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.
摘要：
目的比较美国胸科学会的诊断表现，日本呼吸学会,和拉丁美洲协会（ATS/JRS/ALAT）与美国胸科医师学会（ACCP）对过敏性肺炎（HP）的成像分类。材料和方法在作者机构（2006年1月1日至2021年4月1日）的机构审查委员会批准的间质性肺病（ILD）注册中的患者在MDD被诊断为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。两名对诊断不知情的心胸放射科医生一致对薄层CT图像进行了回顾性审查。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。灵敏度,特异性，正预测值，负预测值，以MDD诊断为参考标准,评估准确性.结果本研究共纳入297例患者：200例（67%）患有HP，49（16%）患有结缔组织病-ILD，和48（16％）在MDD的特发性肺纤维化。两种分类之间的不一致率为21％。假设HP患病率较低（10%），ATS/JRS/ALAT分类优于ACCP分类，具有更高的准确性（92.3％vs87.6％）和更大的阳性预测值（60.7％vs42.9％）。假设患病率高（50%），使用ACCP分类的准确性和阴性预测值优于（81.7％vs79.7％和77.7％vs72.6％，分别)，使用ATS/JRS/ALAT分类的阳性预测值更好（93.3％vs87.1％）。结论在HP患病率低和高的环境中，ATS/JRS/ALAT和ACCPHP分类的准确性更高，分别。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，间质性肺病补充材料可用于本文。©RSNA,2024.
