Pulmonary CT Findings And Related Clinical Analysis Of Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis

Objective:To explore the chest CT findings and related clinical features of anti-neutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV).Method:Retrospectively analyze the chest CT findings of 61 ANCA-associated vasculitis(based on serological diagnosis)diagnosed in Shanxi Provincial People’s Hospital from January 2015 to December 2020;and further analyze the CT changes of ANCA-associated vasculitis after treatment Result:Among the 61 subjects,35 were males and 26 were females,aged 24-89 years old,with an average age of 64 years.Among them,51 were myeloperoxidase(MPO)positive and 10 were protease 3(PR3)positive.Chest CT showed mainly 32 cases of interstitial lung disease,20 cases of patchy ground glass shadow,16 cases of nodules and masses,6cases of bronchiectasis,of which 12 cases were complicated by pleural thickening,emphysema and pulmonary bullae 33 Cases included 23 cases of pleural effusion,5 cases of mediastinal lymphadenopathy;extrapulmonary involvement included 54 cases of kidney,14 cases of facial features(ear and nose),17 cases of skin,and 11 cases of cardiovascular system.In the main chest imaging findings,the proportion of MPO-positive patients with interstitial lung disease was higher.Compared with PR3-positive patients,the difference was statistically significant(P<0.05);while PR3-positive patients had nodules and masses The proportion is higher,and compared with MPO-positive patients,the difference is statistically significant(P<0.05);while there is no statistically significant difference between bronchiectasis and patchy ground glass(P>0.05).In extrapulmonary involvement:Most patients with AAV are associated with varying degrees of renal involvement,accounting for about 90%;PR3-positive patients have a higher proportion of facial features(ear,nose)involved,and compared with MPO-positive patients,the difference is statistically significant(P<0.05);Among them,patients with chest CT showing interstitial lung disease showed no significant changes after standard treatment(cortisol hormone combined with immune preparations),but showed that ground glass shadows,nodules and masses were significantly absorbed and disappear after treatment.Conclusion:The clinical and imaging manifestations of AAV patients are diverse,affecting various organs such as the lungs,kidneys,skin,and nervous system,making it difficult to diagnose.The chest imaging manifestations are mainly interstitial lung disease,patchy ground glass shadows,nodules and masses.The proportion of MPO-positive patients with interstitial lung disease is higher,and the proportion of PR3-positive patients with nodules,masses,and facial features(ears and nose)is higher;radiologists should master the imaging manifestations and related clinical features of AAV patients.Reduce the misdiagnosis and missed diagnosis of diseases.The ground glass shadows,nodules and masses are significantly absorbed and disappeared after standard treatment,and the images of interstitial lung disease have no obvious changes after treatment,which prompts clinicians to make the best treatment plan.