Reproducibility of a Scoring System for Computed Tomography Scanning in Cystic Fibrosis

Brody, Alan S.; Kosorok, Michael R.; Li, Zhanhai; Broderick, Lynn S.; Foster, Jeffrey L.; Laxova, Anita; Bandla, Hari; Farrell, Philip M.

doi:10.1097/01.rti.0000203937.82276.ce

Cited by 167 publications

(145 citation statements)

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“…Typically, bronchiectasis is expected on chest CT, but a pattern of mosaic attenuation is also common in adolescents and young adults with CF (23); it is observed in almost two-thirds of patients (60). Using the established Brody CT scoring system (20), we confirmed the presence of bronchiectasis, centrilobular nodularity, and mosaic attenuation in these patients, consistent with the pathologic findings. The overlap in Brody score between these biopsy subjects and the CF control subjects suggests that many of these histologic processes and radiographic findings may be applicable to a wider spectrum of patients with moderate to severe pulmonary dysfunction.…”

Section: Discussionsupporting

confidence: 70%

“…Mean total Brody score was 47.5 (range, 17-78), with a bronchiectasis subscore of 19.1 (range, 5-40) and a total hyperinflation subscore of 17.0 (range, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. The mean hyperinflation score of the biopsied lobe was 3.0 (range, 2-4.5).…”

Section: Radiographic Imagingmentioning

confidence: 99%

“…The imaging record was reviewed (A.S.B. ), and CT scans were scored using the Brody CT scoring scale, as described previously (20). In brief, the Brody scoring system records the extent and severity of seven features of CF lung disease in each lobe (20)(21)(22)(23).…”

Section: Ct Technique and Imaging Reviewmentioning

confidence: 99%

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Constrictive Bronchiolitis in Cystic Fibrosis Adolescents with Refractory Pulmonary Decline

et al. 2016

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Rationale: Refractory lung function decline in association with recurrent pulmonary exacerbations is a common, yet poorly explained finding in cystic fibrosis (CF). To investigate the histopathologic mechanisms of pulmonary deterioration during adolescence and early adulthood, we reviewed clinicallyindicated lung biopsy specimens obtained during a period of persistent decline.Objectives: To determine if peribronchiolar remodeling is prominent in lung biopsy specimens obtained in adolescents with CF refractory to conventional therapy.Methods: Six adolescents with CF (mean age, 16.2 y; mean FEV 1 , 52% predicted at biopsy) with significant pulmonary deterioration over 12-24 months (mean FEV 1 decline of 14% predicted/year) despite aggressive intervention underwent computed tomography imaging and ultimately lung biopsy to aid clinical management. In addition to routine clinical evaluation, histopathologic investigation included staining for transforming growth factor-b (TGF-b, a genetic modifier of CF lung disease), collagen deposition (a marker of fibrosis), elastin (to evaluate for bronchiectasis), and a-smooth muscle actin (to identify myofibroblasts).

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Section: Discussionsupporting

confidence: 70%

Section: Radiographic Imagingmentioning

confidence: 99%

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Constrictive Bronchiolitis in Cystic Fibrosis Adolescents with Refractory Pulmonary Decline

et al. 2016

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“…A modification of the Bhalla score for structural lung alteration in CF has previously been applied in an adult population [2]. Brody and co-workers have developed a scoring system for HRCT scans obtained in both inspiration and expiration in children suffering from CF [13], which demonstrates both high reproducibility and accuracy [12,14]. Since many CF patients live through adulthood, it appears necessary for optimal radiological patient management to extend CT scoring systems for children with CF to include adults with CF-associated lung disease [15] who underwent LDCT in inspiration.…”

mentioning

confidence: 99%

“…We also assessed the longterm (at least two years) reproducibility of the Brody score in an attending radiologist with 10 years of post-fellowship chest radiology experience, since time intervals between follow-up CT scans of the chest in CF patients are often in the range of several years [2,6]. It has previously been established that the shortterm reproducibility of the Brody score is high among experienced chest radiologists [12,14]. We hypothesized that the intra-observer reproducibility of the Brody score and its different subscores in adult patients with CF who undergo LDCT of the chest in inspiration would be within +/-10 % of the average score, both with a short time interval of 28 -60 days for second-year radiology residents and with a long time interval of at least 2 years for an attending radiologist.…”

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Cystic Fibrosis in Adults: Short-Term and Long-Term Reproducibility of the Brody Score for Lung Morphology in Low-Dose MDCT Scans

