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Green O, Knee A, Patino A, Modahl L, Liautaud S. The effect of a training webinar on decreasing inter-observer variability in making a radiologic diagnosis of bronchiectasis. BMC Med Imaging 2022; 22:148. [PMID: 36002806 PMCID: PMC9399978 DOI: 10.1186/s12880-022-00878-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022] Open
Abstract
Non-cystic fibrosis bronchiectasis is a clinically important disease with an estimated 340,000–522,000 persons living with the disease and 70,000 being diagnosed annually. The radiographic diagnosis remains a pivotal part of recognizing the disease due to its protean clinical manifestations. As physicians are sensitized to this disease, a greater proportion of patients are being diagnosed with mild to moderate bronchiectasis. Despite the established use of CT chest as the main tool for making a radiologic diagnosis of bronchiectasis, the literature supporting the process of making that diagnosis is somewhat sparse. Concurrently, there has been an increased trend to have Web-based radiologic tutorials due to its convenience, the ability of the learner to set the pace of learning and the reduced cost compared to in-person learning. The COVID-19 pandemic has accelerated this trend. We wanted to look carefully at the effect of a Web-based training session on interrater reliability. Agreement was calculated as percentages and kappa and prevalence adjusted kappa calculated. We found that a single Web-based training session had little effect on the variability and accuracy of diagnosis of bronchiectasis. Larger studies are needed in this area with multiple training sessions.
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Affiliation(s)
- O'Neil Green
- UMASS-Baystate, 759 Chestnut St, Springfield, MA, 01144, USA.
| | - Alexander Knee
- Department of Healthcare Delivery and Population Science, Baystate Medical Center, 759 Chestnut St, Springfield, MA, 01144, USA
| | - Angelica Patino
- Department of Radiology, UMASS-Baystate, 759 Chestnut St, Springfield, MA, 01144, USA
| | - Lucy Modahl
- Department of Radiology, UMASS-Baystate, 759 Chestnut St, Springfield, MA, 01144, USA
| | - Sybille Liautaud
- Department of Pulmonary and Critical Care Medicine, UMASS-Baystate, 759 Chestnut St, Springfield, MA, 01144, USA
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2
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Fabri L, Shanthikumar S, Tadd K, Morgan L, Schultz A, Robinson P. Fissure adjacent partial lobe atelectasis in primary ciliary dyskinesia. J Paediatr Child Health 2022; 58:683-686. [PMID: 34786797 DOI: 10.1111/jpc.15818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/27/2021] [Accepted: 10/12/2021] [Indexed: 11/29/2022]
Abstract
AIM Establishing the underlying cause in a child with chronic suppurative lung disease (CSLD) allows for targeted treatment and screening for associated complications. One cause of CSLD is primary ciliary dyskinesia (PCD). Testing for PCD requires specialist expertise which is not widely available. Computed tomography (CT) scans are commonly performed when assessing CSLD. Identifying PCD-specific signs on CT would help clinicians in deciding when to refer for specialist testing. One potential PCD-specific sign we have observed is fissure adjacent partial lobe atelectasis (FAPLA). We aimed to assess if FAPLA is commonly found in CT of PCD patients. METHODS Fifty-eight CT scans from 42 adult and child PCD patients were analysed. The presence and distribution of FAPLA were noted, and its association to sputum culture and other signs commonly seen in CSLD (bronchiectasis, bronchial wall thickening, air trapping and mucus plugging). RESULTS FAPLA was found in 13 of 40 participants in their earliest CT scan. The prevalence of FAPLA was similar in children and adults. FAPLA involved the right middle lobe in all 13 cases and was systematically associated with ≥1 other structural change. There was no association between FAPLA and bacterial isolation from sputum. CONCLUSION FAPLA was found in 32.5% PCD scans, without difference between children and adults in terms of frequency. Future work will determine if it is a PCD-specific sign by assessing whether it is also found in other CSLD processes and analysing more scans from children with PCD to determine how early this sign develops.
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Affiliation(s)
- Loraine Fabri
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Brussels, Anderlecht, Belgium
| | - Shivanthan Shanthikumar
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Katelyn Tadd
- Medical Workforce Unit, Eastern Health, Melbourne, Victoria, Australia
| | - Lucy Morgan
- Department of Respiratory Medicine, Concord Hospital, Sydney, New South Wales, Australia.,School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - André Schultz
- Wal-yan Respiratory Research Centre, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Philip Robinson
- Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, The Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Fretzayas A, Loukou I, Moustaki M, Douros K. Correlation of computed tomography findings and lung function in children and adolescents with cystic fibrosis. World J Pediatr 2021; 17:221-226. [PMID: 34033063 DOI: 10.1007/s12519-020-00388-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND The timely and appropriate monitoring of pulmonary status is of utmost importance for patients with cystic fibrosis (CF). Computed tomography (CT) has been used in clinical and research settings for tracking lung involvement in CF patients. However, as CT delivers a considerable amount of radiation, its sequential use in CF patients remains a concern. The application of CT, therefore, should take into account its potential risks. This review aims to understand whether and to what extent the CT findings correlate with the findings from other monitoring tools in CF lung disease. DATA SOURCES PubMed was searched for articles about the correlation of chest CT findings with spirometric indices and with lung clearance index in children and adolescents with CF. The most relevant articles were reviewed and are presented herein. RESULTS Most studies have shown that forced expiratory volume in the first second (FEV1) and other spirometric indices correlate moderately with CT structural lung damage. However, at the individual level, there were patients with FEV1 within the normal range and abnormal CT and vice versa. Furthermore, longitudinal studies have indicated that the deterioration of structural lung damage does not occur in parallel with the progression of lung function. Lung clearance index is a better predictor of CT findings. CONCLUSIONS In general, the existing studies do not support the use of lung function tests as surrogates of chest CT.
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Affiliation(s)
- Andrew Fretzayas
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. .,Department of Pediatrics, Athens Medical Center, 5-7 Distomou str, 151 25, Marousi, Greece.
| | - Ioanna Loukou
- Department of Cystic Fibrosis, "Agia Sofia", Children's Hospital, Athens, Greece
| | - Maria Moustaki
- Department of Cystic Fibrosis, "Agia Sofia", Children's Hospital, Athens, Greece
| | - Konstantinos Douros
- School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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Thomas M, Raja M, Albakri M, Najim M, Chandra P, Allangawi M. CT score and correlation with lung function and microbiology of adult patients with cystic fibrosis with predominant I1234V genotype in Qatar. Qatar Med J 2020; 2020:4. [PMID: 32300549 PMCID: PMC7147265 DOI: 10.5339/qmj.2020.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Computed tomography (CT) features of cystic fibrosis (CF) lung disease can be objectively quantified using current CT scoring systems to assess the extent and severity of the disease. The aims of this study were to calculate the Santamaria CT scores in adult patients with CF with the predominant CFTR I1234V genotype, determine its reliability, and correlate these parameters with lung function, microbial colonization, compliance to treatment, and exacerbations. Methodology: This retrospective observational study was conducted on adult patients with CF who were regularly followed up in the adult CF service at Qatar via CT scans that were taken not during an acute exacerbation. CT scans were scored using the Santamaria scoring system. Corresponding spirometry, microbiological data of sputum culture, and relevant clinical data were correlated with individual CT scores. Results: Only 23 of the 31 patients underwent CT when not in an acute exacerbation and were included in the study analysis. A total of 20 (87%) patients had the I1234V genotype. There was good agreement between the two radiologists on the Santamaria CT scores with an intraclass correlation coefficient (ICC) value of 0.991. Bronchiectasis was the most consistent finding, followed by interlobular and intralobular septal thickening. Patients with poor lung function and frequent exacerbations had significantly higher CT scores (p = 0.015). The CT scores of patients colonized with Pseudomonas aeruginosa were higher but nonsignificant (p = 0.20). The mean CT scores were significantly higher in patients who were noncompliant to regular treatment than in those who were compliant (p = 0.012). Conclusion: Santamaria CT scores comprise a reliable scoring system for adult patients with CF and can be used to determine the extent and severity of lung disease. P. aeruginosa colonization causes more structural lung damage than other common colonizing organisms. Noncompliance to treatment has a significant impact on the increasing severity of CF lung disease.
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Affiliation(s)
| | | | - Mutaz Albakri
- Department of Chest, Hamad General Hospital, Doha, Qatar
| | - Mostafa Najim
- Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - Prem Chandra
- Medical Research Centre Hamad Medical Corporation, Doha, Qatar
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Turkovic L, Caudri D, Rosenow T, Breuer O, Murray C, Tiddens HA, Ramanauskas F, Ranganathan SC, Hall GL, Stick SM. Structural determinants of long-term functional outcomes in young children with cystic fibrosis. Eur Respir J 2020; 55:13993003.00748-2019. [DOI: 10.1183/13993003.00748-2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 02/12/2020] [Indexed: 11/05/2022]
Abstract
BackgroundAccelerated lung function decline in individuals with cystic fibrosis (CF) starts in adolescence with respiratory complications being the most common cause of death in later life. Factors contributing to lung function decline are not well understood, in particular its relationship with structural lung disease in early childhood. Detection and management of structural lung disease could be an important step in improving outcomes in CF patients.MethodsAnnual chest computed tomography (CT) scans were available from 2005 to 2016 as a part of the AREST CF cohort for children aged 3 months to 6 years. Annual spirometry measurements were available for 89.77% of the cohort (167 children aged 5–6 years) from age 5 to 15 years through outpatient clinics at Perth Children's Hospital (Perth, Australia) and The Royal Children's Hospital in Melbourne (Melbourne, Australia) (697 measurements, mean±sd age 9.3±2.1 years).ResultsChildren with a total CT score above the median at age 5–6 years were more likely to have abnormal forced expiratory volume in 1 s (FEV1) (adjusted hazard ratio 2.67 (1.06–6.72), p=0.037) during the next 10 years compared to those below the median chest CT score. The extent of all structural abnormalities except bronchial wall thickening were associated with lower FEV1 Z-scores. Mucus plugging and trapped air were the most predictive sub-score (adjusted mean change −0.17 (−0.26 – −0.07) p<0.001 and −0.09 (−0.14 – −0.04) p<0.001, respectively).DiscussionChest CT identifies children at an early age who have adverse long-term outcomes. The prevention of structural lung damage should be a goal of early intervention and can be usefully assessed with chest CT. In an era of therapeutics that might alter disease trajectories, chest CT could provide an early readout of likely long-term success.
