Imaging of interstitial lung disease in systemic sclerosis: Computed tomography versus ultrasound

Interstitial lung disease related to systemic sclerosis (SSc-ILD) is a main prognostic determinant of the disease. High-resolution computed tomography is the reference tool to detect SSc-ILD in the clinical arena. It enables the diagnosis, quantification and monitoring of lung involvement, providing robust information for the management of the disease; yet its cost and especially radiological burden can make it unappealing to SSc patients, who are often young women in their reproductive age, who require serial testing to assess the natural history of the disease. Recently, lung ultrasound has been proposed as a nonionizing technique to detect and semiquantifiy SSc-ILD. This new application of ultrasound seems interesting, as it is fast, inexpensive and can easily be performed at the patient's bedside with a handheld device. Magnetic resonance is the current gold standard for noninvasive virtual histological discrimination of different tissues. Despite still being underused for the evaluation of the lungs, it has successfully been employed in a few studies for the depiction of morphologic changes in patients with ILD. Although very promising, until now no other imaging modalities are able to provide all the information yielded by chest high-resolution computed tomography, which remains the gold standard technique for assessing pulmonary fibrosis. However, in a novel perspective of sustainability of our medical methods, the possibility to use radiation-free technologies to assess SSc-ILD seems extremely attractive and justifies further efforts in this field. The next challenge is to keep the high levels of information achieved with modern diagnostic imaging, preferably with the use of less risky techniques. © 2011 Future Medicine Ltd.