Weber¹,

Paolini²,

Schmitz³

et al. 2013

Fortschr Röntgenstr

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Ziel: Auswertungen des semiquantitativen BrodyScore quantifizieren das Ausmaß CF-bedingter Lungenschädigung. Die Studie untersuchte die Kurz-(KZI, 28 -60 Tage) und Langzeit-(LZI, 2 -7 Jahre), Intra-und Inter-Betrachter-Reproduzierbarkeit des Brody-Scores und seiner Subscores (Bronchiektasen, peribronchiale Zeichnungsvermehrung, Mucusplugging, Gewebekonsolidierung und Überblähung) anhand von Niedrig-Dosis-Multidetektor-CT-Aufnahmen in Inspiration (LDCT) von 15 erwachsenen CF-Patienten. Material und Methoden: Die Niedrig-Dosis-Multidetektor-CT-Aufnahmen (Schichtdicke 1,5 und 3 mm, 120 kV, mAS/Schicht 10 -15, effektive Dosis 0,5 mSv, CDTi 1,0 Gy/Patient) von 15 Patienten (8 weiblich, 7 männlich, Altersspanne 18 -50 Jahre, durchschnittliches Alter 33 J.) mit pulmonaler Manifestation bei CF wurden bzgl. des BrodyScore und seiner Subscores (Bronchiektasen, peribronchiale Zeichnungsvermehrung, Schleimverlegung, Gewebekonsolidierung, Überblähung) von 3 unabhängigen Radiologen (1 -20 Jahre Berufserfahrung) jeweils zweimal ausgewertet (Zeitintervall zwischen den Auswertungen, 1 -84 Monate). Ergebnisse: Die durchschnittliche Inter-Betrachter-Reproduzierbarkeit des Brody-Score betrug +/-7 % (2 -30 %). Die Intra-Betrachter-Reproduzierbarkeit lag bei +/-6 % (3 -12 %) (KZI, 4 %, 0 -12 %, LZI, 12 %, 1 -36 %). Für die Subscores betrug die Inter-Betrachter-Reproduzierbarkeit durchschnittlich +/-25 % (15 -41 %), die Intra-Betrachter-Reproduzierbarkeit +/-23 % (12 -46 %). Schlussfolgerung: Der Brody-Score zeigt eine hohe Inter-Betrachter-Reproduzierbarkeit bei LDCTs erwachsener CF-Patienten sowie eine gute IntraBetrachter-Reproduzierbarkeit im KZI erfolgen, welche jedoch im LZI sinkt. Im Vergleich zum Gesamtscore zeigen die Subscores durchschnittlich eine geringere Inter-und Intra-Betrachter-Reproduzierbarkeit. Abstract ! Purpose:The semi-quantitative Brody score measures the severity of cystic fibrosis (CF)-related lung disease. We investigated the short-term (28 -60 days) and long-term (2 -7 years) intraand inter-observer reproducibility of the Brody score in low-dose multidetector row computed tomography examinations performed in inspiration (LDCTs) of adult CF patients. Materials and Methods: Composite Brody scores and respective underlying bronchiectasis, mucus plugging, peribronchial thickening, parenchymal opacity, and hyperinflation subscores were evaluated twice (time interval, 1 -84 months) by each of 3 independent radiologists (1 -20 years of professional diagnostic radiology experience) in LDCTs (4 -64 rows, 120 KVp, 10 -15 mAs/slice, CTDIw approx. 1.0 mGy, effective dose approx. 0.5 mSv) of 15 adult patients with CF-related lung disease (8 female, 7 male, age, 18 -50 years, mean, 33 years). Results: The average reproducibility of the Brody score was within +/-7 % (range, 2 -30 %) between radiologists, and +/-6 % (3 -12 %) within radiologists (short-term, 28 -60 days, 4 %, 0 -12 %, longterm, 2 -7 years, 12 %, 1 -36 %). For the different subscores, the reproducibility was within +/-25 % (15 -41 %) between radiologists an...

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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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Reproducibility of a Scoring System for Computed Tomography Scanning in Cystic Fibrosis

Cited by 167 publications

References 15 publications

Constrictive Bronchiolitis in Cystic Fibrosis Adolescents with Refractory Pulmonary Decline

Constrictive Bronchiolitis in Cystic Fibrosis Adolescents with Refractory Pulmonary Decline

Cystic Fibrosis in Adults: Short-Term and Long-Term Reproducibility of the Brody Score for Lung Morphology in Low-Dose MDCT Scans

Computed tomography and magnetic resonance imaging in cystic fibrosis lung disease

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