["The Berlin definition" and clinical significance of high-resolution CT (HRCT) imaging in acute respiratory distress syndrome].

The clinical criteria of acute respiratory distress syndrome (ARDS) defined by the American-European Consensus Conference (AECC) in 1994 was relevant to clinical practice, trials, and researches for two decades. However, a number of issues with the AECC definition have become apparent. The updated and revised criteria of "The Berlin definition", addressing the limitations of the previous AECC definition, were published in 2012. In the first section of this manuscript, the Berlin definition based on data using patients-level meta-analysis of 4188 patients with ARDS, was reviewed. In the second section, the clinical significance and limitation of radiographic imaging, especially, high-resolution CT (HRCT) findings in ARDS were addressed. Although the early exudative phase of ARDS can not be detected even by HRCT, pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality with an increased susceptibility to multiple organ failure, along with ventilator dependency and its associated outcomes.