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Zorzo C, Caballero P, Diab L, Pastor MT, Gómez-Punter RM, Girón RM. Predictive value of computed tomography scoring systems evolution in adults with cystic fibrosis. Eur Radiol 2020; 30:3634-40. [PMID: 32128619 DOI: 10.1007/s00330-020-06759-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/04/2020] [Accepted: 02/18/2020] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To assess whether the evolution of two consecutive high-resolution computed tomography (HRCT) scores in patients with cystic fibrosis (CF) has prognostic value. METHODS A longitudinal retrospective study was performed to research adult patients with CF. Two consecutive HRCT studies were scored using Bhalla and Brody II scoring scales by two senior radiologists. Annual scoring changes for each scale were calculated and correlated with annual FEV1% decline, with pulmonary exacerbations and number of antibiotic treatments. RESULTS We selected sixty-four adult patients. The median interval between the two HRCTs was 3.88 ± 1.59 years. The mean spirometric values showed dynamic lung volumes lower than the general population; globally, there was a worsening of respiratory function over time. The change in the annual HRCT scores was positive on both scales, indicating a worse structural situation over time. The Brody II scale annual change showed a significant statistical correlation with a decline in the annual FEV1%, exacerbations and number of oral antibiotic treatments. In contrast, for the Bhalla scale, the relationship was moderately inverse with exacerbations and with the number of oral treatments. No statistically significant relationships were found for the change in the annual FEV1% and exacerbations or number of antibiotic treatments. The interobservational and intraobservational agreements were very strong in both scales. CONCLUSIONS The annual evolution of the Brody II HRCT scoring system demonstrated a predictive value and correlated with FEV1% decline, pulmonary exacerbations and oral antibiotic treatments. KEY POINTS • HRCT evolution has prognostic value in cystic fibrosis. • Temporal evolution for the Brody II score is useful for clinical follow-up. • Brody II score changes correlate with FEV1% decline, pulmonary exacerbations and number of antibiotic treatments.
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Lin S, Lin M, Lau K. Efficacy of model-based iterative reconstruction in cystic fibrosis assessment using CT. Clin Radiol 2019; 74:569.e19-569.e27. [DOI: 10.1016/j.crad.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/11/2019] [Indexed: 02/03/2023]
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Sasihuseyinoglu AS, Altıntaş DU, Soyupak S, Dogruel D, Yılmaz M, Serbes M, Duyuler G. Evaluation of high resolution computed tomography findings of cystic fibrosis. Korean J Intern Med 2019; 34:335-343. [PMID: 29976036 PMCID: PMC6406085 DOI: 10.3904/kjim.2017.287] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 03/13/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Morphological changes due to lung disease in patients with cystic fibrosis (CF) were evaluated using high resolution computed tomography (HRCT), and the HRCT scores obtained using the Bhalla scoring system were correlated with those obtained using clinical and laboratory indicators. METHODS Medical records of 28 children with CF who underwent chest CT in Department of Pediatric Allergy and Immunology, Cukurova University Balcali Hospital between March 2011 and January 2016 were retrospectively reviewed. Demographic data and physical examination, respiratory cultures, pulmonary function tests, and chest HRCT findings were evaluated. Patients were divided into the following two groups according to their forced expiratory volume in the first second (FEV1) values: normal FEV1 (≥ 80% of predicted values) and low FEV1 (< 80% of predicted values). Deep throat or sputum cultures were evaluated for the presence of Pseudomonas aeruginosa (PsA) and other bacteria. HRCT scans were scored using the Bhalla scoring system. RESULTS No significant correlation was found between the Bhalla scores and sex, age group, or height percentiles. Significant relationships were found between the Bhalla score and weight (p = 0.036) and body mass index (BMI) (p = 0.032) percentiles below the third percentile, bacterial growth in the sputum/ deep throat cultures (p = 0.009), and presence of PsA (p = 0.004). Moreover, a significant correlation was found between the Bhalla score and FEV1 (r = -0.315, p = 0.0272), forced vital capacity (FVC; r = -0.381, p = 0.0178), forced expiratory flow between 25% and 75% of FVC (r = -0.229, p = 0.0431), and BMI (r = -3.368, p = 0.050). CONCLUSION Chest HRCT is an important diagnostic tool for the pulmonary evaluation of children with CF.
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Affiliation(s)
- Ayse Senay Sasihuseyinoglu
- Department of Pediatric Allergy and Immunology, Cukurova University School of Medicine, Adana, Turkey
- Correspondence to Ayse Senay Sasihuseyinoglu, M.D. Department of Pediatric Allergy and Immunology, Balcali Hospital, Cukurova University School of Medicine, 01330 Balcali, Adana, Turkey Tel: +90-506-608-3040 Fax: +90-322-338-6900 E-mail:
| | - Derya Ufuk Altıntaş
- Department of Pediatric Allergy and Immunology, Cukurova University School of Medicine, Adana, Turkey
| | - Sureyya Soyupak
- Department of Radiology, Cukurova University School of Medicine, Adana, Turkey
| | - Dilek Dogruel
- Department of Pediatric Allergy and Immunology, Cukurova University School of Medicine, Adana, Turkey
| | - Mustafa Yılmaz
- Department of Pediatric Allergy and Immunology, Cukurova University School of Medicine, Adana, Turkey
| | - Mahir Serbes
- Department of Pediatric Allergy and Immunology, Cukurova University School of Medicine, Adana, Turkey
| | - Gulsah Duyuler
- Department of Pediatric Allergy and Immunology, Cukurova University School of Medicine, Adana, Turkey
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Cohen RWF, Folescu TW, Daltro P, Boechat MCB, Lima DF, Marques EA, Leão RS. Methicillin-resistant Staphylococcus aureus in cystic fibrosis patients: do we need to care? A cohort study. SAO PAULO MED J 2017; 135:420-427. [PMID: 28832807 PMCID: PMC10027246 DOI: 10.1590/1516-3180.2016.0350240317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/24/2017] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE The prevalence of a variety of potentially pathogenic microorganisms in cystic fibrosis patients, such as methicillin-resistant Staphylococcus aureus (MRSA), has increased over the past decade. Given the increasing prevalence of MRSA and the few data available in the literature, better understanding of the clinical repercussions of colonization by this bacterium in cystic fibrosis patients becomes essential. This study aimed to evaluate the repercussions of chronic colonization by MRSA in cystic fibrosis patients. DESIGN AND SETTING Retrospective cohort study from January 2004 to December 2013 in a cystic fibrosis reference center. METHODS Each patient with cystic fibrosis was evaluated for nutritional status (body mass index, BMI, and BMI percentile), pulmonary function and tomographic abnormalities (modified Bhalla scores) at the time of chronic colonization by MRSA or methicillin-susceptible Staphylococcus aureus (MSSA) and throughout the study period. RESULTS Twenty pairs of patients were included. There were no significant differences between the groups regarding nutritional characteristics. Spirometric data showed a trend towards greater obstruction of the airways in patients with MRSA. Patients with MRSA presented greater structural damage to their lungs, demonstrated not only by the total Bhalla score but also by its parameters individually. CONCLUSIONS Patients colonized by MRSA presented greater functional and structural respiratory impairment at the time of chronic colonization. Disease progression was also faster in patients chronically colonized by MRSA than in those with MSSA. This was shown through comparisons that avoided possible confounding variables.
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Affiliation(s)
- Renata Wrobel Folescu Cohen
- Assistant Professor of Pediatrics, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), and Pediatric Pulmonologist, Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Fundação Instituto Oswaldo Cruz (IFF/Fiocruz), Rio de Janeiro (RJ), Brazil.
| | - Tânia Wrobel Folescu
- Head of Pediatric Pulmonology, Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Fundação Instituto Oswaldo Cruz (IFF/Fiocruz), Rio de Janeiro (RJ), Brazil.
| | - Pedro Daltro
- Radiologist, Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Fundação Instituto Oswaldo Cruz (IFF/Fiocruz), Rio de Janeiro (RJ), Brazil.
| | - Marcia Cristina Bastos Boechat
- Head of Radiology, Instituto Nacional de Saúde da Mulher da Criança e do Adolescente Fernandes Figueira, Fundação Instituto Oswaldo Cruz (IFF/Fiocruz), Rio de Janeiro (RJ), Brazil.
| | - Danielle Ferreira Lima
- Fellow, Department of Microbiology, Immunology and Parasitology, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro (RJ), Brazil.
| | - Elizabeth Andrade Marques
- Professor, Department of Microbiology, Immunology and Parasitology, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro (RJ), Brazil.
| | - Robson Souza Leão
- Professor, Department of Microbiology, Immunology and Parasitology, School of Medical Sciences, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro (RJ), Brazil.
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Maglione M, Montella S, Mollica C, Carnovale V, Iacotucci P, De Gregorio F, Tosco A, Cervasio M, Raia V, Santamaria F. Lung structure and function similarities between primary ciliary dyskinesia and mild cystic fibrosis: a pilot study. Ital J Pediatr 2017; 43:34. [PMID: 28403885 PMCID: PMC5389053 DOI: 10.1186/s13052-017-0351-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 03/27/2017] [Indexed: 11/14/2022] Open
Abstract
Background Primary ciliary dyskinesia (PCD) and cystic fibrosis (CF) are increasingly compared. There are no chest magnetic resonance imaging (MRI) comparative studies of PCD and CF. We assessed clinical, functional, microbiological and MRI findings in PCD and mild CF patients in order to evaluate different expression of lung disease. Methods Twenty PCD (15.1 years) and 20 CF subjects with mild respiratory impairment (16 years, 70% with pancreatic insufficiency) underwent MRI, spirometry, and sputum cultures when clinically stable. MRI was scored using the modified Helbich system. Results PCD was diagnosed later than CF (9.9 versus 0.6 years, p = 0.03), despite earlier symptoms (0.1 versus 0.6 years, p = 0.02). In the year preceding the study, patients from both groups underwent two systemic antibiotic courses (p = 0.48). MRI total scores were 11.6 ± 0.7 and 9.1 ± 1 in PCD and CF, respectively. FEV1 and FVC Z-scores were −1.75 (range, −4.6–0.7) and −0.6 (−3.9–1.8) in PCD, and −0.9 (range, −5.4–2.3) and −0.3 (−3.4–2.5) in CF, respectively. No difference was found between lung function or structure, despite a higher MRI subscore of collapse/consolidation in PCD versus CF (1.6 ± 0.1 and 0.6 ± 0.2, p < 0.001). These findings were confirmed after data-control for diagnostic delay. Pseudomonas aeruginosa and Staphylococcus aureus were more frequent in CF than in PCD (p = 0.05 and p = 0.003, respectively). Conclusions MRI is a valuable radiation-free tool for comparative PCD and CF lung disease assessment. Patients with PCD may exhibit similar MRI and lung function changes as CF subjects with mild pulmonary disease. Delay in PCD diagnosis is unlikely the only determinant of similarities. Electronic supplementary material The online version of this article (doi:10.1186/s13052-017-0351-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marco Maglione
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Silvia Montella
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Carmine Mollica
- Biostructure and Bioimaging Institute, National Research Council, Naples, Italy
| | - Vincenzo Carnovale
- Department of Translational Medical Sciences, Adult Cystic Fibrosis Center, Federico II University, Naples, Italy
| | - Paola Iacotucci
- Department of Translational Medical Sciences, Adult Cystic Fibrosis Center, Federico II University, Naples, Italy
| | - Fabiola De Gregorio
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Antonella Tosco
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Mariarosaria Cervasio
- Department of Advanced Biomedical Sciences, Anatomo-Pathology Unit, Federico II University, Naples, Italy
| | - Valeria Raia
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Section of Pediatrics, Federico II University, Via Pansini 5, 80131, Naples, Italy.
