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Despite little supportive evidence, ground-glass opacity at high-resolution computed tomography, without other signs of fibrosis, has been equated with potentially reversible disease, and in systemic sclerosis, frequently prompts aggressive anti-inflammatory treatment to prevent pulmonary fibrosis. Our study evaluates ground-glass opacity on sequential high-resolution computed tomography in 41 patients with systemic sclerosis over a mean follow-up period of 27 months (r6 to 60 mo). Ground-glass opacity was the most common imaging finding, present in 66%, and usually associated with other signs of interstitial disease, including nonfibrotic interstitial opacities in 27% and fibrotic interstitial opacities in 32%. Improvement was only documented in 2(5%) patients with ground glass and nonfibrotic interstitial opacities. In systemic sclerosis, ground-glass opacity is most commonly associated with irreversible disease. Disease progression or improvement could not be predicted by the presence of ground-glass opacity.