Ultrafast computerized tomography of the chest in cystic fibrosis: A new scoring system

Abstract

Assessing the presence and severity of bronchiectasis (BR) and mucoid impaction (MI) of the airways in cystic fibrosis (CF) is difficult by non-invasive methods. We hypothesized that scoring ultrafast computerized tomograms (UFCT) of the chest for BR and MI could be useful in detecting early lung changes in 28 patients with CF. To do this, UFCT scores were compared to established clinical and chest X-ray (CXR) scores. Results showed that UFCT scores correlated highly with clinical (r = 0.88) and CXR (r = 0.93) scores, and several pulmonary function tests. Regression analysis indicated that BR influenced clinical and CXR scores more than MI. Both BR and MI were found in all areas of the lungs without a major propensity for one region, although there was significantly more BR in the right upper lobe than the right lower lobe. In patients with CXR score greater than or equal to 21 BR was present in 8/9 and MI in 3/9, while in those with CXR score less than 21 UFCT showed BR in 19/19 and MI in 17/19. We conclude: 1) scored UFCTs correlate well with CXR and clinical scores; 2) BR influences clinical and CXR scores more than MI; 3) UFCTs detect BR and MI in CF patients with minimal evidence of pulmonary disease; and 4) CXR scores less than 21 reflect the presence of both BR and MI.

Computed tomographic imaging of the airways: relationship to structure and function

“…In several studies in which the relationship between lung structure and function has been measured, a strong correlation between measures of forced expiratory flow and HRCT scoring systems has been reported [37,99,138,146,147], except in studies of very young children [128,134,143]. The results of two longitudinal studies have suggested that HRCT scoring may be more sensitive than lung function in detecting disease progression in CF; in both studies, pulmonary function tests (PFTs) remained stable over 2 yrs, whereas the HRCT score detected worsening of disease [36,130].…”

Automated CT Scan Scores of Bronchiectasis and Air Trapping in Cystic Fibrosis

“…In numerous studies, expert reader CT scan scores have been shown to correlate with other CF lung disease parameters, including clinical status and lung function. [10][11][12][13][14][15][16][17] Although expert visual scoring such as the Brody scoring system 16 includes more features of CF lung disease than can be evaluated by automated software, it is time consuming and limited by the number of expert readers available. In contrast, automated computer analysis does not require specially trained observers, avoids observer bias and variability, offers better standardization, and function measures, and sputum markers of infl ammation in children with CF.…”

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.…”

“…In tomosynthesis this method is not optimal as the vessels in the periphery of the lungs are often difficult to define in patients with severe CF changes, which would make measurements unreliable. In the CT scoring system of Nathanson [15], on the other hand, bronchi affected by bronchiectasis are scored for appearance (cylindrical, saccular or cystic) and for extent. In the proposed tomosynthesis scoring system bronchiectatic bronchi are rated for number and appearance.…”

“…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.…”