Imaging Features of Acute Respiratory Distress Syndrome and Their Association with Etiology,Staging,and Prognosis

WU Biao; LI Jinfeng

doi:10.13919/j.issn.2095-6274.ZHJY202506001

Abstract：Objective To investigate the imaging features of Acute Respiratory Distress Syndrome(ARDS)on chest X-ray and computed tomography(CT),and to analyze their relationships with etiology,disease stage,severity,and to identify independent risk factors affecting patient prognosis.Methods A retrospective analy-sis was conducted on clinical and imaging data from 120 ARDS patients admitted to Dachuan District Hospital of Traditional Chinese Medicine between December 2023 and December 2024.Patients were classified according to the Berlin definition for ARDS severity.X-ray and CT manifestations across different etiologies and disease stages were analyzed.Multivariate logistic regression was employed to identify independent predictors of mortality.Re-sults On X-ray,83.33%of patients showed abnormalities in the early stage,primarily manifested as increased and thickened lung markings with scattered small patchy opacities(35.00%).During the exudative phase,"white lung"(53.33%)and pleural effusion(17.50%)were the pre-dominant features.In the recovery phase,lung shadows showed absorption with increased lung radiolucency in 35.83%of patients,while 9.17%developed fibrous stripes or reticulations,suggesting fibrosis.Imaging findings varied by etiology:the"white lung"sign was most frequent in the pulmonary infection group(67.27%),pleural effusion was highest in the sepsis group(38.71%),and early increased lung markings/small patchy shadows were most common in the severe trauma group(55.56%).Furthermore,the incidence of both"white lung"and pleu-ral effusion significantly increased with ARDS severity(P<0.001),with all severe ARDS patients exhibiting the"white lung"sign.Common CT findings included ground-glass opacities(71.67%),consolidation(43.33%),pleural effusion(34.17%),atelectasis(25.00%),fibrous reticulation(24.17%),and subpleural curvilinear shadows(18.33%).Multivariate logistic regression identified age(OR=1.48 per year),severe ARDS(OR=5.93),extensive consolida-tion(OR=5.58),large pleural effusion(OR=4.18),and severe atelectasis(OR=3.78)as independent predictors of mortality.Conclusion Chest X-ray can serve as an initial screening tool for ARDS,with findings closely related to etiology and disease stage.Chest CT provides more precise delineation of the diversity and extent of pulmonary lesions.Extensive consolidation,large pleural effusion,and severe atelectasis are independent imaging markers in-dicative of poor prognosis,offering significant value for clinical risk stratification and treatment decision-making.