To identify CT findings that predict mortality in acute respiratory distress syndrome (ARDS) and to identify CT findings that differentiate diffuse alveolar damage (DAD) from DAD with prominent histopathological features of organizing pneumonia (DAD-OP).
Twenty-eight patients with ARDS (corroborated by open biopsy) and chest CT within 2 weeks of biopsy were included in our study. Differences in CT findings in patients with survivors versus nonsurvivors as well as for DAD versus DAD-OP were compared using Fisher’s exact test.
Lung involvement of greater than 80%, RA/LA ratio >1, and varicoid traction bronchiectasis were statistically more common in nonsurvivors than in survivors (respective p values of 0.001, 0.008, and 0.038). PA dilation greater than 3 cm and RV/LV ratio greater than 0.9 were also more common in nonsurvivors than in survivors but these factors did not achieve significance. CT findings did not differentiate DAD from DAD-OP.
Our study suggests that >80% of lung involvement, RA/LA ratio >1, and varicoid bronchiectasis predict mortality in patients with ARDS/DAD. Signs of right-sided heart failure (PA dilation greater than 3 cm and RV/LV ratio greater than 0.9) approached significance. CT findings did not differentiate DAD from DAD-OP.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Acute respiratory distress syndrome
Diffuse alveolar damage
Multidetector computed tomography
Acute interstitial pneumonitis
Phua J, Badia JR, Adhikari NK, Friedrich JO, Fowler RA, Singh JM et al (2009) Has mortality from acute respiratory distress syndrome decreased over time? A systematic review. Am J Respir Crit Care Med 179:220–227
Ely EW, Wheeler AP, Thompson BT, Ancukiewicz M, Steinberg KP, Bernard GR (2002) Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome. Ann Intern Med 136:25–36
Monchi M, Bellenfant F, Cariou A, Joly LM, Thebert D, Laurent I et al (1998) Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis. Am J Respir Crit Care Med 158:1076–1081
Estenssoro E, Dubin A, Laffaire E, Canales H, Saenz G, Moseinco M et al (2002) Incidence, clinical course, and outcome in 217 patients with acute respiratory distress syndrome. Crit Care Med 30:2450–2456
Cooke CR, Shah CV, Gallop R, Bellamy S, Ancukiewicz M, Eisner MD et al (2009) A simple clinical predictive index for objective estimates of mortality in acute lung injury. Crit Care Med 37:1913–1920
Goodman LR, Fumagalli R, Tagliabue P, Tagliabue M, Ferrario M, Gattinoni L et al (1999) Adult respiratory distress syndrome due to pulmonary and extrapulmonary causes: CT, clinical, and functional correlations. Radiology 213:545–552
Owens CM, Evans TW, Keogh BF, Hansell DM (1994) Computed tomography in established adult respiratory distress syndrome. Correlation with lung injury score. Chest 106:1815–1821
Desai SR, Wells AU, Rubens MB, Evans TW, Hansell DM (1999) Acute respiratory distress syndrome: CT abnormalities at long-term follow-up. Radiology 210:29–35
Desai SR, Wells AU, Suntharalingam G, Rubens MB, Evans TW, Hansell DM (2001) Acute respiratory distress syndrome caused by pulmonary and extrapulmonary injury: a comparative CT study. Radiology 218:689–693
Tomiyama N, Muller NL, Johkoh T, Cleverley JR, Ellis SJ, Akira M et al (2001) Acute respiratory distress syndrome and acute interstitial pneumonia: comparison of thin-section CT findings. J Comput Assist Tomogr 25:28–33
Padley SP, Jordan SJ, Goldstraw P, Wells AU, Hansell DM (2002) Asymmetric ARDS following pulmonary resection: CT findings initial observations. Radiology 223:468–473
Ichikado K, Suga M, Muranaka H, Gushima Y, Miyakawa H, Tsubamoto M et al (2006) Prediction of prognosis for acute respiratory distress syndrome with thin-section CT: validation in 44 cases. Radiology 238:321–329
Patel SR, Karmpaliotis D, Ayas NT, Mark EJ, Wain J, Thompson BT et al (2004) The role of open-lung biopsy in ARDS. Chest 125:197–202
Mandal RV, Mark EJ, Kradin RL (2008) Organizing pneumonia and pulmonary lymphatic architecture in diffuse alveolar damage. Hum Pathol 39:1234–1238
Knaus WA, Wagner DP, Draper EA, Zimmerman JE, Bergner M, Bastos PG et al (1991) The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 100:1619–1636