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Abstract
Objective To evaluate radiologist agreement on the quantification of bronchiectasis by
high-resolution computed tomography (HRCT). Materials and Methods The HRCT scans of 43 patients with bronchiectasis were analyzed by two
radiologists, who used a scoring system to grade the findings. Kappa
(κ) values and overall agreement were calculated. Results For the measurement and appearance of bronchiectasis, the interobserver
agreement was moderate (κ = 0.45 and κ = 0.43, respectively),
as was the intraobserver agreement (κ = 0.54 and κ = 0.47,
respectively). Agreement on the presence of mucous plugging was fair, for
central distribution (overall interobserver agreement of 68.3% and κ
= 0.39 for intraobserver agreement) and for peripheral distribution
(κ = 0.34 and κ = 0.35 for interobserver and intraobserver
agreement, respectively). The agreement was also fair for peribronchial
thickening (κ = 0.21 and κ = 0.30 for interobserver and
intraobserver agreement, respectively). There was fair interobserver and
intraobserver agreement on the detection of opacities (κ = 0.39 and
71.9%, respectively), ground-glass attenuation (64.3% and κ = 0.24,
respectively), and cysts/bullae (κ = 0.47 and κ = 0.44,
respectively). Qualitative analysis of the HRCT findings of bronchiectasis
and the resulting individual patient scores showed that there was an
excellent correlation between the observers (intraclass correlation
coefficient of 0.85 and 0.81 for interobserver and intraobserver agreement,
respectively). Conclusion In the interpretation of HRCT findings of bronchiectasis, radiologist
agreement appears to be fair. In our final analysis of the findings using
the proposed score, we observed excellent interobserver and intraobserver
agreement.
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Affiliation(s)
| | - Maurício Kenji Ota
- MD, Radiologist for the Fundação Instituto de Pesquisa e Estudos de Diagnóstico por Imagem (FIDI), São Paulo, SP, Brazil
| | | | - Gustavo de Souza Portes Meirelles
- PhD, Coordinator of the Thoracic Imaging Team of the Grupo Fleury, São Paulo, SP, Professor and Advisor for the Graduate Course in Clinical Radiology at the Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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Salamone I, Mondello B, Lucanto MC, Cristadoro S, Lombardo M, Barone M. Bronchial tree-shaped mucous plug in cystic fibrosis: imaging-guided management. Respirol Case Rep 2017; 5:e00214. [PMID: 28096997 PMCID: PMC5233562 DOI: 10.1002/rcr2.214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 11/13/2016] [Accepted: 11/15/2016] [Indexed: 11/29/2022] Open
Abstract
We report the case of a 17‐year‐old boy with cystic fibrosis (CF) who presented with persistent cough; after starting intravenous antibiotics for Pseudomonas aeruginosa he underwent a computed tomography (CT) scan of the chest. CT revealed extensive consolidation in the right lower lobe with relative bronchus obstruction; the cause of bronchial obstruction was detected in the mediastinal window, corresponding to a bronchial tree‐shaped, thick, tenacious mucous plug. This was extracted 48 h after unresponsive bronchial washing and endobronchial instillation of rhDNAse, using foreign‐body forceps, with subsequent resolution of cough. This case, which is the second report of plastic bronchitis in CF, was resolved by mechanical removal of the mucous plug, suggesting that a careful observation of CT imaging may guide intervention aimed at resolution of atelectasis.
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Affiliation(s)
- Ignazio Salamone
- Oncological Radiology Unit, Department of Biomedical and Dental Sciences and Morphofunctional Imaging Policlinico G. Martino Hospital - University of Messina Messina Italy
| | - Baldassare Mondello
- Thoracic Surgery Unit, Thorax, Heart and Vascular Department Policlinico G. Martino Hospital - University of Messina Messina Italy
| | - Maria Cristina Lucanto
- Cystic Fibrosis Center, Mother-Child Department Policlinico G. Martino Hospital - University of Messina Messina Italy
| | - Simona Cristadoro
- Cystic Fibrosis Center, Mother-Child Department Policlinico G. Martino Hospital - University of Messina Messina Italy
| | - Mariangela Lombardo
- Cystic Fibrosis Center, Mother-Child Department Policlinico G. Martino Hospital - University of Messina Messina Italy
| | - Mario Barone
- Thoracic Surgery Unit, Thorax, Heart and Vascular Department Policlinico G. Martino Hospital - University of Messina Messina Italy
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Bhat V, Wahab AA, Garg KC, Janahi I, Singh R. HRCT in cystic fibrosis in patients with CFTR I1234V mutation: Assessment of scoring systems with low dose technique using multidetector system and correlation with pulmonary function tests. Indian J Radiol Imaging 2015; 25:44-51. [PMID: 25709165 PMCID: PMC4329687 DOI: 10.4103/0971-3026.150144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Aims: Pulmonary changes in patients with cystic fibrosis (CF) with CFTR I1234V mutation have not been extensively documented. Impact of geographic influence on phenotypical expression is largely unknown. This descriptive clinical study presents the high-resolution computed tomography (HRCT) pulmonary findings and computed tomography (CT) scoring with respect to pulmonary function tests (PFT) in a small subset of CF group. Materials and Methods: We examined 29 patients between 2 and 31 years of age with CFTR I1234V mutation. HRCT and PFT were performed within 2 weeks of each other. Imaging abnormalities on HRCT were documented and analyzed by utilizing the scoring system described by Bhalla et al., Brody et al., Helbich et al.,and Santamaria et al. Efficacy of the scoring system with respect to PFT was compared. Statistical Analysis: Inter-observer reliability of the scoring systems was tested using intraclass correlation (ICC) between the two observers. Spearman correlation coefficients were calculated between the scoring systems and between the scoring systems and PFT results. Results: In our study, right upper and middle lobes were the most frequently involved sites of involvement. Bronchiectasis and peribronchial thickening were the most frequent imaging findings. Scores with all four scoring systems were reproducible, with good ICC coefficient of 0.69. There was good agreement between senior radiologists in all scoring systems. Conclusion: We noted pulmonary imaging abnormalities in a large majority (96%) of our CF patients. There was no significant difference in the CT scores observed from various systems. The CT evaluation system by Broody is detailed and time consuming, and is ideal for research and academic setup. On the other hand, the systems by Bhalla and Santamaria are easy to use, quick, and equally informative. We found the scoring system by Santamaria preferable over that of Bhalla by virtue of additional points of evaluation and ease of use, and therefore better suited for busy clinical practice.
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Affiliation(s)
- Venkatraman Bhat
- Department of Radiology, Narayana Health, Bangalore, Karnataka, India
| | | | - Kailash C Garg
- Department of Radiology, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Janahi
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Biostastistics, Hamad Medical Corporation, Doha, Qatar
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de Lavernhe I, Le Blanche A, Dégrugilliers L, Carette MF, Bayat S. CT density distribution analysis in patients with cystic fibrosis: correlation with pulmonary function and radiologic scores. Acad Radiol 2015; 22:179-85. [PMID: 25442801 DOI: 10.1016/j.acra.2014.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 09/01/2014] [Accepted: 09/02/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The progressive changes in lung morphology observed in cystic fibrosis (CF) can potentially affect the statistical distribution of computed tomography (CT) density values. This study aimed to characterize the lung CT density distributions by quantifying indices of the kurtosis and skewness of the lung density distribution and to compare these indices to radiologic scores and lung function parameters in children and young adults with CF. MATERIALS AND METHODS CT scans and lung function of 26 patients with CF were retrospectively examined. The Bhalla radiologic scoring was performed separately, in random order, by two expert radiologists, blinded to the patient's identity, age, clinical status, results of lung function tests, and the other paired observer's score. RESULTS Positive relations were evidenced between the log indices of lung density distribution kurtosis (iKurtosis) and the overall radiologic scores (RS) of both observers (R = 0.58; P < .001 vs RS1 and R = 0.71; P < .001 vs RS2). A similar relationship was evidenced with the log index of the degree of distribution asymmetry (iSkewness; R = 0.62; P < .001 vs RS1 and R = 0.62; P < .001 vs RS2). Log-iKurtosis and log-iSkewness were related to FEV1 (R = -0.56; P < 10(-5) and R = -0.55; P < 10(-5)) and to residual volume (R = 0.40; P < .001 and R = 0.45; P < .001, respectively). Both radiologic scores showed significant relation with lung function. The correlation between RS1 and RS2 was excellent (R = 0.93), with a Cohen weighted kappa of 0.43. CONCLUSIONS Characteristic indices of lung CT density distribution are correlated to lung function and radiologic scores in patients with CF and merit further evaluation as part of more comprehensive automated methods for quantifying CF lung CT data.
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Affiliation(s)
- Isaure de Lavernhe
- Department of Pediatric Pulmonary Medicine, Amiens University Hospital, 1, Place Victor Pauchet, Amiens Cedex 1 80054, France
| | - Alain Le Blanche
- University of Versailles Saint-Quentin-en-Yvelines, Unité de Formation et de Recherche de Médecine de Paris-Ile-de-France Ouest Simone Veil Versailles, France; Department of Diagnostic and Interventional Radiology, René Dubos Hospital, Paris, France
| | - Loïc Dégrugilliers
- Department of Pediatric Pulmonary Medicine, Amiens University Hospital, 1, Place Victor Pauchet, Amiens Cedex 1 80054, France; Gramfc Laboratory Inserm U1105, University of Picardie Jules Verne
| | - Marie-France Carette
- Department of Radiology, Faculty of Medicine, Pierre and Marie Curie University Paris VI, Tenon University Hospital, Paris, France
| | - Sam Bayat
- Department of Pediatric Pulmonary Medicine, Amiens University Hospital, 1, Place Victor Pauchet, Amiens Cedex 1 80054, France; Gramfc Laboratory Inserm U1105, University of Picardie Jules Verne.
