Pulmonary Disease Assessment in Cystic Fibrosis: Comparison of CT Scoring Systems and Value of Bronchial and Arterial Dimension Measurements

Jong, Pim A. de; Ottink, Mark D; Robben, Simon G. F.; Lequin, Maarten H.; Hop, Wim C. J.; Hendriks, Johan J. E.; Paré, Peter D.; Tiddens, Harm A.W.M.

doi:10.1148/radiol.2312021393

Cited by 161 publications

(117 citation statements)

References 22 publications

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“…(1, 3,17) In parallel with the identification of the most prevalent changes, the results of the present study demonstrated that the use of a semiquantitative scoring system to detect pulmonary abnormalities on HRCT scans from patients with CF allows good overall intraobserver and interobserver agreement, demonstrating that the measurements are reproducible and reliable. We found good interobserver agreement for the total score and for three HRCT findings, namely acinar nodule, severity of bronchiectasis, and extent of bronchiectasis.…”

supporting

confidence: 57%

“…(3) Chest HRCT is an imaging method that is considered specific for early evaluation of involvement of the lung parenchyma, as well as of the proximal and distal airways (bronchial wall thickening, bronchiectasis, mucoid impaction, and lung hyperinflation). (4) Reproducible scoring systems can be used in order to quantify CT findings.…”

Section: Introductionmentioning

confidence: 99%

“…(4) Reproducible scoring systems can be used in order to quantify CT findings. (3) Some studies have reported that magnetic resonance imaging of the chest is an extremely promising imaging method for detecting pulmonary changes in patients with CF; however, a protocol for the use of this method in CF patients has yet to be established. (5) The objective of the present study was to use a CT scoring system to draw comparisons between CF patients chronically colonized with P. aeruginosa and those chronically colonized with S. aureus in terms of HRCT findings.…”

Section: Introductionmentioning

confidence: 99%

“…Other authors (3) used five different scoring systems in order to evaluate HRCT scans of the intraobserver and interobserver reliability results for each parameter in isolation and for the total score. 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, 5.0 ± 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), the difference being statistically significant (p < 0.001).…”

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confidence: 99%

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Escore tomográfico em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa ou Staphylococcus aureus

et al. 2012

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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.Keywords: Cystic fibrosis; Tomography; Staphylococcus aureus; Pseudomonas aeruginosa. ResumoObjetivo: Comparar achados de TCAR em pacientes com fibrose cística (FC) colonizados cronicamente por Pseudomonas aeruginosa ou Staphylococcus aureus, empregando o escore de Bhalla modificado, e avaliar as confiabilidades intraobservador e interobservador do método. Métodos: Estudo transversal retrospectivo incluindo 41 pacientes portadores de FC, 26 dos quais colonizados cronicamente por P. aeruginosa (grupo Pa) e 15 por S. aureus (grupo Sa). Dois radiologistas analisaram independentemente em duas ocasiões, as imagens de TCAR desses pacientes e aplicaram o escore de Bhalla modificado. As confiabilidades intra e interobservador foram avaliadas segundo o coeficiente de correlação intraclasse (CCI). Resultados: Houve boa concordância intraobservador e interobservador (CCI > 0,8). Os resultados dos escores do grupo Pa foram mais elevados que os do grupo Sa para o observador 1 (média de 13,50 ± 3,90 e mediana de 13,5 vs. média de 5,0 ± 5,28 e mediana de 3,0) e para o observador 2 (média de 11,96 ± 5,07 e mediana de 12,0 vs. média de 5,07 ± 5,65 e mediana de 5,0). Alterações tomográficas, como bronquiectasias, espessamento das paredes brônquicas, formação de tampões mucosos, comprometimento de gerações de divisões brônquicas e padrão de atenuação em mosaico, foram mais prevalentes no grupo colonizado por P. aeruginosa. Conclusões: O escore de Bhalla modificado se mostrou reprodutível e confiável p...

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supporting

confidence: 57%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Escore tomográfico em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa ou Staphylococcus aureus

et al. 2012

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“…These results are concordant with analyses from other studies in which the three most prevalent abnormalities were bronchiectasis (86-90%), peribronchial thickening (53-80%) and mucous plugging (63-79%). 11,[26][27][28] In the present study, the modified Bhalla score values demonstrated that MRSA patients showed greater structural lung damage Although the other more prevalent injuries, such as peribronchial thickening, mucous plugging and mosaic perfusion, are known to be reversible, these were also more frequent in the MRSA group.…”

Section: Discussionsupporting

confidence: 53%

Methicillin-resistant Staphylococcus aureus in cystic fibrosis patients: do we need to care? A cohort study

et al. 2017

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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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Computed tomography and magnetic resonance imaging in cystic fibrosis lung disease

Eichinger

Heußel²,

Kauczor

et al. 2010

Magnetic Resonance Imaging

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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. J. Magn. Reson. Imaging 2010;32:1370–1378. © 2010 Wiley‐Liss, Inc.

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Pulmonary Disease Assessment in Cystic Fibrosis: Comparison of CT Scoring Systems and Value of Bronchial and Arterial Dimension Measurements

Abstract: Thin-section CT scores were reproducible and were correlated with PFT results. Measurements of bronchial dimensions were not significantly related to scores or PFT results.

Cited by 161 publications

References 22 publications

Escore tomográfico em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa ou Staphylococcus aureus

Escore tomográfico em pacientes com fibrose cística colonizados por Pseudomonas aeruginosa ou Staphylococcus aureus

Methicillin-resistant Staphylococcus aureus in cystic fibrosis patients: do we need to care? A cohort study

Computed tomography and magnetic resonance imaging in cystic fibrosis lung disease

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