Quantitative assessment of airway dimensions in young children with cystic fibrosis lung disease using chest computed tomography

Abstract

AA-ratio differences were present in young CF patients relative to disease controls. A A-ratio as an objective parameter for bronchiectasis could reduce sample sizes for clinical trials.

Chest CT scoring for evaluation of lung sequelae in congenital diaphragmatic hernia survivors

“…Tracheobronchomalacia can best be detected on expiratory scans. Of course volume control is only feasible in children aged 5 years and above 24,25 unless if performed under general anesthesia and with cuffed endotracheal intubation. 26 In our clinical follow-up program this was not feasible nor desirable.…”

Pediatric Pulmonology Year in Review 2018: Rare lung disease, neuromuscular disease, and diagnostic testing

“…It is known that significant structural lung disease can be present on CT scans in young children with cystic fibrosis (CF), even with minimal symptoms, but radiation exposure limits CT as a surveillance tool. The AREST‐CF study, in which CF patients undergo volume‐controlled surveillance chest CT at age 1 and 3 years, afforded an opportunity to assess whether surveillance CT changes management. Newbegin et al reviewed CT results and medical records in 50 children from AREST‐CF and found that 31% of scans resulted in direct change in clinical management, most commonly prompted by the finding of bronchiectasis.…”

“…It is known that significant structural lung disease can be present on CT scans in young children with cystic fibrosis (CF), even with minimal symptoms, but radiation exposure limits CT as a surveillance tool. The AREST-CF study, 58 This was then assessed against BAL neutrophilia (>20%) as a standard measure for airways inflammation. While the authors noted that this scoring system achieved reasonable inter-rater reliability, they also concluded it would need to be further validated in prospective studies.…”

The imaging definition of bronchiectasis in children: Is it time for a change?

“…Does use of the outer diameter as proposed by Kuo and colleagues add advantage to the long held traditional method of using the inner diameter? As calculated above, measuring the outer wall would reduce the upper limit of normal by about 1/3 which more closely approximates the upper limits of normal found by Long et al and by Kapur et al There is far too little data at this point to determine how using the outer diameter would affect either research or clinical care, and hence the current standard of using the inner diameter remains the gold standard.…”

“…Currently, the method proposed but Kuo and colleagues cannot be used clinically but using a pediatric derived bronchoarterial ratio in children (which is lower compared to adults), whether by using a less than 1:1 ratio in the standard radiological manner (ie using the inner bronchial diameter), or by measuring the outer wall diameter would be advantageous especially in the context that unlike adults with bronchiectasis, radiological bronchiectasis in children may be reversible when children are appropriately treated . In order to determine the appropriate ratio and measurement technique, clearly more studies defining bronchoarterial ratio in children with and without cardiopulmonary diseases concurrent with in‐depth clinical associations and follow‐up are required.…”