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Vult von Steyern K, Björkman-Burtscher IM, Geijer M. Radiography, tomosynthesis, CT and MRI in the evaluation of pulmonary cystic fibrosis: an untangling review of the multitude of scoring systems. Insights Imaging 2013; 4:787-98. [PMID: 24065629 PMCID: PMC3846934 DOI: 10.1007/s13244-013-0288-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 07/04/2013] [Accepted: 09/02/2013] [Indexed: 02/03/2023] Open
Abstract
Objective The first radiographic scoring system for pulmonary cystic fibrosis was presented in 1958. Since then a multitude of scoring systems for radiography and computed tomography (CT) have been presented, recently also for tomosynthesis and magnetic resonance imaging (MRI). The aim of the current review was to analyse and compare the plethora of scoring systems for cystic fibrosis, especially regarding which scoring components are considered most important. Methods Four scoring systems for chest radiography, one for tomosynthesis, eight for CT and one for MRI were compared regarding components evaluated and their terminology; the areas scored; scoring levels; the weighting of each component in percentage of the total score; and the calculations for the final score. Results In most radiological scoring systems the lungs are evaluated for increased volume, bronchial wall thickening, bronchiectasis, mucus plugging, atelectasis and consolidation. In addition, for instance abscesses, bullae, septal thickening, mosaic perfusion, ground glass opacities and air trapping are evaluated in some CT scoring systems. Pleural affection and perfusion defects are scored on MRI. Conclusions Bronchiectasis alone, or in combination with mucus plugging, is given the highest weighting in most scoring systems and is thus commonly considered to be the most significant finding when evaluating cystic fibrosis lung disease. Teaching points Scoring of examinations is used for comparison of outcome in studies. Scoring of examinations can also be used for monitoring disease progression. Cystic fibrosis can be scored on radiography, tomosynthesis, CT or MRI. The typical imaging findings of cystic fibrosis depend on the imaging modality used. Bronchiectasis is commonly considered the most significant finding when scoring cystic fibrosis.
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Affiliation(s)
- Kristina Vult von Steyern
- Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Lund University, 221 85, Lund, Sweden,
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Widger J, Ranganathan S, Robinson PJ. Progression of structural lung disease on CT scans in children with cystic fibrosis related diabetes. J Cyst Fibros 2013; 12:216-21. [DOI: 10.1016/j.jcf.2012.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 09/06/2012] [Accepted: 09/21/2012] [Indexed: 11/23/2022]
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Folescu TW, Marques EDA, Boechat MCB, Daltro P, Higa LYS, Cohen RWF. High-resolution computed tomography scores in cystic fibrosis patients colonized with Pseudomonas aeruginosa or Staphylococcus aureus. J Bras Pneumol 2012; 38:41-9. [PMID: 22407039 DOI: 10.1590/s1806-37132012000100007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 10/26/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare HRCT findings in cystic fibrosis (CF) patients chronically colonized with Pseudomonas aeruginosa or Staphylococcus aureus using the modified Bhalla CT scoring system, as well as to evaluate intraobserver and interobserver reliability of the method. METHODS This was a retrospective cross-sectional study involving 41 CF patients, 26 of whom were chronically colonized with P. aeruginosa (Pa group), and 15 of whom were colonized with S. aureus (Sa group).Two independent radiologists evaluated the HRCT scans of these patients using the modified Bhalla CT scoring system in two different moments. Intraobserver and interobserver reliability was calculated using the intraclass correlation coefficient (ICC). RESULTS There was good intraobserver and interobserver agreement (ICC > 0.8). Scores were higher in the Pa group than in the Sa group for observer 1 (mean, 13.50 ± 3.90; median, 13.5 vs. mean, 5.00 ± 5.28; median, 3.0) and for observer 2 (mean, 11.96 ± 5.07; median, 12.0 vs. mean, 5.07 ± 5.65; median, 5.0). In addition, HRCT findings, such as bronchiectasis, bronchial wall thickening, mucus plugging, generation of bronchial divisions, and mosaic attenuation/perfusion pattern, were more prevalent in the Pa group. CONCLUSIONS The modified Bhalla CT scoring system was reproducible and reliable for use in the evaluation of HRCT scans, allowing distinctions to be drawn between the two groups of patients under study. The higher scores in the Pa group provided evidence of greater pulmonary impairment in that group.
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Affiliation(s)
- Tania Wrobel Folescu
- Serviço de Pneumologia Pediátrica, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
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Vult von Steyern K, Björkman-Burtscher IM, Höglund P, Bozovic G, Wiklund M, Geijer M. Description and validation of a scoring system for tomosynthesis in pulmonary cystic fibrosis. Eur Radiol 2012; 22:2718-28. [PMID: 22752406 DOI: 10.1007/s00330-012-2534-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 04/26/2012] [Accepted: 05/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To design and validate a scoring system for tomosynthesis (digital tomography) in pulmonary cystic fibrosis. METHODS A scoring system dedicated to tomosynthesis in pulmonary cystic fibrosis was designed. Three radiologists independently scored 88 pairs of radiographs and tomosynthesis examinations of the chest in 60 patients with cystic fibrosis and 7 oncology patients. Radiographs were scored according to the Brasfield scoring system and tomosynthesis examinations were scored using the new scoring system. RESULTS Observer agreements for the tomosynthesis score were almost perfect for the total score with square-weighted kappa >0.90, and generally substantial to almost perfect for subscores. Correlation between the tomosynthesis score and the Brasfield score was good for the three observers (Kendall's rank correlation tau 0.68, 0.77 and 0.78). Tomosynthesis was generally scored higher as a percentage of the maximum score. Observer agreements for the total score for Brasfield score were almost perfect (square-weighted kappa 0.80, 0.81 and 0.85). CONCLUSIONS The tomosynthesis scoring system seems robust and correlates well with the Brasfield score. Compared with radiography, tomosynthesis is more sensitive to cystic fibrosis changes, especially bronchiectasis and mucus plugging, and the new tomosynthesis scoring system offers the possibility of more detailed and accurate scoring of disease severity. KEY POINTS Tomosynthesis is more sensitive than conventional radiography for pulmonary cystic fibrosis changes. The radiation dose from chest tomosynthesis is low compared with computed tomography. Tomosynthesis may become useful in the regular follow-up of patients with cystic fibrosis.
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Affiliation(s)
- Kristina Vult von Steyern
- Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund University, 221 85, Lund, Sweden.
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Maglione M, Bush A, Montella S, Mollica C, Manna A, Esposito A, Santamaria F. Progression of lung disease in primary ciliary dyskinesia: is spirometry less accurate than CT? Pediatr Pulmonol 2012; 47:498-504. [PMID: 22006708 DOI: 10.1002/ppul.21569] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/09/2011] [Indexed: 11/07/2022]
Abstract
Despite its extensive use, there is no evidence that spirometry is useful in the assessment of progression of lung disease in primary ciliary dyskinesia (PCD). We hypothesize that high-resolution computed tomography (HRCT) is a better indicator of PCD lung disease progression than spirometry. We retrospectively evaluated two paired spirometry and HRCT examinations from 20 PCD patients (age, 11.6 years; range, 6.5-27.5 years). The evaluations were performed in stable state and during unstable lung disease. HRCT scans were scored blind by two raters. Compared to the first assessment, at the second evaluation spirometry did not change while HRCT scores significantly worsened (P < 0.01). Age was significantly related to HRCT total (r = 0.5; P = 0.02) and bronchiectasis scores (r = 0.5; P = 0.02). At both evaluations, HRCT total score correlated with FEV(1) (r = -0.5, P = 0.01; r = -0.7, P = 0.001, respectively) and FVC Z scores (r = -0.6, P = 0.006; r = -0.7, P = 0.001, respectively), and bronchiectasis score was related to FEV(1) (r = -0.5, P = 0.03; r = -0.6; P = 0.002, respectively) and FVC Z scores (r = -0.6, P = 0.008; r = -0.7, P = 0.001, respectively). No relationship was found between the change in HRCT scores and the change in spirometry. In PCD, structural lung disease may worsen despite spirometry being stable.
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Affiliation(s)
- Marco Maglione
- Department of Pediatrics, Federico II University, Via Pansini 5, Naples, Italy
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Albi G, Rayón-Aledo J, Caballero P, Rosado P, García-Esparza E. Fibrosis quística en imágenes. Clasificación de Bhalla para la tomografía computarizada en pacientes pediátricos. Radiología 2012; 54:260-8. [DOI: 10.1016/j.rx.2011.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 04/02/2011] [Accepted: 04/03/2011] [Indexed: 10/24/2022]
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Biederer J, Mirsadraee S, Beer M, Molinari F, Hintze C, Bauman G, Both M, Van Beek EJ, Wild J, Puderbach M. MRI of the lung (3/3)-current applications and future perspectives. Insights Imaging 2012; 3:373-86. [PMID: 22695943 DOI: 10.1007/s13244-011-0142-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 11/09/2011] [Accepted: 11/17/2011] [Indexed: 01/17/2023] Open
Abstract
Background MRI of the lung is recommended in a number of clinical indications. Having a non-radiation alternative is particularly attractive in children and young subjects, or pregnant women. Methods Provided there is sufficient expertise, magnetic resonance imaging (MRI) may be considered as the preferential modality in specific clinical conditions such as cystic fibrosis and acute pulmonary embolism, since additional functional information on respiratory mechanics and regional lung perfusion is provided. In other cases, such as tumours and pneumonia in children, lung MRI may be considered an alternative or adjunct to other modalities with at least similar diagnostic value. Results In interstitial lung disease, the clinical utility of MRI remains to be proven, but it could provide additional information that will be beneficial in research, or at some stage in clinical practice. Customised protocols for chest imaging combine fast breath-hold acquisitions from a “buffet” of sequences. Having introduced details of imaging protocols in previous articles, the aim of this manuscript is to discuss the advantages and limitations of lung MRI in current clinical practice. Conclusion New developments and future perspectives such as motion-compensated imaging with self-navigated sequences or fast Fourier decomposition MRI for non-contrast enhanced ventilation- and perfusion-weighted imaging of the lung are discussed. Main Messages • MRI evolves as a third lung imaging modality, combining morphological and functional information. • It may be considered first choice in cystic fibrosis and pulmonary embolism of young and pregnant patients. • In other cases (tumours, pneumonia in children), it is an alternative or adjunct to X-ray and CT. • In interstitial lung disease, it serves for research, but the clinical value remains to be proven. • New users are advised to make themselves familiar with the particular advantages and limitations.
