Bronchiectases at early chest computed tomography in children with cystic fibrosis are associated with increased risk of subsequent pulmonary exacerbations and chronic pseudomonas infection

Abstract

In CF children free from chronic PsA, both CT scores and FEV1 values demonstrate significant correlation with disease severity in the subsequent 6 years but CT score has higher predictive value in the identification of patients at risk.

Pathogenesis, imaging and clinical characteristics of CF and non-CF bronchiectasis

“…The role of bronchiectasis as a robust predictive marker has been shown in several longitudinal observations [150,[155][156][157][158][159]. The extent of bronchiectasis at baseline can predict the number of respiratory tract exacerbations (RTE) [155][156][157][158], and the change of the subscore in a two year follow up is strongly associated with numbers of RTEs where FEV1 did not provide value [156]. This has been similarly described for a decade long observational study [158].…”

“…In this context scoring of bronchiectasis particularly in the lung periphery is important [137], whereas air trapping, mosaic perfusion, and mucus plugging seem to be more sensitive markers than CT or MRI which detect effects of interventions [153,154]. The role of bronchiectasis as a robust predictive marker has been shown in several longitudinal observations [150,[155][156][157][158][159]. The extent of bronchiectasis at baseline can predict the number of respiratory tract exacerbations (RTE) [155][156][157][158], and the change of the subscore in a two year follow up is strongly associated with numbers of RTEs where FEV1 did not provide value [156].…”

2014 year in review: Cystic fibrosis

“…Automated reading of CT chest in school‐age CF patients correlated with expert readings when assessing bronchiectasis via visual airway counts and air trapping by lung attenuation density indices . Children 4–11 years of age who had higher CT chest scores for bronchiectasis had a higher rate of pulmonary exacerbations over the next 6 years; those who also had a low FEV 1 and FEV1% predicted of 25–75% were more susceptible to chronic PA . Presence or absence of structural changes on a CT chest scan 3 years later was predicted by LCI .…”

Computed tomography dose optimisation in cystic fibrosis: A review

“…Clinical trials increasingly use CT to monitor response to antibiotics and gene therapy in the treatment of CF [17,18] . Although quantification of changes in disease severity by CT closely correlates with the frequency of infective exa cerbations and disease progression [19,20] , one must remain cognisant of the radiation dose incurred from this method of assessment [21] . Recent studies have shown that the dose from dose optimised CT scans is equivalent to onethird of one year's background radiation [22] .…”