{"id":2415,"date":"2022-11-25T12:45:57","date_gmt":"2022-11-25T12:45:57","guid":{"rendered":"https:\/\/ciehaufr1i.wpdns.site\/nouvelles\/limportance-des-radiologistes-dans-la-detection-de-la-progression-des-maladies-pulmonaires-interstitielles-fibrosantes\/"},"modified":"2024-08-30T14:27:33","modified_gmt":"2024-08-30T14:27:33","slug":"limportance-des-radiologistes-dans-la-detection-de-la-progression-des-maladies-pulmonaires-interstitielles-fibrosantes","status":"publish","type":"post","link":"https:\/\/car.ca\/fr\/nouvelles\/limportance-des-radiologistes-dans-la-detection-de-la-progression-des-maladies-pulmonaires-interstitielles-fibrosantes\/","title":{"rendered":"L\u2019importance des radiologistes dans la d\u00e9tection de la progression des maladies pulmonaires interstitielles fibrosantes"},"content":{"rendered":"
Content sponsor\u00e9 par Boehringer Ingelheim<\/h6>\n
Par Victoria Tan<\/em><\/h6>\n

Les maladies pulmonaires interstitielles (MPI) fibrosantes constituent un groupe de maladies parenchymateuses important et vari\u00e9. La fibrose pulmonaire idiopathique (FPI) est la MPI fibrosante la plus \u00e9tudi\u00e9e et est progressive par d\u00e9finition1<\/sup>. Un sous-ensemble de patients atteints de MPI fibrosante (dont l\u2019\u00e9tiologie diff\u00e8re de la FPI) pr\u00e9sente \u00e9galement des signes de fibrose pulmonaire progressive (FPP). Ces fibroses ressemblent \u00e0 la FPI tant par leur comportement clinique que par les m\u00e9canismes pathologiques\u00a0sous-jacents1<\/sup>. Les MPI fibrosantes pouvant pr\u00e9senter une FPP sont vari\u00e9es et comprennent les pneumonies interstitielles idiopathiques (par exemple, la pneumopathie interstitielle non sp\u00e9cifique [PINS]), les MPI auto-immunes (c\u2019est-\u00e0-dire li\u00e9es \u00e0 la polyarthrite rhumato\u00efde [MPI-PR], \u00e0 la scl\u00e9rodermie [MPI-ScS] et \u00e0 d\u2019autres maladies du tissu conjonctif), les MPI li\u00e9es \u00e0 l\u2019exposition (c\u2019est-\u00e0-dire la pneumopathie d\u2019hypersensibilit\u00e9 fibrosante [PHF]), les MPI fibrosantes li\u00e9es \u00e0 la sarco\u00efdose chronique, et les MPI inclassables. Bien que la pr\u00e9valence de la FPP dans les MPI fibrosantes soit inconnue, une \u00e9tude r\u00e9cente du Registre canadien de la fibrose pulmonaire a r\u00e9v\u00e9l\u00e9 que la progression est courante chez les patients atteints de MPI fibrosante et que sa pr\u00e9valence est similaire dans les PHF et les FPI2<\/sup>.<\/p>\n

La d\u00e9tection d\u2019une MPI fibrosante et l\u2019\u00e9valuation de la progression par le radiologiste sont importantes pour la prise en charge des patients, car les traitements antifibrosants, la pirf\u00e9nidone et le nintedanib, ont \u00e9t\u00e9 approuv\u00e9s par Sant\u00e9 Canada pour le traitement de la FPI. Il a \u00e9t\u00e9 d\u00e9montr\u00e9 que les antifibrosants r\u00e9duisent le taux de d\u00e9clin de la fonction pulmonaire et le taux de mortalit\u00e9 chez les patients atteints de FPI3<\/sup>. Cela a conduit \u00e0 la recherche d\u2019antifibrosants dans d\u2019autres MPI fibrosantes. Un changement de paradigme s\u2019est produit r\u00e9cemment en faveur d\u2019un traitement antifibrosant pour les MPI fibrosantes autres que la FPI, apr\u00e8s qu\u2019un essai clinique a mis en \u00e9vidence un effet\u00a0b\u00e9n\u00e9fique4, 5<\/sup>.<\/p>\n

Le parcours naturel de la FPI est la progression de la maladie, avec une \u00e9volution variable du d\u00e9clin. De m\u00eame, dans d\u2019autres MPI fibrosantes avec FPP, l\u2019\u00e9volution peut \u00eatre h\u00e9t\u00e9rog\u00e8ne et difficile \u00e0 pr\u00e9voir. La mortalit\u00e9 est \u00e9lev\u00e9e dans les cas de MPI fibrosantes avec FPP. Dans le cas de la FPI, la survie m\u00e9diane n\u2019est que de 3\u00a0\u00e0 4\u00a0ans apr\u00e8s le diagnostic chez les patients non trait\u00e9s par des antifibrosants1, 6<\/sup>. La mortalit\u00e9 dans le cas des MPI fibrosantes autres que la FPI est variable. Le pronostic est peu favorable dans les cas de PHF et de MPI-PR (avec un profil UIP) 1<\/sup>. La MPI-ScS est une des principales causes de d\u00e9c\u00e8s chez les patients atteints de scl\u00e9rodermie1<\/sup>. Cependant, le pronostic semble \u00eatre meilleur dans le cas de la PINS idiopathique, o\u00f9 le taux de survie sur 5\u00a0ans est de 75\u00a0%1<\/sup>.<\/p>\n

