Desai S R, Wells A U, Suntharalingam G, Rubens M B, Evans T W, Hansell D M
Department of Radiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, England.
Radiology. 2001 Mar;218(3):689-93. doi: 10.1148/radiology.218.3.r01mr31689.
To determine computed tomographic (CT) differences between acute respiratory distress syndrome (ARDS) due to pulmonary injury (ARDS(p)) and extrapulmonary injury (ARDS(ex)).
CT appearances in 41 patients (27 male, 14 female; mean age, 47.1 years +/- 17.1 [SD]; age range, 17-79 years; those with ARDS(p), n = 16; those with ARDS(ex), n = 25) were categorized as typical or atypical of ARDS by two observers. The extent of individual CT patterns was also quantified.
Typical CT appearances were more frequent in ARDS(ex) than ARDS(p) (18 [72%] of 25 vs five [31%] of 16 patients, respectively; P <.01). Sensitivity, specificity, and accuracy of a typical CT pattern for the diagnosis of ARDS(ex) were 72%, 69%, and 71%, respectively. Atypical appearances were characterized by more extensive nondependent intense parenchymal opacification (IPO) (P =.03) and cysts (P =.05), whereas typical CT appearances had more extensive dependent IPO (P =.01). Typical appearances at CT were independently related to the cause of ARDS (odds ratio, 8.9; 95% CI: 1.8, 44.2; P <.01) but were independent of the time from intubation. Foci of nondependent IPO were more extensive in ARDS(p) (P =.05) than ARDS(ex), but this finding was ascribable to differences in time to CT (after intubation) between ARDS(p) and ARDS(ex).
The differentiation between ARDS(p) and ARDS(ex) can, with some caveats, be based on whether the CT appearances are typical or atypical of ARDS but not on any individual CT pattern in isolation.
确定肺损伤所致急性呼吸窘迫综合征（ARDS(p)）与肺外损伤所致急性呼吸窘迫综合征（ARDS(ex)）在计算机断层扫描（CT）上的差异。
41例患者（男性27例，女性14例；平均年龄47.1岁±17.1[标准差]；年龄范围17 - 79岁；ARDS(p)患者16例，ARDS(ex)患者25例）的CT表现由两名观察者分类为ARDS的典型或非典型表现。还对各个CT模式的范围进行了量化。
典型CT表现在ARDS(ex)中比ARDS(p)更常见（分别为25例中的18例[72%]和16例中的5例[31%]；P<.01）。典型CT模式诊断ARDS(ex)的敏感性、特异性和准确性分别为72%、69%和71%。非典型表现的特征是更广泛的非重力依赖性实质致密影（IPO）（P =.03）和囊肿（P =.05），而典型CT表现有更广泛的重力依赖性IPO（P =.01）。CT上的典型表现与ARDS的病因独立相关（优势比，8.9；95%可信区间：1.8，44.2；P<.01），但与插管时间无关。非重力依赖性IPO灶在ARDS(p)中比ARDS(ex)更广泛（P =.05），但这一发现归因于ARDS(p)和ARDS(ex)之间CT检查（插管后）时间的差异。
在有一些注意事项的情况下，ARDS(p)和ARDS(ex)之间的鉴别可以基于CT表现是否为ARDS的典型或非典型，而不是基于任何单独的CT模式。
