard J, Javadi H, Nabipour I, Nabipour I, Raeisi A, Assadi M, Eftekhari M. 99mTc-MIBI Lung Scintigraphy in the Assessment of Pulmonary Involvement in Interstitial Lung Disease and Its Comparison With Pulmonary Function Tests and High-Resolution Computed Tomography: A Preliminary Study. Medicine (Baltimore) 2015;94:e2082. [Crossref] [PubMed]
- Bahtouee M, Saberifard J, Javadi H, Nabipour I, Malakizadeh H, Monavvarsadegh G, Ilkhani Pak H, Sadeghi A, Assadi M. 99mTc-IgG-Lung Scintigraphy in the Assessment of Pulmonary Involvement in Interstitial Lung Disease and Its Comparison With Pulmonary Function Tests and High-Resolution Computed Tomography: A Preliminary Study. Iran J Radiol 2015;12:e14619. [Crossref] [PubMed]
- Szema A, Mirsaidi N, Patel B, Viens L, Forsyth E, Li J, Dang S, Dukes B, Giraldo J, Kim P, Burns M. Proposed Iraq/Afghanistan War-Lung Injury (IAW-LI) Clinical Practice Recommendations: National Academy of Sciences' Institute of Medicine Burn Pits Workshop. Am J Mens Health 2015. [Epub ahead of print].