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O'Connell OJ, McWilliams S, McGarrigle A, O'Connor OJ, Shanahan F, Mullane D, Eustace J, Maher MM, Plant BJ. Radiologic imaging in cystic fibrosis: cumulative effective dose and changing trends over 2 decades. Chest 2011; 141:1575-1583. [PMID: 22207674 DOI: 10.1378/chest.11-1972] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE With the increasing life expectancy for patients with cystic fibrosis (CF), and a known predisposition to certain cancers, cumulative radiation exposure from radiologic imaging is of increasing significance. This study explores the estimated cumulative effective radiation dose over a 17-year period from radiologic procedures and changing trends of imaging modalities over this period. METHODS Estimated cumulative effective dose (CED) from all thoracic and extrathoracic imaging modalities and interventional radiology procedures for both adult and pediatric patients with CF, exclusively attending a nationally designated CF center between 1992-2009 for > 1 year, was determined. The study period was divided into three equal tertiles, and estimated CED attributable to all radiologic procedures was estimated for each tertile. RESULTS Two hundred thirty patients met inclusion criteria (2,240 person-years of follow-up; 5,596 radiologic procedures). CED was > 75 mSv for one patient (0.43%), 36 patients (15.6%) had a CED between 20 and 75 mSv, 56 patients (24.3%) had a CED between 5 and 20 mSv, and in 138 patients (60%) the CED was estimated to be between 0 and 5 mSv over the study period. The mean annual CED per patient increased consecutively from 0.39 mSv/y to 0.47 mSv/y to 1.67 mSv/y over the tertiles one to three of the study period, respectively (P < .001). Thoracic imaging accounted for 46.9% of the total CED and abdominopelvic imaging accounted for 42.9% of the CED, respectively. There was an associated 5.9-fold increase in the use of all CT scanning per patient (P < .001). CONCLUSIONS This study highlights the increasing exposure to ionizing radiation to patients with CF as a result of diagnostic imaging, primarily attributable to CT scanning. Increased awareness of CED and strategies to reduce this exposure are needed.
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Affiliation(s)
- Oisin J O'Connell
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - Sebastian McWilliams
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - AnneMarie McGarrigle
- Department of Radiation Physics, Cork University Hospital, University College Cork, Cork, Ireland
| | - Owen J O'Connor
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Fergus Shanahan
- Department of Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - David Mullane
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland
| | - Joseph Eustace
- Department of Renal Medicine, Cork University Hospital, University College Cork, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, University College Cork, Cork, Ireland
| | - Barry J Plant
- Cork Cystic Fibrosis Center, Cork University Hospital, University College Cork, Cork, Ireland.
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Eichinger M, Heussel CP, Kauczor HU, Tiddens H, Puderbach M. Computed tomography and magnetic resonance imaging in cystic fibrosis lung disease. J Magn Reson Imaging 2011; 32:1370-8. [PMID: 21105141 DOI: 10.1002/jmri.22374] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Computed tomography (CT) is the current "gold standard" for assessment of lung morphology and is so far the most reliable imaging modality for monitoring cystic fibrosis (CF) lung disease. CT has a much higher radiation exposure than chest x-ray. The cumulative radiation dose for life-long repeated CT scans has limited its use for CF patients as their life expectancy increases. Clearly, no dose would be preferable over low dose when the same or more relevant information can be obtained. Magnetic resonance imaging (MRI) is comparable to CT with regard to the detection of most morphological changes in the CF lung. It is thought to be less sensitive to detect small airway disease. At the same time, MRI is superior to CT when it comes to the assessment of functional changes such as altered pulmonary perfusion. The recommendation is to further reduce radiation dose related to the use of CT and to use MRI in the follow-up of morphological changes where possible.
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Affiliation(s)
- Monika Eichinger
- German Cancer Research Center (DKFZ) Heidelberg, Radiology (E010), Heidelberg, Germany
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Abstract
Cystic fibrosis (CF) is the most common life-limiting inherited disease in Caucasian populations. The main cause of death in CF patients is respiratory failure resulting from chronic pulmonary infection. Pseudomonas aeruginosa is the most prevalent organism in the airway colonization of CF patients, and its persistence in the airways has been related to greater morbidity with a more rapid deterioration in lung function. P. aeruginosa has enormous genetic and metabolic flexibility that allows it to adapt and persist within the airways of CF patients, and it has the ability to easily acquire antimicrobial resistance. For these reasons, the management of infections and chronic colonization by P. aeruginosa remains a challenge for physicians. This article reviews the current and future antibacterial chemotherapy options for respiratory pseudomonal infection in CF patients.
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Affiliation(s)
- Roger Sordé
- Department of Infectious Diseases, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Nasr SZ, Sakmar E, Christodoulou E, Eckhardt BP, Streetman DS, Strouse PJ. The use of high resolution computerized tomography (HRCT) of the chest in evaluating the effect of tobramycin solution for inhalation in cystic fibrosis lung disease. Pediatr Pulmonol 2010; 45:440-9. [PMID: 20425851 DOI: 10.1002/ppul.21188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To compare the usefulness of HRCT of the chest versus spirometric measures (PFTs) in evaluating the effect of tobramycin solution for inhalation (TSI) in cystic fibrosis (CF). METHODS Thirty-two CF patients with mostly mild lung disease age > or = 6 years, were enrolled in a double-blind, placebo-controlled pilot study. Patients were chronically colonized with Pseudomonas aeruginosa for at least 6 months prior to and at enrollment. If patients were on TSI, they were taken off for at least 3 months prior to enrollment. Duration was 6 months; 31 subjects completed the study. HRCT and PFTs were evaluated at baseline, after 28 days of treatment and at the end of the study. Study medication was administered as 5 ml nebulized treatment twice a day for 28 days followed by 28 days off (one cycle). Study consisted of three cycles. Two radiologists scored all films using a validated system. A total HRCT score consists of the sum of subscores: linear opacities, hyperinflation, nodular opacities, peribronchial thickening, mucous plugging, and bronchiectasis; each subscore could range from 0 to 80, with potential total scores varying from 0 to 480. The percent of the maximum possible HRCT score was then calculated and used for all comparisons. RESULTS Using two tailed paired t-test, the percent maximum HRCT score decreased by 1.4 +/- 2.6% (mean +/- SD) (P = 0.049) and 0.3 +/- 2.8% (P = 0.63) for the TSI group and decreased by 0.1 +/- 1.5% (P = 0.74) and increased by 0.6 +/- 1.8% (P = 0.23) for the placebo group between visits 1 and 2, and visits 1 and 3, respectively. The data were then analyzed using a mixed model utilizing changes in scores over the durations of the study for each group. The change of HRCT score for the TSI group was -0.24/day (P = 0.02) and -0.03/day (P = 0.22), and for the control group the change was -0.01 (P = 0.93) and 0.02 (P = 0.29) between visits 1 and 2, and visits 1 and 3 respectively. FEF(25-75)% and FEV(1)% changes were not statistically significant using both analyses. CONCLUSION HRCT seems to be more sensitive in detecting treatment effect than PFT in CF patients with mild lung disease, especially following the first treatment period (visit 2). Total HRCT score showed some improvement at the end of the study, though not statistically significant. This is probably due to obtaining the HRCT an average of 30 days after completion of the TSI treatment, and selection of study population with mostly mild lung disease. This could indicate that the most significant improvement in the total HRCT score in this patient population occurs after the first treatment period with TSI.
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Affiliation(s)
- Samya Z Nasr
- Division of Pediatric Pulmonology, Department of Pediatrics, University of Michigan Health System, Ann Arbor, Michigan, USA.
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Cleveland RH, Zurakowski D, Slattery D, Colin AA. Cystic Fibrosis Genotype and Assessing Rates of Decline in Pulmonary Status. Radiology 2009; 253:813-21. [DOI: 10.1148/radiol.2533090418] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Belmaati E, Jensen C, Kofoed KF, Iversen M, Steffensen I, Nielsen MB. Primary graft dysfunction; possible evaluation by high resolution computed tomography, and suggestions for a scoring system. Interact Cardiovasc Thorac Surg 2009; 9:859-67. [PMID: 19671582 DOI: 10.1510/icvts.2009.207852] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We have reviewed and discussed current knowledge on existing scoring systems regarding high resolution computed tomography (HRCT) images for the assessment of primary graft dysfunction (PGD) after lung transplantation. Adult respiratory distress syndrome (ARDS) has been more widely studied and appears to have many morphological features similar to what is found in PGD, and might, therefore, be usefully extrapolated to PGD. Principles of HRCT, scoring systems based on HRCT and various terms describing PGD were reviewed and summarized. The sensitivity, inter-intra observer variability, and reproducibility of these systems were discussed. Lastly, the future perspectives for 64-multi-slice computed tomography (MSCT) in relation to PGD were discussed. Few studies on scoring systems of lung tissue by HRCT in ARDS patients and idiopathic pulmonary fibrosis (IPF) patients were found. Most studies were performed on patients with cystic fibrosis (CF). Sensitivity of HRCT for the detection of parenchymal changes is superior to other imaging methods. High levels of reproducibility are achievable amongst observers who score HRCT lung images. Development of standardized criteria that specify the inclusion/exclusion criteria of patients, pilot testing, and training investigators through review of disagreements, were possibilities suggested for decreasing inter/intra observer variability. Factors affecting the image attenuation (Hounsfield numbers) and thus, the reproducibility of CT densitometric measurements were of minimal influence. Studies have reported on how lung tissue images, derived by HRCT, can be scored and graded. There does not seem to be a golden standard for evaluating these images, which makes comparison between methods challenging. These scoring systems assess the presence, severity, and extent of parenchymal change in the lung. HRCT is considered relevant and superior in evaluating disease severity, disease progression, and in evaluating the effects of therapy regimes in the lung. It is, however, not clear to what extent these scoring methods may be implemented for grading PGD. Further efforts could be made to standardize scoring methods for lung tissue with regards to PGD.
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Affiliation(s)
- Esther Belmaati
- Department of Radiology X, Diagnostic Imaging Centre, Rigshospitalet, Copenhagen University Hospital, Denmark.
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Failo R, Wielopolski PA, Tiddens HAWM, Hop WCJ, Mucelli RP, Lequin MH. Lung morphology assessment using MRI: a robust ultra-short TR/TE 2D steady state free precession sequence used in cystic fibrosis patients. Magn Reson Med 2009; 61:299-306. [PMID: 19165879 DOI: 10.1002/mrm.21841] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To evaluate feasibility and diagnostic quality of ultra-short TR/TE two-dimensional (2D) steady state free precession (SSFP) MRI for cystic fibrosis (CF) patients. We performed lung MRI at 1.5 Tesla in 20 CF-patients (6-17 years, 12 males). Axial, coronal, and sagittal sections were acquired in inspiration and expiration with maximum breath-hold time 10 s. MR and CT images were scored using a modified Brody scoring system to assess bronchiectasis, mucous plugging, atelectasis/consolidations, and air trapping. All images were scored by two experienced observers. A complete MR investigation took maximally 15 min. Maximal breath-holds were only 10 s and well tolerated. MRI identified major bronchiectasis, mucous plugging and atelectasis. End-expiratory scans showed patches of parenchyma with reduced signal intensity that may corresponded to areas of trapped air on expiratory CT scans. This MRI protocol based on ultra-short TR/TE 2D SSFP is quick and well tolerated and provides highly relevant imaging features as seen on CT in CF patients. Most importantly, the SNR of the expiratory scans enables to visualize air trapping. The preliminary results of this study suggest MRI as a noteworthy additional imaging tool for routine monitoring of CF patients.
