de Jong Pim A, Tiddens Harm A W M
Department of Pediatric Pulmonology and Allergology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.
Proc Am Thorac Soc. 2007 Aug 1;4(4):338-42. doi: 10.1513/pats.200611-175HT.
This article presents a review and discussion of the current knowledge regarding cystic fibrosis (CF)-specific scoring of chest computed tomography (CT) scans. First, the basic principles of CT scoring systems in CF are described. Second, between- and within-observer variability of a composite CT score and of component CT scores are reviewed, and issues regarding training of CT scan readers discussed. Third, arguments regarding whether CT scoring systems are ready to be used in clinical studies as a surrogate endpoint are summarized. The between- and within-observer variability of the present CT composite scoring systems is low enough to be useful for clinical studies, although the variability for some of the component scores is larger than for others. Scoring systems fulfill the requirements for surrogate endpoints for CF lung disease, but this role could be further strengthened by including CT scans in large trials and demonstrating the correlation with true endpoints. The conclusion presented is that, given the experience of the variety of published scoring systems, it is important to develop a consensus CT scoring system for future studies in CF. Such a scoring system should evaluate all lung lobes individually and include all relevant CT findings in CF. Development of reference images for the components of this system will be important in reducing the variability between observers and to train new readers.
本文对目前关于囊性纤维化（CF）胸部计算机断层扫描（CT）特异性评分的知识进行了综述和讨论。首先，描述了CF中CT评分系统的基本原理。其次，回顾了复合CT评分和各组成CT评分在观察者间和观察者内的变异性，并讨论了CT扫描阅片者培训的相关问题。第三，总结了关于CT评分系统是否已准备好作为替代终点用于临床研究的相关论点。目前的CT复合评分系统在观察者间和观察者内的变异性足够低，可用于临床研究，尽管某些组成评分的变异性比其他评分更大。评分系统满足CF肺部疾病替代终点的要求，但通过将CT扫描纳入大型试验并证明其与真实终点的相关性，这一作用可得到进一步加强。得出的结论是，鉴于已发表的各种评分系统的经验，为CF未来研究开发一个共识性CT评分系统很重要。这样的评分系统应分别评估所有肺叶，并纳入CF中所有相关的CT表现。为该系统的各组成部分开发参考图像对于减少观察者间的变异性以及培训新阅片者将很重要。
