Acute interstitial pneumonia -: Comparison of high-resolution computed tomography findings between survivors and nonsurvivors
Acute interstitial pneumonia -: Comparison of high-resolution computed tomography findings between survivors and nonsurvivors
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DOI：
10.1164/rccm.2106157
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发表时间：
2002-06-01
影响因子：
24.7
通讯作者：
Ando, M
中科院分区：
文献类型：
--
作者：
Ichikado, K;Suga, M;Ando, M
本研究比较了10例急性间质性肺炎幸存者和21例急性间质性肺炎非幸存者的高分辨率计算机断层扫描（CT）结果，并评估CT结果是否能预测患者对治疗的反应。病理或临床诊断为急性间质性肺炎的生存组和非生存组在年龄、性别、病程和肺损伤评分方面相似。CT扫描的回顾性、主观评估由两名不了解患者结果的独立观察员进行。CT表现根据连续的病理分期分为1 - 6级：(1)正常衰减，(2)毛玻璃衰减，(3)实变，(4)毛玻璃衰减与牵引性细支扩张或支气管扩张相关，(5)实变与牵引性细支扩张或支气管扩张相关，(6)蜂窝。通过量化每个肺的三个肺区中每个异常的程度来获得总体评分。与牵引性细支气管扩张或支气管扩张相关的毛玻璃衰减或实变程度在幸存者中小于非幸存者（p = 0.004和p = 0.009分别）。建筑变形较少发生，生存者比非生存者更广泛出现无牵引性细支气管扩张的毛玻璃衰减或实变（p = 0.007, p = 0.002和p = 0.029）。幸存者的CT总评分明显低于非幸存者（p = 0.0003）。CT评分低于245分，对生存的预测值为80%阳性，90%阴性。观察者之间对CT表现的评估有很好的一致性（Kappa 0.75）。结果表明，无论生理异常程度如何，CT评估都可能有助于预测急性间质性肺炎患者的预后。
This study compared high-resolution computed tomography (CT) findings between 10 survivors and 21 nonsurvivors of acute interstitial pneumonia and evaluated whether the CT findings were predictive of patients' response to treatment. The survivor and nonsurvivor groups with pathologically or clinically diagnosed acute interstitial pneumonia were similar in age, sex, disease duration, and lung injury score. Retrospective, subjective evaluations of the CT scans were conducted by two independent observers without knowledge of patient outcomes. CT findings were graded on a one to six scale corresponding to consecutive pathologic phases as follows: areas of (1) normal attenuation, (2) ground-glass attenuation, (3) consolidation, (4) ground-glass attenuation associated with traction bronchiolectasis or bronchiectasis, (5) consolidation associated with traction bronchiolectasis or bronchiectasis, and (6) honeycombing. An overall score was obtained by quantifying the extent of each abnormality in three lung zones in each lung. The extent of ground-glass attenuation or consolidation associated with traction bronchiolectasis or bronchiectasis was less in survivors than nonsurvivors (p = 0.004 and p = 0.009, respectively). Architectural distortion was less frequent, and ground-glass attenuation or consolidation without traction bronchiolectasis or bronchiectasis was more extensive in survivors than in nonsurvivors (p = 0.007, p = 0.002, and p = 0.029, respectively). Overall CT scores of survivors were significantly lower than those of nonsurvivors (p = 0.0003). A CT score of less than 245 had an 80% positive and a 90% negative predictive value for survival. There was good interobserver agreement in the assessment of the CT findings (Kappa 0.75). The results indicate that CT assessment is potentially helpful in predicting patient prognosis in acute interstitial pneumonia regardless of the degree of physiologic abnormality.