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Affiliation(s)
- Riccarda Failo
- Pediatric Radiology and Pulmonology Department, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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Song JW, Koh W, Lee KS, Lee JY, Chung MJ, Kim TS, Kwon OJ. High-Resolution CT Findings of Mycobacterium avium-intracellulare Complex Pulmonary Disease: Correlation with Pulmonary Function Test Results. AJR Am J Roentgenol 2008; 191:W160-6. [DOI: 10.2214/ajr.07.3505] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Linnane B, Robinson P, Ranganathan S, Stick S, Murray C. Role of high-resolution computed tomography in the detection of early cystic fibrosis lung disease. Paediatr Respir Rev 2008; 9:168-74; quiz 174-5. [PMID: 18694708 DOI: 10.1016/j.prrv.2008.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
High-resolution computed tomography (HRCT) has been demonstrated to be sensitive at detecting early lung disease in cystic fibrosis (CF), often before it is apparent clinically. There is emerging evidence that structural changes in the lung occur earlier in life than previously appreciated. Despite this, the role of HRCT in young children with CF has yet to be defined, principally because the repeated exposure of children to X-ray doses several multiples that of a standard chest X-ray raises the concern of the long-term risks of ionizing radiation. With the challenges of acquiring HRCT images in young children in mind, we review scanning protocols and settings specific to young children, and review the best available evidence that describes early structural lung disease in young children with CF. The role of CT scoring and quantitative measures of CF lung disease are reviewed. The challenge for the future is to develop techniques that provide clinically useful information at the lowest possible radiation risk.
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Affiliation(s)
- Barry Linnane
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Australia.
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Cademartiri F, Luccichenti G, Palumbo AA, Maffei E, Pisi G, Zompatori M, Krestin GP. Predictive value of chest CT in patients with cystic fibrosis: a single-center 10-year experience. AJR Am J Roentgenol 2008; 190:1475-80. [PMID: 18492894 DOI: 10.2214/AJR.07.3000] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE The objective of our study was to assess the accuracy of one of the most used scoring systems, the Bhalla scoring system, in the detection of lung impairment in patients with cystic fibrosis and in the prediction of cystic fibrosis progression. MATERIALS AND METHODS From the database of our center, 300 CT examinations performed between 1991 and 2001 were reviewed. Pulmonary function tests performed the same day as radiologic assessment were available. Of this group, 145 examinations were retrospectively included, referring to 87 patients with confirmed cystic fibrosis and a mean age (+/- SD) of 15.6 +/- 8.4 years (range, 9 months-38 years). Thirty patients underwent one CT examination, 56 underwent two examinations, and one patient underwent three examinations. The mean interval between two examinations was 36.5 months. The 145 examinations were independently reviewed by three radiologists who were blinded to the clinical and pulmonary function test results. The CT examinations were assessed using the scoring system proposed by Bhalla and colleagues. RESULTS CT assessed using the Bhalla scoring system is mildly correlated with functional pulmonary test results and has high interobserver reproducibility. The CT score significantly changed between scans obtained in a mean interval of 36.5 months, whereas functional pulmonary test results did not, suggesting that CT is more sensitive than function tests for detecting small changes. However, the variation in CT scores did not predict progression of functional pulmonary test results or progression of CT findings between scans. CONCLUSION CT assessment based on the Bhalla scoring system is more sensitive than pulmonary function tests in detecting initial morphologic changes. However, we found no evidence of the predictive value of CT.
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Santamaria F, Montella S, Tiddens HAWM, Guidi G, Casotti V, Maglione M, de Jong PA. Structural and functional lung disease in primary ciliary dyskinesia. Chest 2008; 134:351-357. [PMID: 18403663 DOI: 10.1378/chest.07-2812] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND High-resolution CT (HRCT) scan data on primary ciliary dyskinesia (PCD) related lung disease are scarce. STUDY OBJECTIVES We evaluated the lung disease in children and adults with PCD by a modified Brody composite HRCT scan score to assess the prevalence of the structural abnormalities; to evaluate the correlation among HRCT scan scores, spirometry findings, and clinical data; and to compare the PCD scores with those of age-matched and sex-matched cystic fibrosis (CF) patients. PATIENTS AND METHODS Twenty PCD patients (age range, 4.6 to 27.5 years) underwent HRCT scanning, spirometry, and deep throat or sputum culture. A modified Brody score was used to assess bronchiectasis, mucous plugging, peribronchial thickening, parenchyma abnormalities, and mosaic perfusion. RESULTS The total HRCT scan score was 6% of the maximal score (range, 0.5 to 25.5). Subscores were as follows: bronchiectasis, 5.6%; mucous plugging, 5.6%; peribronchial thickening, 8.3%; parenchyma, 3%; and mosaic perfusion, 0%. The prevalence of lung changes were as follows: bronchiectasis, 80%; peribronchial thickening, 80%; mucous plugging, 75%; parenchyma, 65%; and mosaic perfusion, 45%. Sixteen of 19 PCD patients had positive culture findings, and the most common pathogen found was Haemophilus influenzae (84%). The total HRCT scan score was significantly related to age (p = 0.006), FEV(1) (p = 0.02), and FVC (p = 0.02). The bronchiectasis subscore was significantly related to FEV(1) (p = 0.04) and FVC (p = 0.03). In CF patients, the total HRCT scan score was significantly higher than that in PCD patients (p = 0.02). CONCLUSIONS PCD patients show significantly lower pulmonary HRCT scan scores than CF patients. The PCD total and bronchiectasis scores correlate with spirometry findings. The PCD HRCT scan score might be used for longitudinal assessment and/or represent an outcome surrogate in future studies.
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Affiliation(s)
| | - Silvia Montella
- Department of Pediatrics, Federico II University, Naples, Italy
| | - Harm A W M Tiddens
- Department of Diagnostic Imaging, Radiology Service, AORN Antonio Cardarelli, Naples, Italy
| | - Guido Guidi
- Department of Diagnostic Imaging, Radiology Service, AORN Antonio Cardarelli, Naples, Italy
| | - Valeria Casotti
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Marco Maglione
- Department of Pediatrics, Federico II University, Naples, Italy
| | - Pim A de Jong
- Department of Pediatric Pulmonology and Allergology, Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.
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Oikonomou A, Tsanakas J, Hatziagorou E, Kirvassilis F, Efremidis S, Prassopoulos P. High resolution computed tomography of the chest in cystic fibrosis (CF): is simplification of scoring systems feasible? Eur Radiol 2008; 18:538-47. [DOI: 10.1007/s00330-007-0810-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Revised: 09/28/2007] [Accepted: 10/17/2007] [Indexed: 11/25/2022]
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Abstract
Early and aggressive therapy already at the stage when no apparent signs of significant lung disease are detectable, may delay the development and progression of cystic fibrosis (CF). Identification of markers for early pulmonary disease in CF is crucial to monitor adherence to preventive therapy and determine its success. Currently several surrogate markers are available that are used in both the decision making and evaluation of the timing and success of early intervention namely, pulmonary function tests (PFT), microbial cultures, imaging techniques, inflammatory markers, serological markers, and several general signs such as exacerbation rate and nutritional status. This review will present the current status and discuss the significance of their application as well as their limitations for patients with CF and no apparent pulmonary disease.
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Affiliation(s)
- Giora Weiser
- Department of Pediatrics and Cystic Fibrosis Center, Hadassah-Hebrew University Medical Center, Mount Scopus, Jerusalem, Israel
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Cortese G, Malfitana V, Placido R, Ferrari A, Grosso B, De Rose V, Nespoli P, Fava C. Role of chest radiography in the diagnosis of allergic bronchopulmonary aspergillosis in adult patients with cystic fibrosis. Radiol Med 2007; 112:626-36. [PMID: 17657421 DOI: 10.1007/s11547-007-0169-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 10/26/2006] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to verify the usefulness of chest radiography in the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in adult patients with cystic fibrosis. MATERIALS AND METHODS Eleven patients (with a total of 14 episodes) affected by ABPA were selected from among subjects attending a Regional Cystic Fibrosis Centre. For each episode, we retrospectively reviewed the baseline chest radiographs obtained before the diagnosis of ABPA, those obtained during the course of ABPA and those obtained during follow-up. Radiographs were assessed for the presence of bronchial wall thickening, bronchiectasis, infiltrates, atelectasis, mucoid impaction, lymphadenopathy, pleural effusion and fluid levels. Radiographic findings that had appeared at the time of ABPA diagnosis and disappeared after treatment were considered related to ABPA and thus useful for a correct diagnosis of the disease. Chest radiograph abnormalities were compared with changes on the respiratory function tests [forced expiratory volume in 1 s (FEV1)] during the different stages of the disease. RESULTS Radiographic findings at the time of ABPA diagnosis appeared to have deteriorated in 8/14 cases when compared with the baseline films; after treatment, the radiographic findings deteriorated in 6/14 cases and improved in 6/14. The most significant among the radiographic signs considered (infiltrates and mucoid impaction) appeared at the time of ABPA diagnosis in 7/14 and 4/14 cases, respectively, and in some patients, they were also present at baseline and persisted during follow-up. FEV1 values were significantly decreased (>10%) in 9/14 cases at the time of ABPA diagnosis. CONCLUSIONS Our results demonstrate the limited usefulness of chest radiography in the diagnosis of ABPA in patients with cystic fibrosis. The most significant abnormalities are nonspecific and commonly seen on baseline films in cystic fibrosis without ABPA and persist after treatment in most cases.
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Affiliation(s)
- G Cortese
- Servizio di Radiologia, Ospedale degli Infermi, Via Caraccio 5, I-13900 Biella, Italy
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Abstract
In the last 2 decades significant strides have been made in the application of chest imaging modalities to assess cystic fibrosis (CF) lung disease. This article covers current chest imaging modalities. It discusses CT, the research modality most commonly used to assess lung disease in CF, new insights regarding CF lung disease, and future directions in research and clinical care.
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Affiliation(s)
- Terry E Robinson
- Department of Pediatrics, Center of Excellence in Pulmonary Biology (Pulmonary Division), Stanford University Medical Center, 770 Welch Road,Palo Alto, CA 94304-5715, USA.
