High resolution computed tomography of the chest in cystic fibrosis (CF): is simplification of scoring systems feasible?

Abstract

The purpose of this study was to simplify HRCT scoring systems (SS) for CF by selecting representative HRCT parameters. Forty-two consecutive patients with CF underwent baseline and follow-up chest HRCT. Three radiologists evaluated 84 HRCTs employing five SS. "Simplified" HRCT SS were formed by selection of parameters exhibiting statistically significant relations with FEV1. Pulmonary function tests (PFTs) and nutrition (IBW%) were recorded. Regression analysis, Pearson correlation and T-test were used for statistical analysis. Three HRCT parameters were selected for the formation of "simplified" HRCT SS (severity of bronchiectasis, bronchial wall thickening, atelectasis-consolidation) using regression analysis. There was excellent correlation between each "simplified" and corresponding complete score (0.892 < r < 0.0967, p < 0.0001) or the remaining four complete scores (0.786 < r < 0.961, p < 0.0001). Strong correlation was found among the five "simplified" scores (0.803 < r < 0.997, p < 0.0001). Comparing baseline complete and "simplified" scores with corresponding follow-up ones, significant worsening was observed (p < 0.0001). PFTs and IBW% did not change significantly. HRCT scores correlated moderately with FVC and FEV1, but there was no correlation with FEF25-75 and IBW%. "Simplified" HRCT SS are as reliable as the complete ones and detect progression of lung disease earlier than clinical parameters. They are easy to use and could be adopted in clinical practice.

Comparison Between Magnetic Resonance Imaging and Computed Tomography of the Lung in Patients With Cystic Fibrosis With Regard to Clinical, Laboratory, and Pulmonary Functional Parameters

“…[8][9][10] As repeated, life-long pulmonary imaging is required, the cumulative radiation exposure can itself become a complication for patients with CF, particularly with regard to their increasing life expectancy, even if low-dose CT protocols are used; in the case of 1 to 2 CT examinations per year, cumulative radiation doses of more than 40 mSv can be achieved. [8][9][10][11] Magnetic resonance imaging (MRI) of the lung has increasingly been proposed as a radiation-free diagnostic alternative in patients with CF. [12][13][14] In 1987, Fiel et al 15 first described the use of lung MRI in young adults with CF.…”

“…Computed tomography scores have been described to can be even more sensitive than pulmonary functional parameters in the detection of early CF lung disease and in determining the progression of lung manifestation. 10,29,37,38 Oikonomou et al 10 reported that simplification of the CT scoring systems provided even better findings than the original more extent scores. The more simplified structure of the Eichinger scoring system might be one main reason that the Eichinger score showed in general higher clinical correlations and stronger agreement between CT and MRI demonstrated in the Bland-Altman plot (Fig.…”

“…Results: The overall modified Helbich CT score had a mean (SD) of 15. [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] and median of 15.0 (IQR, 7.3). Without assessment of perfusion, the overall Eichinger score resulted in the following values for CT vs MR examinations: mean (SD), 20.3 (7.2) (range, 4-31); and median, 21.0 (IQR, 9.5) vs mean (SD), 19.5 (7.1) (range, ; and median, 20.0 (IQR, 9.0).…”

Description and validation of a scoring system for tomosynthesis in pulmonary cystic fibrosis

“…This tomosynthesis scoring system is based on previously reported scoring systems for radiography [3][4][5][6][7][8][9][10][11][12][13] and CT [14][15][16][17][18][19][20][21][22]. Typical findings of CF pulmonary disease seen with tomosynthesis and evaluated with the scoring system are overinflation, bronchial wall thickening, parenchymal lesions, bronchiectasis and mucus plugging.…”

“…On the other hand, tomosynthesis does not show all the abnormal features used for CT scoring [14][15][16][17][18][19][20][21][22], such as ground glass opacities, regional emphysema, mosaic perfusion, or focal air trapping on expiratory images. Also, many CT scoring systems score individual bronchopulmonary segments or lobes, which cannot be accurately defined by tomosynthesis.…”