La progression de la fibrose pulmonaire est d\u00e9finie par des lignes directrices de pratique clinique de\u00a02022 de l\u2019ATS\/ERS\/JRS\/ALAT au sujet de la FPI et de la FPP comme pr\u00e9sentant deux des trois r\u00e9sultats suivants, attribuables \u00e0 la fibrose pulmonaire\u00a0: 1) aggravation des sympt\u00f4mes respiratoires, 2) progression physiologique de la maladie (d\u00e9clin de la CVF ou de la DLCO), et 3) progression radiologique de la maladie4<\/sup>. Les caract\u00e9ristiques radiologiques sp\u00e9cifiques comprennent une nouvelle opacit\u00e9 en verre d\u00e9poli avec bronchectasie de traction, et une bronchectasie de traction\/bronchiolectasie nouvelle ou aggrav\u00e9e, une r\u00e9ticulation, un alv\u00e9olage ou une perte de volume.<\/p>\n

Les r\u00e9sultats radiologiques en tant que facteurs pr\u00e9dictifs de la maladie progressive ont suscit\u00e9 un int\u00e9r\u00eat croissant. Dans les cas de FPI, la progression des bronchectasies de traction a \u00e9t\u00e9 signal\u00e9e comme un facteur pr\u00e9dictif ind\u00e9pendant important de la mortalit\u00e94<\/sup>. Dans les cas de MPI fibrosantes, l\u2019alv\u00e9olage et la bronchectasie de traction sont associ\u00e9s \u00e0 un pronostic plus d\u00e9favorable1, 4<\/sup>. Une fibrose plus \u00e9tendue est un facteur pr\u00e9dictif de mortalit\u00e9 dans la FPI et dans de nombreuses MPI fibrosantes autres que la FPI4<\/sup>.<\/p>\n

La progression radiologique est \u00e9valu\u00e9e visuellement par les radiologistes. Cependant, cette m\u00e9thode se heurte \u00e0 la subjectivit\u00e9 et \u00e0 la variabilit\u00e9 inter-observateurs. Une \u00e9tude r\u00e9alis\u00e9e en\u00a02016 aupr\u00e8s de 112\u00a0radiologistes n\u2019a r\u00e9v\u00e9l\u00e9 qu\u2019une concordance inter-observateur mod\u00e9r\u00e9e entre les radiologistes thoraciques pour les crit\u00e8res de tomodensitom\u00e9trie ATS\/ERS\/JRS\/ALAT pour l\u2019UIP7<\/sup>. La tomodensitom\u00e9trie quantitative assist\u00e9e par ordinateur offre la possibilit\u00e9 d\u2019une m\u00e9thode d\u2019\u00e9valuation objective et reproductible. Une \u00e9tude r\u00e9alis\u00e9e en\u00a02021 aupr\u00e8s de patients cor\u00e9ens \u00e0 l\u2019aide d\u2019une analyse par tomodensitom\u00e9trie quantitative a r\u00e9v\u00e9l\u00e9 que l\u2019\u00e9tendue et l\u2019intervalle de changement de la gravit\u00e9 de la MPI \u00e9taient associ\u00e9s de mani\u00e8re mod\u00e9r\u00e9e aux tests de la fonction pulmonaire, aux biomarqueurs s\u00e9riques et \u00e0 l\u2019\u00e9valuation visuelle chez les patients atteints de MPI-PR.8<\/sup> Une analyse r\u00e9trospective r\u00e9cente d\u2019un registre national de la FPI en Australie, utilisant l\u2019analyse de texture guid\u00e9e par les donn\u00e9es (DTA), a r\u00e9v\u00e9l\u00e9 que l\u2019\u00e9tendue de la fibrose quantifi\u00e9e par la tomodensitom\u00e9trie initiale \u00e9tait associ\u00e9e aux r\u00e9sultats, ind\u00e9pendamment de la fonction\u00a0pulmonaire9<\/sup>.<\/p>\n

En r\u00e9sum\u00e9, les radiologistes jouent un r\u00f4le cl\u00e9 dans le diagnostic des MPI fibrosantes et la d\u00e9tection de leur progression. Cela facilite les d\u00e9cisions de prise en charge, notamment l\u2019instauration d\u2019un traitement antifibrosant. \u00c9tant donn\u00e9 le r\u00f4le important que joue l\u2019imagerie, une \u00e9tude et une validation plus pouss\u00e9es de la tomodensitom\u00e9trie quantitative seraient b\u00e9n\u00e9fiques pour sa mise en \u0153uvre dans la recherche et les milieux cliniques.<\/p>\n