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Davis SD, Fordham LA, Brody AS, Noah TL, Retsch-Bogart GZ, Qaqish BF, Yankaskas BC, Johnson RC, Leigh MW. Computed Tomography Reflects Lower Airway Inflammation and Tracks Changes in Early Cystic Fibrosis. Am J Respir Crit Care Med 2007; 175:943-50. [PMID: 17303797 DOI: 10.1164/rccm.200603-343oc] [Citation(s) in RCA: 140] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Detecting and tracking early cystic fibrosis (CF) lung disease are difficult due to lack of sensitive markers of airway dysfunction. OBJECTIVES The goals were to detect regional distribution of airway disease through high-resolution computed tomography, correlate abnormalities to lower airway inflammation/infection, and compare computed tomography findings before and after intravenous antibiotic therapy in children with CF younger than 4 years experiencing a pulmonary exacerbation. METHODS High-resolution computed tomography was performed in 17 children scheduled for bronchoscopy. The radiologist identified the lobes with the "greatest" and "least" disease based on computed tomography, and bronchoalveolar lavage was performed in these areas. In 13 subjects, imaging was repeated after antibiotic completion. Modified Brody scores were assigned by two radiologists. MEASUREMENTS AND MAIN RESULTS The lobe with greatest disease was predominantly localized to the right and had higher modified Brody scores, indicating more severe abnormalities (p < 0.01), compared with the lobe with least disease. The total modified Brody score (p < 0.01), hyperinflation subscore (p < 0.01), and bronchial dilatation/bronchiectasis subscore (p < 0.01) improved after antibiotics and intensified airway clearance. Interleukin-8 levels (p < 0.01) and % neutrophils (p = 0.04) were increased in the lobe with greatest disease compared with the lobe with least disease. CONCLUSIONS These results indicate that, in young children with CF experiencing a pulmonary exacerbation, computed tomography detects regional differences in airway inflammation, may be a sensitive outcome to evaluate therapeutic interventions, and identifies early lung disease as being more prominent on the right.
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Abstract
Computed tomography (CT) has two potential roles in the evaluation of patients with cystic fibrosis (CF) lung disease: as a diagnostic test primarily for the detection of supervening complications and as a monitoring tool in clinical research. Interest in the latter role has gained momentum in the last 5 years because of two factors: (1) therapeutic options for CF lung disease are developing rapidly, hence the need for an outcome measure that can be applied in clinical intervention trials; and (2) it has become clear that traditional outcome measures such as pulmonary function tests are relatively insensitive to the early structural damage that occurs in CF. Several recent studies have shown that CT can be used as a potential surrogate outcome measure, although its suitability for this specific role is controversial and still under investigation. This review summarises current concepts relating to the research applications of CT in CF, with particular emphasis on the evidence supporting the use of CT as a surrogate outcome measure in clinical trials.
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Affiliation(s)
- Z A Aziz
- Department of Radiology, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK
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McCormick J, Conway SP, Mehta A. Paediatric Northern Score centile charts for the chest radiograph in cystic fibrosis. Clin Radiol 2007; 62:78-81. [PMID: 17145268 DOI: 10.1016/j.crad.2006.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2006] [Revised: 08/29/2006] [Accepted: 09/10/2006] [Indexed: 11/21/2022]
Abstract
AIM To create the first national centile charts for the chest radiograph Northern Score using the UK Cystic Fibrosis (CF) Database (UKCFD). MATERIALS AND METHODS All active patients for 2002 from the UKCFD were analysed in 1-year cohorts from 0 to 18 years. Northern Score results from the annual review forms were used to construct centile lines for the 5th, 25th, 50th, 75th, 95th centiles. RESULTS There were 1806 patients with recorded Northern Score data for 2002 (927 male patients, male:female ratio 1.05). The centile chart demonstrates a quasi-linear rise throughout childhood. A Northern Score in excess of age in years equates to >95th centile in school-aged CF patients. CONCLUSION This centile chart provides a disease-specific reference range for monitoring individual patients or for evaluating therapeutic change using the dominant chest radiograph scoring system in the UK. Patients, parents and clinicians may find these useful during the annual review process.
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Affiliation(s)
- J McCormick
- Respiratory Unit, Royal Hospital for Sick Children, Yorkhill NHS Trust, Glasgow, UK.
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Montaudon M, Berger P, Cangini-Sacher A, de Dietrich G, Tunon-de-Lara JM, Marthan R, Laurent F. Bronchial measurement with three-dimensional quantitative thin-section CT in patients with cystic fibrosis. Radiology 2006; 242:573-81. [PMID: 17179399 DOI: 10.1148/radiol.2422060030] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively compare bronchial measurements obtained with three-dimensional quantitative thin-section computed tomography (CT) with those obtained with thin-section CT scores in the assessment of the severity of pulmonary cystic fibrosis (CF). MATERIALS AND METHODS Ethics committee approval was obtained. Sixteen patients with CF (mean age, 26.6 years; range, 18-42 years) and five healthy volunteers (mean age, 27.4 years; range, 21-44 years) gave written informed consent, underwent multi-detector row CT and a pulmonary function test (PFT), and were divided into three groups: group A, healthy volunteers; group B, patients with mild CF (forced expiratory volume in 1 second [FEV(1)] > 80%); and group C, patients with severe CF (FEV(1) < 80%). Two observers obtained thin-section CT scores with eight scoring systems. Bronchial cross-sectional wall area (WA), lumen area (LA), airway area, and wall thickness (WT) were measured with customized software and were normalized on the basis of subject body surface. Morphologic characteristics, PFT results, thin-section CT scores, and quantitative measurements were compared among the three groups with analysis of variance. Correlations among bronchial measurements, PFT results, and CT scores were calculated with the Spearman correlation coefficient. RESULTS Thin-section CT scores were different between group C and either group A or group B (P < .05). WA and WT were significantly different among all groups (P < .05). Interscore correlations and correlations between bronchial parameters and scores were high (r > 0.89, P < .0001). Scores, WA, and WT were significantly correlated with PFT obstructive indexes (P < .047). CONCLUSION WA and WT assessed with dedicated software on multi-detector row CT images allow evaluation of the severity of pulmonary CF.
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Affiliation(s)
- Michel Montaudon
- Laboratory of Cellular Respiratory Physiology, Université Bordeaux 2, Bordeaux, France
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Judge EP, Dodd JD, Masterson JB, Gallagher CG. Pulmonary abnormalities on high-resolution CT demonstrate more rapid decline than FEV1 in adults with cystic fibrosis. Chest 2006; 130:1424-32. [PMID: 17099020 DOI: 10.1378/chest.130.5.1424] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND FEV1 may remain stable while high-resolution CT (HRCT) appearances deteriorate in children with cystic fibrosis (CF). However, spirometry results commonly decline in older age groups. OBJECTIVES To compare the rate of decline in HRCT abnormalities and spirometry results over time in an adult cohort with CF. METHODS The HRCT scans of 39 consecutive patients (19 males and 20 females; mean age, 22 years; range, 16 to 48 years) with two HRCT scans > 18 months apart were randomly and blindly scored using a modified Bhalla scoring system by two independent chest radiologists. Age, body mass index, spirometry, and sputum cultures were recorded at the time of both HRCTs. Rates of change in clinical parameters and HRCT abnormalities were calculated and compared using repeated-measures analysis of variance. RESULTS Mean FEV1 declined at a rate of - 2.3% per year, while mean HRCT total score declined at a rate of -2.7% per year. Several individual HRCT abnormalities as well as HRCT total scores declined significantly faster than FEV1 (p < 0.001). Six patients showed stable spirometry results but worsening HRCT scores. Mucus plugging and extent of bronchiectasis deteriorated at a more rapid rate in the group with mildly impaired lung function. Air trapping, collapse/consolidation, peribronchial thickening, severity of bronchiectasis, and generations of bronchial divisions involved deteriorated at a more rapid rate in the group with moderate-to-severely impaired lung function. CONCLUSIONS Adult CF patients have more rapid rates of decline in HRCT abnormalities than in spirometry results. Individual HRCT abnormalities decline at different rates depending on the degree of lung function impairment.
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Affiliation(s)
- Eoin P Judge
- Department of Respiratory Medicine, St Vincent's University Hospital, Dublin, Ireland
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Nasr SZ, Gordon D, Sakmar E, Yu X, Christodoulou E, Eckhardt BP, Strouse PJ. High resolution computerized tomography of the chest and pulmonary function testing in evaluating the effect of tobramycin solution for inhalation in cystic fibrosis patients. Pediatr Pulmonol 2006; 41:1129-37. [PMID: 17068818 DOI: 10.1002/ppul.20447] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To evaluate the sensitivity of high-resolution computerized tomography (HRCT) of the chest compared to spirometry measures in evaluating the effects of tobramycin solution for inhalation (TSI) in cystic fibrosis (CF) patients.Thirty-two subjects >/=6 years old with mild to moderate CF lung disease were enrolled in a randomized, double-blind, placebo-controlled pilot study. Duration was 28 days; 31 subjects completed the study.HRCT scores decreased 4.06 +/- 3.20 (mean +/- SD) for TSI and decreased 0.17 +/- 1.78 for placebo subjects (P = 0.13). Mean forced expiratory flow during middle half of forced vital capacity (FEF(25%-75%)) predicted increased 6.08 +/- 4.86 for TSI and decreased 0.60 +/- 2.34 for placebo (P = 0.23). Percentage forced expiratory volume in 1 s (FEV(1)) predicted increased slightly for both TSI and placebo (1.29 +/- 3.33 for TSI and 1.17 +/- 1.4 for placebo) (P = 0.97). Two of eight HRCT component scores (atelectasis and inhomogeneity) were observed to be highly discordant with observed HRCT global total score and other HRCT component scores. A modified total score was calculated by dropping them from the global total score. The modified HRCT total scores decreased 6.68 +/- 3.09 for TSI subjects and increased 0.02 +/- 2.0 for the placebo subjects (P = 0.07). Sample sizes were calculated to show statistical significance by differences in modified total HRCT scores, global total HRCT scores, FEF(25%-75%) predicted or FEV(1) % predicted. A total of 60, 100, 200, and over 800 patients would be necessary respectively.HRCT can be a useful measure of change in CF pulmonary disease, requiring a smaller sample size than that required to show treatment effect by pulmonary function testing (PFT) alone.
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Affiliation(s)
- Samya Z Nasr
- Department of Pediatrics, Division of Pediatric Pulmonology, University of Michigan Health System, Ann Arbor, Michigan, USA.