Ichikado K, Suga M, Muller NL, Taniguchi H, Kondoh Y, Akira M et al (2002) Acute interstitial pneumonia: comparison of high-resolution computed tomography findings between survivors and nonsurvivors. Am J Respir Crit Care Med 165:1551–1556
Kao KC, Tsai YH, Wu YK, Chen NH, Hsieh MJ, Huang SF et al (2006) Open lung biopsy in early-stage acute respiratory distress syndrome. Crit Care 10:R106
Zapol WM, Snider MT (1977) Pulmonary hypertension in severe acute respiratory failure. N Engl J Med 296:476–480
van der Meer RW, Pattynama PM, van Strijen MJ, van den Berg-Huijsmans AA, Hartmann IJ, Putter H et al (2006) Right-ventricular dysfunction and the pulmonary vascular obstruction index: predictable variables of the clinical course over 3 months in patients with acute lung emboli. Ned Tijdschr Geneeskd 150:845–850
van der Meer RW, Pattynama PM, van Strijen MJ, van den Berg-Huijsmans AA, Hartmann IJ, Putter H et al (2005) Right ventricular dysfunction and pulmonary obstruction index at helical CT: prediction of clinical outcome during 3-month follow-up in patients with acute pulmonary embolism. Radiology 235:798–803
Ghaye B, Ghuysen A, Willems V, Lambermont B, Gerard P, D’Orio V et al (2006) Severe pulmonary embolism:pulmonary artery clot load scores and cardiovascular parameters as predictors of mortality. Radiology 239:884–891
Bazeed MF, Saad A, Sultan A, Ghanem MA, Khalil DM (2010) Prediction of pulmonary embolism outcome and severity by computed tomography. Acta Radiol 51:271–276
Cornet AD, Hofstra JJ, Swart EL, Girbes AR, Juffermans NP (2010) Sildenafil attenuates pulmonary arterial pressure but does not improve oxygenation during ARDS. Intensive Care Med 36:758–764
Greene R (1986) Pulmonary vascular obstruction in the adult respiratory distress syndrome. J Thorac Imaging 1:31–38
Greene R, Lind S, Jantsch H, Wilson R, Lynch K, Jones R et al (1987) Pulmonary vascular obstruction in severe ARDS: angiographic alterations after i.v. fibrinolytic therapy. AJR Am J Roentgenol 148:501–508
Ichikado K, Johkoh T, Ikezoe J, Takeuchi N, Kohno N, Arisawa J et al (1997) Acute interstitial pneumonia: high-resolution CT findings correlated with pathology. AJR Am J Roentgenol 168:333–338
Nowers K, Rasband JD, Berges G, Gosselin M (2002) Approach to ground-glass opacification of the lung. Semin Ultrasound CT MR 23:302–323
Remy-Jardin M, Giraud F, Remy J, Copin MC, Gosselin B, Duhamel A (1993) Importance of ground-glass attenuation in chronic diffuse infiltrative lung disease: pathologic-CT correlation. Radiology 189:693–698
Remy-Jardin M, Remy J, Giraud F, Wattinne L, Gosselin B (1993) Computed tomography assessment of ground-glass opacity: semiology and significance. J Thorac Imaging 8:249–264
Desai SR (2002) Acute respiratory distress syndrome: imaging of the injured lung. Clin Radiol 57:8–17
Gattinoni L, Pelosi P, Vitale G, Pesenti A, D’Andrea L, Mascheroni D (1991) Body position changes redistribute lung computed-tomographic density in patients with acute respiratory failure. Anesthesiology 74:15–23
Gattinoni L, Pesenti A, Mascheroni D, Marcolin R, Fumagalli R, Rossi F et al (1986) Low-frequency positive-pressure ventilation with extracorporeal CO2 removal in severe acute respiratory failure. JAMA 256:881–886
Maunder RJ, Shuman WP, McHugh JW, Marglin SI, Butler J (1986) Preservation of normal lung regions in the adult respiratory distress syndrome. Analysis by computed tomography. JAMA 255:2463–2465
Puybasset L, Cluzel P, Chao N, Slutsky AS, Coriat P, Rouby JJ (1998) A computed tomography scan assessment of regional lung volume in acute lung injury. The CT Scan ARDS Study Group. Am J Respir Crit Care Med 158(5 Pt 1):1644–1655
Lynch D, Travis W, Muller N, Galvin J, Hansell D, Grenier P et al (2005) Idiopathic interstitial pneumonias: CT features. Radiology 236:10–21
Rights and permissions
About this article
Cite this article
Chung, J.H., Kradin, R.L., Greene, R.E. et al. CT predictors of mortality in pathology confirmed ARDS. Eur Radiol 21, 730–737 (2011). https://doi.org/10.1007/s00330-010-1979-0
- Acute respiratory distress syndrome
- Diffuse alveolar damage
- Right-sided heart strain