Hypersensitivity Pneumonitis on Thin-Section Chest CT Scans: Diagnostic Performance of the ATS/JRS/ALAT versus ACCP Imaging Guidelines.

IF 3.8 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Lydia Chelala, Ayodeji Adegunsoye, Mary Strek, Cathryn T Lee, Renea Jablonski, Aliya N Husain, Inemesit Udofia, Jonathan H Chung
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Abstract

Purpose To compare the diagnostic performance of the American Thoracic Society, Japanese Respiratory Society, and Asociación Latinoamericana del Tórax (ATS/JRS/ALAT) versus the American College of Chest Physicians (ACCP) imaging classifications for hypersensitivity pneumonitis (HP). Materials and Methods Patients in the institutional review board-approved Interstitial Lung Disease (ILD) registry referred for multidisciplinary discussion (MDD) at the authors' institution (January 1, 2006-April 1, 2021) were included in this retrospective study when ILD was diagnosed at MDD. MDD diagnoses included HP, connective tissue disease-ILD, and idiopathic pulmonary fibrosis. Retrospective review of thin-section CT images was performed in consensus by two cardiothoracic radiologists blinded to the diagnosis. Diagnostic patterns were determined for thin-section CT images using both classifications. Discordance rates were determined. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were assessed using MDD diagnosis as the reference standard. Results A total of 297 patients were included in the study: 200 (67%) with HP, 49 (16%) with connective tissue disease-ILD, and 48 (16%) with idiopathic pulmonary fibrosis at MDD. The discordance rate between the two classifications was 21%. Assuming low HP prevalence (10%), ATS/JRS/ALAT classification outperformed ACCP classification, with greater accuracy (92.3% vs 87.6%) and greater positive predictive value (60.7% vs 42.9%). Assuming high prevalence (50%), accuracy and negative predictive value were superior using ACCP classification (81.7% vs 79.7% and 77.7% vs 72.6%, respectively), and positive predictive value was superior using ATS/JRS/ALAT classification (93.3% vs 87.1%). Conclusion Accuracy of the ATS/JRS/ALAT and ACCP HP classifications was greater in settings with low and high HP prevalence, respectively. Diagnostic performance of both classifications was discordant in a minority of cases. Keywords: CT, Thorax, Hypersensitivity Pneumonitis, Interstitial Lung Disease Supplemental material is available for this article. © RSNA, 2024.

薄层胸部 CT 扫描显示的超敏性肺炎:ATS/JRS/ALAT与ACCP成像指南的诊断性能对比。
目的 比较美国胸科学会、日本呼吸学会和拉丁美洲肺病协会 (ATS/JRS/ALAT) 与美国胸科医师学会 (ACCP) 对超敏性肺炎 (HP) 的影像学分类的诊断效果。材料与方法 作者所在机构经机构审查委员会批准的间质性肺病(ILD)登记处(2006 年 1 月 1 日至 2021 年 4 月 1 日)中转诊进行多学科讨论(MDD)的患者在 MDD 诊断为 ILD 时被纳入本回顾性研究。MDD 诊断包括 HP、结缔组织病-ILD 和特发性肺纤维化。薄层 CT 图像的回顾性审查由两名对诊断结果保密的心胸放射科医生共同完成。使用两种分类方法确定了薄层 CT 图像的诊断模式。确定了不一致率。以 MDD 诊断为参考标准,评估敏感性、特异性、阳性预测值、阴性预测值和准确性。结果 共有 297 名患者被纳入研究:其中 200 人(67%)患有 HP,49 人(16%)患有结缔组织病-ILD,48 人(16%)患有 MDD 特发性肺纤维化。两种分类的不一致率为 21%。假设肺纤维化发病率较低(10%),ATS/JRS/ALAT 分类的准确率(92.3% 对 87.6%)和阳性预测值(60.7% 对 42.9%)均高于 ACCP 分类。假设发病率较高(50%),使用 ACCP 分类法的准确性和阴性预测值更高(分别为 81.7% vs 79.7% 和 77.7% vs 72.6%),而使用 ATS/JRS/ALAT 分类法的阳性预测值更高(93.3% vs 87.1%)。结论 ATS/JRS/ALAT 和 ACCP HP 分类在 HP 发病率低和高的环境中分别具有更高的准确性。在少数病例中,两种分类的诊断性能不一致。关键词CT、胸部、过敏性肺炎、间质性肺病 本文有补充材料。© RSNA, 2024.
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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