Escore tomográfico em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa ou Staphylococcus aureus

Abstract

Objective: To compare HRCT findings in cystic fibrosis (CF) patients chronically colonized with Pseudomonas aeruginosa or Staphylococcus aureus using the modified Bhalla CT scoring system, as well as to evaluate intraobserver and interobserver reliability of the method. Methods: This was a retrospective cross-sectional study involving 41 CF patients, 26 of whom were chronically colonized with P. aeruginosa (Pa group), and 15 of whom were colonized with S. aureus (Sa group).Two independent radiologists evaluated the HRCT scans of these patients using the modified Bhalla CT scoring system in two different moments. Intraobserver and interobserver reliability was calculated using the intraclass correlation coefficient (ICC). Results: There was good intraobserver and interobserver agreement (ICC > 0.8). Scores were higher in the Pa group than in the Sa group for observer 1 (mean, 13.50 ± 3.90; median, 13.5 vs. mean, 5.00 ± 5.28; median, 3.0) and for observer 2 (mean, 11.96 ± 5.07; median, 12.0 vs. mean, 5.07 ± 5.65; median, 5.0). In addition, HRCT findings, such as bronchiectasis, bronchial wall thickening, mucus plugging, generation of bronchial divisions, and mosaic attenuation/perfusion pattern, were more prevalent in the Pa group. Conclusions: The modified Bhalla CT scoring system was reproducible and reliable for use in the evaluation of HRCT scans, allowing distinctions to be drawn between the two groups of patients under study. The higher scores in the Pa group provided evidence of greater pulmonary impairment in that group.Keywords: Cystic fibrosis; Tomography; Staphylococcus aureus; Pseudomonas aeruginosa. ResumoObjetivo: Comparar achados de TCAR em pacientes com fibrose cística (FC) colonizados cronicamente por Pseudomonas aeruginosa ou Staphylococcus aureus, empregando o escore de Bhalla modificado, e avaliar as confiabilidades intraobservador e interobservador do método. Métodos: Estudo transversal retrospectivo incluindo 41 pacientes portadores de FC, 26 dos quais colonizados cronicamente por P. aeruginosa (grupo Pa) e 15 por S. aureus (grupo Sa). Dois radiologistas analisaram independentemente em duas ocasiões, as imagens de TCAR desses pacientes e aplicaram o escore de Bhalla modificado. As confiabilidades intra e interobservador foram avaliadas segundo o coeficiente de correlação intraclasse (CCI). Resultados: Houve boa concordância intraobservador e interobservador (CCI > 0,8). Os resultados dos escores do grupo Pa foram mais elevados que os do grupo Sa para o observador 1 (média de 13,50 ± 3,90 e mediana de 13,5 vs. média de 5,0 ± 5,28 e mediana de 3,0) e para o observador 2 (média de 11,96 ± 5,07 e mediana de 12,0 vs. média de 5,07 ± 5,65 e mediana de 5,0). Alterações tomográficas, como bronquiectasias, espessamento das paredes brônquicas, formação de tampões mucosos, comprometimento de gerações de divisões brônquicas e padrão de atenuação em mosaico, foram mais prevalentes no grupo colonizado por P. aeruginosa. Conclusões: O escore de Bhalla modificado se mostrou reprodutível e confiável p...

Methicillin-resistant Staphylococcus aureus in cystic fibrosis patients: do we need to care? A cohort study

“…These results are concordant with analyses from other studies in which the three most prevalent abnormalities were bronchiectasis (86-90%), peribronchial thickening (53-80%) and mucous plugging (63-79%). 11,[26][27][28] In the present study, the modified Bhalla score values demonstrated that MRSA patients showed greater structural lung damage Although the other more prevalent injuries, such as peribronchial thickening, mucous plugging and mosaic perfusion, are known to be reversible, these were also more frequent in the MRSA group.…”

High-resolution computed tomography findings in young infants with cystic fibrosis detected by newborn screening

“…The total score could range from zero (absence of abnormalities) to 37 (all abnormalities present and severe). The modified Bhalla score was previously validated in CF patients in another study at this institution (14) and was subsequently established not only for clinical studies but also for patient follow-up (15,25).…”

“…The development of high-resolution computed tomography (HRCT) has allowed the early detection of pathological changes in lung parenchyma as well as in the proximal and distal airways (bronchial wall thickening, bronchiectasis, mucoid impaction and lung hyperinflation) (11). Reproducible scoring systems can be used to quantify CT findings (14,15). Furthermore, some studies that used HRCT scoring systems for children and adults with CF and well-established lung disease demonstrated more severe bronchiectasis in the upper lobes (16-18).…”

“…Although there have been studies investigating the application of various CT scoring systems, a formal recommendation for the routine use of such systems has yet to be made for CF patients (19). In this scenario, the modified Bhalla CT scoring system has been shown to be reproducible and reliable for evaluating HRCT scans, even in patients with mild CF lung disease (14).…”

Lung ultrasound assessment of response to antibiotic therapy in cystic fibrosis exacerbations: a study of two cases

“… BMI: body mass index; PIns: pancreatic insufficiency; DM: diabetes mellitus; CFTR : cystic fibrosis transmembrane regulator; LUS: lung ultrasound; A: A-pattern; B: B-pattern; PI: pleural irregularity; and C: consolidation. a The modified Bhalla CT scoring system was used as in Folescu et al 10 : the total score for each patient is obtained by summing the scores for each morphological change, which are attributed on the basis of the severity/extent of the abnormality. The total score can range from zero (absence of abnormalities) to 37 (all abnormalities present and severe).…”