Evaluation of high resolution computed tomography findings of cystic fibrosis

Abstract

Monitoring of pulmonary physiology is fundamental to the clinical management of patients with Cystic Fibrosis. The current standard clinical practise uses spirometry to assess lung function which delivers a clinically relevant functional readout of total lung function, however does not supply any visible or localised information. High Resolution Computed Tomography (HRCT) is a well-established current 'gold standard' method for monitoring lung anatomical changes in Cystic Fibrosis patients. HRCT provides excellent morphological information, however, the X-ray radiation dose can become significant if multiple scans are required to monitor chronic diseases such as cystic fibrosis. X-ray phase-contrast imaging is another emerging X-ray based methodology for Cystic Fibrosis lung assessment which provides dynamic morphological and functional information, albeit with even higher X-ray doses than HRCT. Magnetic Resonance Imaging (MRI) is a non-ionising radiation imaging method that is garnering growing interest among researchers and clinicians working with Cystic Fibrosis patients. Recent advances in MRI have opened up the possibilities to observe lung function in real time to potentially allow sensitive and accurate assessment of disease progression. The use of hyperpolarized gas or non-contrast enhanced MRI can be tailored to clinical needs. While MRI offers significant promise it still suffers from poor spatial resolution and the development of an objective scoring system especially for ventilation assessment.

Association between sputum culture results and pulmonary changes in children with cystic fibrosis

“…In the present study, there was a significant association between positive results of sputum culture and Bhalla scoring of HRCT findings in children aged 14–16 years (P<0.05). In accordance with our results, Sasihuseyinoglu et al and Robinson et al reported significant relationship between the Bhalla score and bacterial growth in the sputum cultures of children with CF ( 27 , 28 ). On the other hand, Thomas et al didn’t find any significant difference between colonization with P. aeruginosa and S. aureus regarding lung structural changes detected by HRCT, which might be attributed to the relatively small study population and using a different HRCT scoring system ( 15 ).…”

State-of-the-art review of lung imaging in cystic fibrosis with recommendations for pulmonologists and radiologists from the “iMAging managEment of cySTic fibROsis” (MAESTRO) consortium

“…Despite many specialist centres using CR as the imaging technique of choice in infants and preschool children, CT shows higher sensitivity in detecting early abnormalities in both symptomatic and asymptomatic CF patients [5,10,12,53,54,[60][61][62][63]. Therefore, using CR in the early post-screening phase seems to be of limited value, with CT being a more efficient way of detecting early disease and monitoring disease progression [10,13,29,50].…”

Lung Function in Preschool Children in Low and Middle Income Countries: An Under-Represented Potential Tool to Strengthen Child Health

“…Spirometry was also used in South American, Turkish and South African children to monitor lung function in cystic fibrosis ( 59 ), and showed good correlation between CT scan Bhalla score and FEV 1 , FVC, FEF 25−75 ( 60 ).…”