Heitkamp Darel E, Albin Matthias M, Chung Jonathan H, Crabtree Traves P, Iannettoni Mark D, Johnson Geoffrey B, Jokerst Clinton, McComb Barbara L, Saleh Anthony G, Shah Rakesh D, Steiner Robert M, Mohammed Tan-Lucien H, Ravenel James G
*Department of Radiology, Indiana University, Indianapolis, IN †National Jewish Health, Denver, CO ‡Department of Surgery, Society of Thoracic Surgeons, Washington University School of Medicine, Saint Louis, MO §Department of Cardiothoracic Surgery, Society of Thoracic Surgeons, University of Iowa, Iowa City, IO ∥Mayo Clinic, Rochester, MN ¶Department of Medical Imaging, University of Arizona College of Medicine, Tucson, AZ #Mayo Clinic, Jacksonville, FL §§Department of Radiology, University of Florida College of Medicine, Gainesville, FL **The American College of Chest Physicians, New York Methodist Hospital, Brooklyn, NY ††North Shore University Hospital, Manhasset, NY ‡‡Department of Radiology, Temple University, Philadelphia, PA ∥∥Department of Radiology, Medical University of South Carolina, Charleston, SC.
J Thorac Imaging. 2015 May;30(3):W2-5. doi: 10.1097/RTI.0000000000000153.
The respiratory system is often affected by complications of immunodeficiency, typically manifesting clinically as acute respiratory illness. Ongoing literature reviews regarding the appropriateness of imaging in these patients are critical, as advanced medical therapies including stem cell transplantation, chemotherapy, and immunosuppressive therapies for autoimmune disease continue to keep the population of immunosuppressed patients in our health care system high. This ACR Appropriateness Criteria topic describes clinical scenarios of acute respiratory illness in immunocompromised patients with cough, dyspnea, chest pain, and fever, in those with negative, equivocal, or nonspecific findings on chest radiography, in those with multiple, diffuse, or confluent opacities on chest radiography, and in those in whom noninfectious disease is suspected. The use of chest radiography, chest computed tomography, transthoracic needle biopsy, and nuclear medicine imaging is discussed in the context of these clinical scenarios. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or is not definitive, expert opinion may be used to recommend imaging or treatment.
免疫系统缺陷的并发症常累及呼吸系统，临床上通常表现为急性呼吸道疾病。鉴于包括干细胞移植、化疗以及针对自身免疫性疾病的免疫抑制疗法等先进医学治疗手段持续使得医疗保健系统中免疫抑制患者数量居高不下，持续开展关于这些患者影像学检查适用性的文献综述至关重要。本美国放射学会适宜性标准主题描述了免疫功能低下患者出现急性呼吸道疾病的临床情况，这些患者伴有咳嗽、呼吸困难、胸痛和发热，胸部X线检查结果为阴性、不明确或非特异性，胸部X线检查有多个、弥漫性或融合性混浊，以及怀疑患有非感染性疾病的患者。在这些临床情况下，讨论了胸部X线检查、胸部计算机断层扫描、经胸针吸活检和核医学成像的应用。美国放射学会适宜性标准是针对特定临床情况的循证指南，由多学科专家小组每3年进行一次审查。指南的制定和审查包括对同行评审期刊上的当前医学文献进行广泛分析，并应用成熟的共识方法（改良德尔菲法）由专家小组对影像学检查和治疗程序的适宜性进行评分。在缺乏证据或证据不明确的情况下，可采用专家意见来推荐影像学检查或治疗。
