A computed tomography scoring system to assess pulmonary disease among premature infants

Abstract

CONTEXT AND OBJECTIVE: High-resolution computed tomography (HRCT) is considered to be the best method for detailed pulmonary evaluation. The aim here was to describe a scoring system based on abnormalities identified on HRCT among premature infants, and measure the predictive validity of the score in relation to respiratory morbidity during the first year of life. DESIGN AND SETTING: Prospective cohort study in Instituto Fernandes Figueira, Fundação Oswaldo Cruz. METHODS: Scoring system based on HRCT abnormalities among premature newborns. The affected lung area was quantified according to the number of compromised lobes, in addition to bilateral pulmonary involvement. Two radiologists applied the score to 86 HRCT scans. Intraobserver and interobserver agreement were analyzed. The score properties were calculated in relation to predictions of respiratory morbidity during the first year of life. RESULTS: Most of the patients (85%) presented abnormalities on HRCT, and among these, 56.2% presented respiratory morbidity during the first year of life. Scores ranged from zero to 12. There was good agreement between observers (intraclass correlation coefficient, ICC = 0.86, confidence interval, CI: 0.64-0.83). The predictive scores were as follows: positive predictive value 81.8%, negative predictive value 56.3%, sensitivity 39.1%, and specificity 90.0%. CONCLUSION: The scoring system is reproducible, easy to apply and allows HRCT comparisons among premature infants, by identifying patients with greater likelihood of respiratory morbidity during the first year of life. Its use will enable HRCT comparisons among premature infants with different risk factors for respiratory morbidity.

Lung CT imaging in patients with bronchopulmonary dysplasia: A systematic review

“…All studies showed abnormal CT findings in patients with BPD, both in the neonatal period and later in life . Furthermore, most studies which assessed the clinical severity of BPD (mild, moderate, severe) found an increase in CT abnormalities within the patients with more severe BPD .…”

“…The studies in which patients >1 year of age were investigated found higher CT scores in the BPD patients compared with control patients . In contrast, studies performing chest CT during the neonatal period found abnormal CT findings in almost all preterm infants exposed to mechanical ventilation and oxygen exposure irrespective of whether they had a clinical BPD diagnosis …”

“…In total, nine different scoring systems were identified. Intra‐observer and inter‐observer variability were described in, respectively, 5 and 12 of the 19 articles and showed kappa's for different components scored between 0.45 and 0.95 and between 0.18 and 0.99 . The most commonly scored structural components were hyperlucency, emphysema, opacities (both linear and subpleural), bronchial wall thickening and collapse, consolidation, or atelectasis (Table ).…”

“…Long et al defined a clinical severity score at 36 weeks (mean airway pressure × FiO2 at 36 weeks) and also found significant positive correlation with architectural distortion, linear and triangular opacities, and air trapping on CT scans . In seven studies, CT findings of BPD patients were compared with control patients, which were either healthy term born or preterm born without BPD . The studies in which patients >1 year of age were investigated found higher CT scores in the BPD patients compared with control patients .…”

Pesquisas em pneumologia recentemente publicadas em revistas brasileiras

“…Boechat et al (32) described a scoring system based on abnormalities identified on HRCT scans of premature infants and measured the predictive validity of the score in relation to respiratory morbidity during the first year of life. According to the authors, the scoring system is reproducible and easy to apply, allowing HRCT comparisons among premature infants by the identification of patients with different risk factors for respiratory morbidity.…”