 <\/p>\n

 <\/p>\n

    \n
  1. Kolb M, Va\u0161\u00e1kov\u00e1 M. The natural history of progressive fibrosing interstitial lung diseases. Respir Res<\/em>. 2019 Mar 14;20(1):57. doi: 10.1186\/s12931-019-1022-1.<\/li>\n
  2. Hambly N, Farooqi M, Dvorkin-Gheva A, et. al. Prevalence and Characteristics of Progressive Fibrosing Interstitial Lung Disease in a Prospective Registry. Eur Respir J<\/em> 2022; 60: 2102571. doi: 10.1183\/13993003.02571-2021<\/li>\n
  3. Kang J, Han M, Song JW. Antifibrotic treatment improves clinical outcomes in patients with idiopathic pulmonary fibrosis: a propensity score matching analysis. Sci Rep. 2020 Sep 24;10(1):15620. doi: 10.1038\/s41598-020-72607-1.<\/li>\n
  4. Raghu G, Remy-Jardin M, Richeldi L, et al. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS\/ERS\/JRS\/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med<\/em>. 2022 May 1;205(9):e18-e47. doi: 10.1164\/rccm.202202-0399ST.<\/li>\n
  5. Flaherty KR, Wells AU, Cottin V, et al.; INBUILD Trial Investigators. Nintedanib in Progressive Fibrosing Interstitial Lung Diseases. N Engl J Med<\/em>. 2019 Oct 31;381(18):1718-1727. doi: 10.1056\/NEJMoa1908681.<\/li>\n
  6. Ryerson CJ, Kolb M. The increasing mortality of idiopathic pulmonary fibrosis: fact or fallacy? Eur Respir J<\/em>. 2018 Jan 18;51(1):1702420. doi: 10.1183\/13993003.02420-2017.<\/li>\n
  7. Walsh SL, Calandriello L, Sverzellati N, Wells AU, Hansell DM; UIP Observer Consort. Interobserver agreement for the ATS\/ERS\/JRS\/ALAT criteria for a UIP pattern on CT. Thorax<\/em>. 2016 Jan;71(1):45-51. doi: 10.1136\/thoraxjnl-2015-207252.<\/li>\n
  8. Lee JS, Kim GJ, Ha YJ, et al. The Extent and Diverse Trajectories of Longitudinal Changes in Rheumatoid Arthritis Interstitial Lung Diseases Using Quantitative HRCT Scores. J Clin Med<\/em>. 2021 Aug 25;10(17):3812. doi: 10.3390\/jcm10173812.<\/li>\n
  9. Humphries SM, Mackintosh JA, Jo HE, et al. Quantitative computed tomography predicts outcomes in idiopathic pulmonary fibrosis. Respirology<\/em>. 2022 Jul 25. doi: 10.1111\/resp.14333.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Content sponsor\u00e9 par Boehringer Ingelheim Par Victoria Tan Les maladies pulmonaires interstitielles (MPI) fibrosantes constituent un groupe de maladies parenchymateuses important et vari\u00e9. La fibrose pulmonaire idiopathique (FPI) est la MPI fibrosante la plus \u00e9tudi\u00e9e et est progressive par d\u00e9finition1. Un sous-ensemble de patients atteints de MPI fibrosante (dont l\u2019\u00e9tiologie diff\u00e8re de la FPI) pr\u00e9sente 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Jones","author_link":"https:\/\/car.ca\/fr\/author\/tenika\/"},"uagb_comment_info":0,"uagb_excerpt":"Content sponsor\u00e9 par Boehringer Ingelheim Par Victoria Tan Les maladies pulmonaires interstitielles (MPI) fibrosantes constituent un groupe de maladies parenchymateuses important et vari\u00e9. La fibrose pulmonaire idiopathique (FPI) est la MPI fibrosante la plus \u00e9tudi\u00e9e et est progressive par d\u00e9finition1. Un sous-ensemble de patients atteints de MPI fibrosante (dont l\u2019\u00e9tiologie diff\u00e8re de la FPI) pr\u00e9sente\u2026","_links":{"self":[{"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/posts\/2415","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/comments?post=2415"}],"version-history":[{"count":1,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/posts\/2415\/revisions"}],"predecessor-version":[{"id":2792,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/posts\/2415\/revisions\/2792"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/media\/1101"}],"wp:attachment":[{"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/media?parent=2415"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/categories?post=2415"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/tags?post=2415"},{"taxonomy":"post_topic_taxonomy","embeddable":true,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/post_topic_taxonomy?post=2415"},{"taxonomy":"post_modality_taxonomy","embeddable":true,"href":"https:\/\/car.ca\/fr\/wp-json\/wp\/v2\/post_modality_taxonomy?post=2415"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}