美国胸科学会-欧洲呼吸学会特发性间质性肺炎分类:2002年以来的知识进展

American Thoracic Society-European Respiratory Society Classification of the Idiopathic Interstitial Pneumonias: Advances in Knowledge since 2002.

作者信息

Sverzellati Nicola, Lynch David A, Hansell David M, Johkoh Takeshi, King Talmadge E, Travis William D

机构信息

From the Section of Diagnostic Imaging, Department of Surgical Sciences, University of Parma, Via Gramsci 14, 43100 Parma, Italy (N.S.); Department of Radiology, National Jewish Health, Denver, Colo (D.A.L.); Department of Radiology, Royal Brompton Hospital, London, England (D.M.H.); Department of Radiology, Kinki Central Hospital of Mutual Aid Association of Public School Teachers, Hyogo, Japan (T.J.); Department of Medicine, University of California-San Francisco, San Francisco, Calif (T.E.K.); and Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY (W.D.T.).

出版信息

Radiographics. 2015 Nov-Dec;35(7):1849-71. doi: 10.1148/rg.2015140334. Epub 2015 Oct 9.

Abstract

In the updated American Thoracic Society-European Respiratory Society classification of the idiopathic interstitial pneumonias (IIPs), the major entities have been preserved and grouped into (a) "chronic fibrosing IIPs" (idiopathic pulmonary fibrosis and idiopathic nonspecific interstitial pneumonia), (b) "smoking-related IIPs" (respiratory bronchiolitis-associated interstitial lung disease and desquamative interstitial pneumonia), (c) "acute or subacute IIPs" (cryptogenic organizing pneumonia and acute interstitial pneumonia), and (d) "rare IIPs" (lymphoid interstitial pneumonia and idiopathic pleuroparenchymal fibroelastosis). Furthermore, it has been acknowledged that a final diagnosis is not always achievable, and the category "unclassifiable IIP" has been proposed. The diagnostic interpretation of the IIPs is often challenging because other diseases with a known etiology (most notably, connective tissue disease and hypersensitivity pneumonitis) may show similar morphologic patterns. Indeed, more emphasis has been given to the integration of clinical, computed tomographic (CT), and pathologic findings for multidisciplinary diagnosis. Typical CT-based morphologic patterns are associated with the IIPs, and radiologists play an important role in diagnosis and characterization. Optimal CT quality and a systematic approach are both pivotal for evaluation of IIP. Interobserver variation for the various patterns encountered in the IIPs is an issue. It is important for radiologists to understand the longitudinal behavior of IIPs at serial CT examinations, especially for providing a framework for cases that are unclassifiable or in which a histologic diagnosis cannot be obtained.

摘要

在更新后的美国胸科学会-欧洲呼吸学会特发性间质性肺炎(IIP)分类中,主要类型得以保留,并分为以下几类:(a)“慢性纤维化IIP”(特发性肺纤维化和特发性非特异性间质性肺炎),(b)“吸烟相关IIP”(呼吸性细支气管炎相关间质性肺疾病和脱屑性间质性肺炎),(c)“急性或亚急性IIP”(隐源性机化性肺炎和急性间质性肺炎),以及(d)“罕见IIP”(淋巴细胞间质性肺炎和特发性胸膜肺实质纤维弹性组织增生症)。此外,人们认识到并非总能做出最终诊断,因此提出了“无法分类的IIP”这一类别。IIP的诊断性解读往往具有挑战性,因为其他具有已知病因的疾病(最显著的是结缔组织病和过敏性肺炎)可能表现出相似的形态学模式。事实上,多学科诊断更强调临床、计算机断层扫描(CT)和病理结果的整合。基于CT的典型形态学模式与IIP相关,放射科医生在诊断和特征描述中发挥着重要作用。最佳的CT质量和系统的方法对于IIP的评估都至关重要。IIP中各种模式的观察者间差异是一个问题。放射科医生了解IIP在系列CT检查中的纵向表现很重要,特别是为无法分类或无法获得组织学诊断的病例提供一个框架。

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