Role of computed tomography in diagnosis of bronchiectasis.

Abstract

Bronchograms and computed tomograms were performed in 27 patients who presented consecutively for bronchography with chronic sputum production. The films were reported separately by three consultant radiologists, who had been asked to give a diagnostic interpretation of the films for each bronchopulmonary segment. The reporting of bronchiectasis on computed tomograms was compared with that on bronchograms. The sensitivity and specificity of computed tomography at segmental level compared with bronchography was 66% and 92%, respectively. We conclude that computed tomography alone is not yet suitable for accurate characterisation and localisation of disease in patients in whom surgery is contemplated. Computed tomography may be useful in patients in whom bronchography is contraindicated and for monitoring progression of disease after initial combined computed tomography and bronchography.Bronchography has been used for many years as a definitive investigation to identify the presence, severity, and extent of bronchial abnormalities, particularly bronchiectasis, but it is an invasive investigation and unpleasant for the patient. Despite refinements in technique and contrast medium, complications may occur, which include allergic and foreign body reaction to the contrast medium, pulmonary infection, and a temporary reduction in pulmonary function with impaired ventilation and diffusion.' Bronchiectasis, as the term is used in this study, is permanent, irreversible dilatation of the bronchial tree, and its features as seen by the newer technique of computed tomography (CT) have been described by Naidich et al.2 Mootoosamy et al recently concluded that CT was useful in assessing bronchiectasis,3 but Muller et al, on the other hand, found it unreliable in diagnosing cylindrical and varicose bronchiectasis.4In view of the apparent conflict in current reports, we conducted a controlled study to assess the sensitivity and specificity of CT compared with bronchography in the diagnosis of bronchiectasis.Address for reprint requests: Dr J Cooke, Department of Radiology, Royal Marsden Hospital, London SW3 6JJ.Accepted I October 1986 Patients and methods PATIENTSTwenty seven patients who presented consecutively for bronchography with symptoms of cough and sputum were studied. Of these, 26 expectorated sputum daily (median duration eight years) and the sputum in 24 was purulent; one expectorated sputum intermittently. All but one of the patients were examined more than three months after an exacerbation, the exception having a repeat CT scan three months later; only the second scan was included in the analysis. INVESTIGATIONS

Role of high resolution computed tomography in evaluation of diffuse lung diseases

“…It was detected in ten patients commonly affecting right middle lobe and left lower lobe in five patients each.lobar as well as segmental dilatation was possible in all patients as stated by by Cooke JS et al 12 The characteristic signet ring appearance described by Grenier P et al was identified in 6 patients. 13 The three pathological types (cylindrical in four patients, varicose in two patients, cystic in six patients ) described by Reid LM.…”

Central bronchiectasis in allergic bronchopulmonary aspergillosis: comparative evaluation of computed tomography of the thorax with bronchography

“…The sensitivity rate in these studies has ranged from 60-100%, while specificity has been of the order of 90-100% [7][8][9][10][11][12][13]. However, there has not yet been a systematic study to evaluate CT of the thorax in comparison to bronchography for demonstration of CB in ABPA.…”

“…In studies of CT of thorax with the standard 10 mm sections at 10 mm intervals for demonstration of bronchiectasis, it was felt that the bronchi were not sharply visualized, due to partial volume averaging effect [7,8,11,13]. Furthermore, a gap of 10 mm between the sections may lead to small bronchiectatic lesions being missed [8,9,11], especially in bronchi that course horizontally as their axes lie parallel to the transverse plane. On the other hand, very thin to medium sections of 2-5 mm increase the radiation dose to the patient [12].…”

“…Computed tomography (CT) has now emerged as an effective alternative in the diagnosis of bronchiectasis [6][7][8][9][10][11][12][13]. However, no comparative study has been reported, so far, on patients with ABPA.…”

Bronchiectasis: Diagnostic Accuracy of Chest Computed Radiography

“…The reported diagnostic accuracy of chest radiography for the detection of bronchiectasis varies. Cooke et al (10) found that the sensitivity of chest radiography, compared with bronchography, was only 37%, and the specificity, 95%. In a study by Currie et al (3), the sensitivity, specificity, and diagnostic accuracy of chest radiography in the detection of bronchographically-diagnosed bronchiectasis were 47%, 100%, and 63%, respectively.…”