高分辨率CT诊断特发性肺纤维化:有效开展多学科讨论  

High resolution computed tomography in the diagnosis of idiopathic pulmonary fibrosis:How to make the MDD effective

作　　者：陈利华 张久权 

机构地区：[1]重庆大学附属肿瘤医院影像科,重庆400030

出　　处：《临床肺科杂志》2023年第9期1442-1446,共5页Journal of Clinical Pulmonary Medicine

基　　金：重庆市科卫联合医学重点项目(No.2023DZXM010);重庆市科卫联合医学面上项目(No.2023MSXM038)。

摘　　要：特发性肺纤维化(IPF)是一种进行性纤维化的间质性肺病(ILD)。由于IPF的特征性影像学征象并不是唯一的诊断依据,还取决于其临床背景,因此,在理解和分析HRCT影像征象时,临床信息的重要性也不容忽视。在临床资料缺乏或高分辨率CT(HRCT)诊断不确定的情况下,有必要由具有ILD鉴别诊断经验的肺科医生和放射科医生进行多学科讨论(MDD)以明确诊断。2022版的成人IPF和进行性纤维化诊疗指南建议,HRCT表现为普通型间质性肺炎(UIP)或很可能UIP型的患者,如在MDD后诊断为IPF,则无需肺活检。然而,关于如何有效开展MDD的研究报道不多。为此,在这篇文章中,我们阐述了HRCT在诊断IPF中的核心作用,并对多学科之间如何针对HRCT诊断IPF开展有效的沟通进行了探讨。Idiopathic pulmonary fibrosis(IPF)is a developmental fibrosing interstitial lung disease(ILD).As the likelihood that typical radiologic features diagnose IPF is not absolute,clinical information is important in the interpretation of high-resolution computed tomography(HRCT),but also dependent on the clinical background.In this situation where the clinical information or HRCT pattern are uncertain,multi-disciplinary discussion(MDD)between a pulmonologist and radiologist well-experienced in the diagnosis of ILD is necessary to receive a diagnosis.In the 2022 guidelines for diagnosis of IPF,patients with a radiological pattern of usual interstitial pneumonia(UIP)or probable UIP can establish a diagnosis of IPF after MDD without lung biopsy.In this study,we describe the core role of HRCT in the diagnosis of IPF and discuss how communication between pulmonologists and radiologists might be improved to make the MDD more effective.

关 键 词：特发性肺纤维化 放射科医生 影像学征象 临床信息 影像征象 肺活检 HRCT 鉴别诊断 

分 类 号：R563[医药卫生—呼吸系统]