Zein Kattih, Brett Bade, Hiroto Hatabu, Kevin Brown, Joseph Parambil, Akinori Hata, Peter J Mazzone, Stephen Machnicki, Dominick Guerrero, Muhammad Qasim Chaudhry, Liz Kellermeyer, Kaitlin Johnson, Stuart Cohen, Ramona Ramdeo, Jason Naidich, Alain Borczuck, Suhail Raoof
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引用次数: 0
Abstract
Topic importance: As interstitial lung abnormalities (ILAs) are increasingly recognized on imaging and in clinical practice, identification and appropriate management are critical. We propose an algorithmic approach to the identification and management of patients with ILAs.
Review findings: The radiologist initially identifies chest CT scan findings suggestive of an ILA pattern and excludes findings that are not consistent with ILAs. The next step is to confirm that these findings occupy > 5% of a nondependent lung zone. At this point, the radiologic pattern of ILA is identified. These findings are classified as non-subpleural, subpleural nonfibrotic, and subpleural fibrotic. It is then incumbent on the clinician to ascertain if the patient has symptoms and/or abnormal pulmonary physiology that may be attributable to these radiologic changes. Based on the patient's symptoms, physiological assessment, and risk factors for interstitial lung disease (ILD), we recommend classifying patients as having ILA, at high risk for developing ILD, probable ILD, or ILD. In patients identified as having ILA, a multidisciplinary discussion should evaluate features that indicate an increased risk of progression. If these features are present, serial monitoring is recommended to be proactive. If the patient does not have imaging or clinical features that indicate an increased risk of progression, then monitoring is recommended to be reactive. If ILD is subsequently diagnosed, the management is disease specific.
Summary: We anticipate this algorithmic approach will aid clinicians in interpreting the radiologic pattern described as ILA within the clinical context of their patients.
主题的重要性:随着肺间质异常(ILAs)在影像学和临床实践中被越来越多地认识到,识别和适当的管理至关重要。我们提出了一种识别和处理 ILAs 患者的算法方法:放射科医生首先确定提示 ILA 模式的胸部 CT 扫描结果,并排除不符合 ILA 的结果。下一步是确认这些发现占非独立肺区的比例大于 5%。至此,ILA 的放射学模式就确定了。这些发现可分为非胸膜下、胸膜下非纤维化和胸膜下纤维化。然后,临床医生有责任确定患者是否因这些放射学改变而出现症状和/或肺部生理异常。根据患者的症状、生理评估和间质性肺病(ILD)的危险因素,我们建议将患者分为 ILA、ILD 高危人群、可能 ILD 或 ILD。对于已确定患有 ILA 的患者,应通过多学科讨论评估表明病情恶化风险增加的特征。如果存在这些特征,建议进行连续监测,以未雨绸缪。如果患者没有影像学或临床特征表明病情恶化的风险增加,则建议进行反应性监测。总结:我们预计这种算法将有助于临床医生在患者的临床背景下解释被描述为 ILA 的放射学模式。
期刊介绍:
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.