68 research outputs found
Integrating Clinical Probability into the Diagnostic Approach to Idiopathic Pulmonary Fibrosis: An International Working Group Perspective
Background. When considering the diagnosis of idiopathic pulmonary fibrosis (IPF), experienced
clinicians integrate clinical features that help to differentiate IPF from other fibrosing interstitial lung
diseases, thus generating a “pre-test” probability of IPF. The aim of this international working group
perspective was to summarize these features using a tabulated approach similar to chest HRCT and
histopathologic patterns reported in the international guidelines for the diagnosis of IPF, and to help
formally incorporate these clinical likelihoods into diagnostic reasoning to facilitate the diagnosis of
IPF.
Methods. The committee group identified factors that influence the clinical likelihood of a diagnosis
of IPF, which was categorized as a pre-test clinical probability of IPF into “high” (70-100%),
“intermediate” (30-70%), or “low” (0-30%). After integration of radiological and histopathological
features, the post-test probability of diagnosis was categorized into “definite” (90-100%), “high
confidence” (70-89%), “low confidence” (51-69%), or “low” (0-50%) probability of IPF.
Findings. A conceptual Bayesian framework was created, integrating the clinical likelihood of IPF
(“pre-test probability of IPF”) with the HRCT pattern, the histopathology pattern when available,
and/or the pattern of observed disease behavior into a “post-test probability of IPF”. The diagnostic
probability of IPF was expressed using an adapted diagnostic ontology for fibrotic interstitial lung
diseases.
Interpretation. The present approach will help incorporate the clinical judgement into the diagnosis
of IPF, thus facilitating the application of IPF diagnostic guidelines and, ultimately improving
diagnostic confidence and reducing the need for invasive diagnostic techniques
High-resolution CT phenotypes in pulmonary sarcoidosis: a multinational Delphi consensus study
One view of sarcoidosis is that the term covers many different diseases. However, no classification framework exists for the future exploration of pathogenetic pathways, genetic or trigger predilections, patterns of lung function impairment, or treatment separations, or for the development of diagnostic algorithms or relevant outcome measures. We aimed to establish agreement on high-resolution CT (HRCT) phenotypic separations in sarcoidosis to anchor future CT research through a multinational two-round Delphi consensus process. Delphi participants included members of the Fleischner Society and the World Association of Sarcoidosis and other Granulomatous Disorders, as well as members' nominees. 146 individuals (98 chest physicians, 48 thoracic radiologists) from 28 countries took part, 144 of whom completed both Delphi rounds. After rating of 35 Delphi statements on a five-point Likert scale, consensus was achieved for 22 (63%) statements. There was 97% agreement on the existence of distinct HRCT phenotypes, with seven HRCT phenotypes that were categorised by participants as non-fibrotic or likely to be fibrotic. The international consensus reached in this Delphi exercise justifies the formulation of a CT classification as a basis for the possible definition of separate diseases. Further refinement of phenotypes with rapidly achievable CT studies is now needed to underpin the development of a formal classification of sarcoidosis
Embolie pulmonaire non massive (impact de la distensibilité des artères pulmonaires sur le score d'obstruction)
LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Etude séquentielle de la pneumopathie chronique interstitielle fibrosante au cours de la sclérodermie systématique (à propos de 90 patients)
LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Détection automatique des embolies pulmonaires périphériques en angioscannographie simple et double source
LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Angioscanographie thoracique au gadolinium en TDM multicoupe (analyse rétrospective de la qualité image et de la tolérance chez 45 patients évalué antérieurement à la description de la fibrose systémique néphrogénique)
LILLE2-BU Santé-Recherche (593502101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
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