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Communications to the Editor |

CT Virtual Bronchoscopy for Detecting Wegener Granulomatosis FREE TO VIEW

Ken-ichiro Inoue, MD
Author and Funding Information

Affiliations: Naka Central Hospital Ibaraki, Japan,  Warren G. Magnuson Clinical Center Bethesda, MD,  National Institutes of Health Bethesda, MD

Correspondence to: Ken-ichiro Inoue, MD, Department of Internal Medicine, Naka Central Hospital, 1733–1, Iida, Naka-cho, Naka-gun, Ibaraki, 311-0134, Japan; e-mail: keni@kk.iij4u.or.jp



Chest. 2002;122(4):1496. doi:10.1378/chest.122.4.1496
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To the Editor:

Summers and colleagues (January 2002)1 showed a beneficial method for detecting central airways involvement in patients with Wegener granulomatosis (WG). Indeed, CT virtual bronchoscopy (VB) has an advantage in visualizing stenosis of the airways over either CT scanning alone or bronchoscopy alone. The investigators applied the method to 11 patients with WG, however, they did not describe any detailed patient characteristics, including inflammatory activity, serologic values, the presence or absence of other affected organs, and previous or current treatment of these patients, except for disease duration. In addition, Summers and colleagues did not provide the outcomes for these patients who were enrolled in the study.

WG is a systemic disease of unknown origin that is characterized histologically by the presence of necrotizing granulomatous inflammation and vasculitis involving small arteries, veins, and capillaries. It most commonly affects the upper and lower respiratory tracts, and the kidneys. Because a delayed confirmation of the diagnosis and initiation of the treatment may result in the patient requiring tracheotomy or hemodialysis, we rheumatologists must attempt to understand the disease activity by radiologic examination, urinalysis, and the titer of antineutrophil cytoplasmic antibodies as soon as possible. Recurrence is also quite common among patients with WG.2A high rate of recurrence often compels us to continue administering immunosuppressive agents. However, the prolonged use of these agents may cause patients to experience irritable side effects.3

Further studies are needed to demonstrate the contribution of VB to the improvement in the outcomes of WG patients or the prevention of disease recurrence, which are the most pivotal factors for patients with WG, before VB can be recognized as an efficient examining tool.

Summers, RM, Aggarwal, NR, Sneller, MC, et al (2002) CT virtual bronchoscopy of the central airways in patients with Wegener’s granulomatosis.Chest121,242-250. [PubMed] [CrossRef]
 
Hoffman, GO, Kerr, GO, Lotte, RYE, et al Wegener’s granulomatosis: an analysis of 158 patients.Ann Intern Med1992;116,488-498. [PubMed]
 
Inoue, K, Yoshikawa, T, Kawahito, Y, et al What is proper treatment for Wegener granulomatosis?Arch Intern Med2001;161,1777-1778. [PubMed]
 
To the Editor:

We thank Dr. Inoue for the comments regarding our recent manuscript. Our study was primarily to assess whether the relatively noninvasive technique of virtual bronchoscopy correctly identified morphologic airway abnormalities depicted by conventional bronchoscopy. As shown in the article, we found that virtual bronchoscopy was capable of visualizing the central airways and detecting stenoses in patients with Wegener granulomatosis. The fidelity of the virtual bronchoscopy images was striking when compared with the corresponding conventional bronchoscopic images. While we did not provide the outcomes of most of the patients enrolled, we did show how virtual bronchoscopy could depict progression of a stenosis of the bronchus intermedius in one subject (Fig 2). Finally, we agree that further studies are warranted before one can conclude that virtual bronchoscopy leads to decreased morbidity in patients with Wegener granulomatosis.


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References

Summers, RM, Aggarwal, NR, Sneller, MC, et al (2002) CT virtual bronchoscopy of the central airways in patients with Wegener’s granulomatosis.Chest121,242-250. [PubMed] [CrossRef]
 
Hoffman, GO, Kerr, GO, Lotte, RYE, et al Wegener’s granulomatosis: an analysis of 158 patients.Ann Intern Med1992;116,488-498. [PubMed]
 
Inoue, K, Yoshikawa, T, Kawahito, Y, et al What is proper treatment for Wegener granulomatosis?Arch Intern Med2001;161,1777-1778. [PubMed]
 
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