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Aukland SM, Halvorsen T, Fosse KR, Daltveit AK, Rosendahl K. High-resolution CT of the chest in children and young adults who were born prematurely: findings in a population-based study. AJR Am J Roentgenol 2006; 187:1012-8. [PMID: 16985150 DOI: 10.2214/ajr.05.0383] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to use a scoring system for high-resolution CT in the evaluation of radiologic findings in young people born extremely preterm and to examine the reproducibility of this scoring system. SUBJECTS AND METHODS High-resolution CT of the lungs was assessed in 72 children born at a gestational age of < or = 28 weeks or with a birth weight of < or = 1,000 g within a defined region in western Norway in 1982-1985 (n = 40) or in 1991-1992 (n = 32). All images were analyzed by two pediatric radiologists using a scoring system in which a total of 14 features were assessed. RESULTS Sixty-three (88%) of the subjects had abnormal findings, the most common being linear opacities (n = 52), triangular opacities (n = 42), air trapping (n = 19), and mosaic perfusion (n = 10). Right and left lungs were equally affected. There were fewer abnormalities in the younger age group (born in 1991-1992). Intraobserver agreement and interobserver agreement were moderate (weighted kappa = 0.54 and kappa = 0.52, respectively). Fifty-six of the 72 children had a clinical diagnosis of bronchopulmonary dysplasia, and the median total score and the median scores of the four most common findings were higher in the bronchopulmonary dysplasia group; however, the differences were not statistically significant. CONCLUSION High-resolution CT in young people of preterm birth revealed abnormal radiologic findings in 81.3% of the patients at age 10 years and 92.5% at age 18 years. Linear, triangular, and subpleural opacities were the most common. The reproducibility of the applied scoring system was acceptable.
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Affiliation(s)
- Stein Magnus Aukland
- Department of Radiology, Section of Paediatrics, Haukeland University Hospital, 5021 Bergen, Norway.
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Santamaria F, Montella S, Camera L, Palumbo C, Greco L, Boner AL. Lung structure abnormalities, but normal lung function in pediatric bronchiectasis. Chest 2006; 130:480-6. [PMID: 16899848 DOI: 10.1378/chest.130.2.480] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Bronchiectasis is not considered to be uncommon in children anymore. The relationship between pulmonary function and severity of bronchiectasis is still controversial. STUDY OBJECTIVES To assess the extent and severity of bronchiectasis through high-resolution CT (HRCT) scan score, and to correlate it with clinical, microbiological, and functional data. PATIENTS AND METHODS Forty-three white children with HRCT-diagnosed bronchiectasis were studied. Bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity were evaluated using the Reiff score. Clinical, microbiological, and spirometry results were related to total HRCT scan score and to subscores as well. RESULTS The percentages of affected lobes were as follows: right lower lobe, 65%; middle lobe, 56%; left lower lobe, 51%; right upper lobe, 37%; lingula, 30%; and left upper lobe, 30% (chi(2) = 18.4; p = 0.002). The mean (+/- SEM) HRCT score was 20 +/- 2.6. Total score or subscores of bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity were not significantly related to FEV(1) and FVC. Seventy-four percent of patients had asthma. The age at the onset of cough correlated with age at the time of the HRCT scan (p = 0.004) and with the presence of asthma (p = 0.01). Positive findings of deep throat or sputum cultures were found more frequently in atopic patients (p = 0.02) and asthmatic (p < 0.01) patients, and in children who were < 2 years of age at the onset of cough (p < 0.01). CONCLUSIONS Normal lung function may coexist with HRCT scan abnormalities and does not exclude damage to the bronchial structure. Pulmonary function is not an accurate method for assessing the severity of lung disease in children with bronchiectasis.
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Abstract
Cystic fibrosis (CF) patients demonstrate lung inflammation and infection beginning early in life. Both inflammation and infection lead to irreversible structural lung damage, primarily as bronchiectasis and fibrosis. The course of CF varies widely between patients due to genotypic and environmental differences. The primary aim of CF therapy is to prevent or delay structural damage and conserve lung function. Adequate monitoring of CF lung disease is paramount to tailoring treatment to a patient's need. Pulmonary function tests (PFTs) are important in monitoring lung function. PFTs, however, are only an indirect measure of lung structure and are insensitive to localised or early damage. By contrast, computed tomography (CT) is currently the most sensitive tool to monitor lung structure. As up to 50% of patients will have discordant staging of lung disease when PFTs are compared to CT findings, both methods are needed to adequately assess a patient's pulmonary condition and tailor the treatment strategy to the patient's needs.
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Affiliation(s)
- Harm A W M Tiddens
- Erasmus MC-Sophia, Department of Pediatric Pulmonology and Allergology, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
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Abstract
High-resolution computed tomography (HRCT) scanning of the chest should not be considered a routine clinical investigation in the management of CF. Although it demonstrates the detection of early lung damage in children with cystic fibrosis (CF), before HRCT can be considered for routine clinical use in CF it needs to be shown that the benefit from the information obtained will out-weigh potential risks. There is insufficient evidence for the benefit of HRCT for its inclusion into routine care. Moreover, in the absence of information resulting in change in management, HRCT has the potential to increase anxiety for both clinicians and families. In order to advocate for incorporating this technology into routine CF care, further support for its role in management decisions is needed.
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Affiliation(s)
- Peter Cooper
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Sydney, Australia.
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van Beek EJR, Hill C, Woodhouse N, Fichele S, Fleming S, Howe B, Bott S, Wild JM, Taylor CJ. Assessment of lung disease in children with cystic fibrosis using hyperpolarized 3-Helium MRI: comparison with Shwachman score, Chrispin-Norman score and spirometry. Eur Radiol 2006; 17:1018-24. [PMID: 16941089 DOI: 10.1007/s00330-006-0392-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Revised: 06/19/2006] [Accepted: 07/07/2006] [Indexed: 11/29/2022]
Abstract
This study assesses the feasibility of hyperpolarized 3-Helium MRI in children with cystic fibrosis (CF) and correlates the findings with standard clinical parameters based on chest radiograph (CXR) and pulmonary function tests (PFT). An uncontrolled, observational study in eighteen children with cystic fibrosis aged 5 - 17 years (median 12.1 years), with different severity of disease was carried out. All subjects underwent routine clinical assessment including PFT and standard auxology; CXR was obtained and Shwachman and Chrispin-Norman scores calculated. Hyperpolarized 3-He magnetic resonance imaging (MRI) was carried out using a spin-exchange polarizer and a whole body 1.5 T scanner. Ventilation distribution images were obtained during a 21-second breath-hold and scored according to previously defined criteria. Spearman's non-parametric correlations test was performed to assess for statistical significance at the p<0.05 level. The children tolerated the procedure well. No desaturation events were observed during 3-He MRI. A significant, albeit moderate, correlation was found between MRI score and FEV1% predicted (r=-0.41; p=0.047) and FVC% predicted (r=-0.42; p=0.04), while there were trends of correlations between Shwachman score and MRI score (r=-0.38; p=0.06) and Shwachman score and FEV1% predicted (r=0.39; p=0.055). The feasibility of hyperpolarized 3-He MRI in children with CF was demonstrated. MRI appears to be able to demonstrate functional lung changes, although correlations with routine clinical tests are only moderate to poor. This non-ionising radiation technique could be useful for monitoring lung disease and assessing therapy in this patient population.
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McMahon CJ, Dodd JD, Hill C, Woodhouse N, Wild JM, Fichele S, Gallagher CG, Skehan SJ, van Beek EJR, Masterson JB. Hyperpolarized 3helium magnetic resonance ventilation imaging of the lung in cystic fibrosis: comparison with high resolution CT and spirometry. Eur Radiol 2006; 16:2483-90. [PMID: 16871384 DOI: 10.1007/s00330-006-0311-5] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Revised: 04/20/2006] [Accepted: 04/21/2006] [Indexed: 01/08/2023]
Abstract
The purpose of this study was to compare hyperpolarized 3helium magnetic resonance imaging (3He MRI) of the lungs in adults with cystic fibrosis (CF) with high-resolution computed tomography (HRCT) and spirometry. Eight patients with stable CF prospectively underwent 3He MRI, HRCT, and spirometry within 1 week. Three-dimensional (3D) gradient-echo sequence was used during an 18-s breath-hold following inhalation of hyperpolarized 3He. Each lung was divided into six zones; 3He MRI was scored as percentage ventilation per lung zone. HRCT was scored using a modified Bhalla scoring system. Univariate (Spearman rank) and multivariate correlations were performed between 3He MRI, HRCT, and spirometry. Results are expressed as mean+/-SD (range). Spirometry is expressed as percent predicted. There were four men and four women, mean age = 31.9+/-9 (20-46). Mean forced expiratory volume in 1 s (FEV)1 = 52%+/-29 (27-93). Mean 3He MRI score = 74%+/-25 (55-100). Mean HRCT score = 48.8+/-24 (13.5-83). The correlation between 3He MRI and HRCT was strong (R = +/-0.89, p < 0.001). Bronchiectasis was the only independent predictor of 3He MRI; 3He MRI correlated better with FEV1 and forced vital capacity (FVC) (R = 0.86 and 0.93, p < 0.01, respectively) than HRCT (R = +/-0.72 and +/-0.81, p < 0.05, respectively). This study showed that 3He MRI correlates strongly with structural HRCT abnormalities and is a stronger correlate of spirometry than HRCT in CF.
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Affiliation(s)
- Colm J McMahon
- Department of Radiology, St. Vincent's University Hospital, Dublin 4, Ireland.
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Abstract
The first cystic fibrosis (CF) scoring system was published in 1958. Since then, many other scoring systems were developed. Clinical parameters, details about statistical evaluations, and recent strategic uses of scores were identified. Several similar scores aiming to assess chronic illness severity (Shwachman-Kulczycki score and a modification, Cooperman, Berneze-score and the NIH score) have not been evaluated and are out of date, given the changing natural history of CF. Of the current scoring systems, the modified Shwachman score by Doershuk is perhaps most reliable for describing follow-up studies. Scores designed for acute changes and short-term evaluation were also developed. The modified Huang score may be useful in the prognostic evaluation of patients with end-stage disease. It could also be used for discrimination of adult patients with differing disease severity and for longitudinal evaluation. Scores assessing pulmonary exacerbations could help provide consensus among clinicians regarding the need for intervention. Most of these scores require further evaluation. Although scores could provide an objective measure of disease severity, progression, need for and response to interventions, including value in selecting patients for lung transplantation and as an outcome measure for research studies, no scoring system can fulfill all these objectives. Nevertheless, there is a need for the development of a modern day longitudinal score that is sensitive, valid and reproducible, to reflect the milder disease status of patients.
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Affiliation(s)
- Gaudenz M Hafen
- Department of Respiratory Medicine, Royal Children's Hospital, Melbourne, Parkville, Victoria, Australia.
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