Robinson Terry E
Pediatric Pulmonary Division, Stanford University Medical Center, Palo Alto, California 94305-5786, USA.
Curr Opin Pulm Med. 2004 Nov;10(6):537-41. doi: 10.1097/01.mcp.0000142924.38801.45.
High-resolution CT (HRCT) imaging of the chest can provide both structural and functional lung analysis useful to evaluate initial and progressive cystic fibrosis (CF) lung disease. Chest HRCT scoring systems have been used to evaluate the extent and severity of CF specific airway and lung parenchymal disease. The purpose of this review is to summarize recent developments in HRCT and volumetric chest CT imaging, CF chest CT scoring systems, and review how HRCT/volumetric CT can provide useful outcome measures for future CF clinical research.
Early manifestation of CF lung disease determined by chest CT/HRCT imaging in CF infants and children with mild disease include regional air trapping and bronchial wall thickness. The distribution of findings in more progressed CF lung disease are heterogeneous, and there appears to be a large amount of nonhomogeneity of progressive lung pathology. Recent CF studies have used new clinical CT parameters such as quantitative air trapping, quantitative airway measurements, and a composite CT/pulmonary function test (PFT) score, which appear to be promising new outcome measures that are more sensitive than global pulmonary function measurements or total chest CT scores in discriminating early or mild CF lung disease and treatment effects during clinical interventions.
Chest HRCT and volumetric CT imaging can detect regional CF lung changes before changes in global pulmonary function measurements. Chest HRCT scoring has been used in descriptive studies defining CF lung disease severity, in longitudinal studies to define progression of disease, and in clinical intervention studies to evaluate treatment effects. In the last 2 years, CF CT research has evolved from solely using chest HRCT scoring systems to utilization of composite CT/PFT scores, quantitative airway and air trapping measurements, and the utilization of volumetric CT imaging to evaluate three-dimensional data sets in patients with CF lung disease.
胸部高分辨率CT（HRCT）成像可提供结构和功能方面的肺部分析，有助于评估初始和进展期囊性纤维化（CF）肺病。胸部HRCT评分系统已用于评估CF特异性气道和肺实质疾病的范围和严重程度。本综述的目的是总结HRCT和容积胸部CT成像、CF胸部CT评分系统的最新进展，并探讨HRCT/容积CT如何为未来CF临床研究提供有用的结局指标。
胸部CT/HRCT成像确定的CF婴儿和轻度疾病儿童CF肺病的早期表现包括局部气体潴留和支气管壁增厚。进展期CF肺病的表现分布不均，进展性肺部病理似乎存在大量的非均质性。最近的CF研究使用了新的临床CT参数，如定量气体潴留、定量气道测量以及综合CT/肺功能测试（PFT）评分，这些似乎是很有前景的新结局指标，在鉴别早期或轻度CF肺病以及临床干预期间的治疗效果方面比整体肺功能测量或胸部CT总评分更敏感。
胸部HRCT和容积CT成像可在整体肺功能测量出现变化之前检测到局部CF肺部改变。胸部HRCT评分已用于描述CF肺病严重程度的描述性研究、定义疾病进展的纵向研究以及评估治疗效果的临床干预研究。在过去两年中，CF CT研究已从单纯使用胸部HRCT评分系统发展到使用综合CT/PFT评分、定量气道和气体潴留测量，以及利用容积CT成像评估CF肺病患者的三维数据集。
