Santamaria F, Grillo G, Guidi G, Rotondo A, Raia V, de Ritis G, Sarnelli P, Caterino M, Greco L
Department of Pediatrics, Federico II University, Naples, Italy.
Pediatrics. 1998 May;101(5):908-13. doi: 10.1542/peds.101.5.908.
To provide indications for high-resolution computed tomography (HRCT) of the chest in patients with cystic fibrosis (CF).
We compared the HRCT and conventional chest radiography (CCR) scores and assessed their correlation with clinical scores and pulmonary function tests.
Department of Pediatrics, Federico II University, Naples, Italy.
A total of 30 patients with CF 6.75 to 24 years of age.
CCR scores correlated highly with HRCT (r = -0.8) and clinical (r = 0.5) scores, whereas total HRCT scores were not related to clinical scores. Of all the specific HRCT findings, only bronchiectasis appeared related significantly to the clinical score (r = 0.6). Most pulmonary function tests were related to CCR and total HRCT scores, but not to HRCT scoring of specific changes. Forced vital capacity and CCR scores appeared the best predictors of the HRCT score (multiple R = 0.58 and 0.79, respectively). In patients with mild lung disease, HRCT detected bronchiectasis and air trapping in 57% and 71% of the cases, respectively. In patients with more abnormal chest radiographs, bronchiectasis and air trapping were demonstrated on HRCT in all cases.
These findings suggest that HRCT of the chest is most useful in the identification of early lung abnormalities in patients with CF with mild respiratory symptoms, whereas for established disease, CCR is still the first-line imaging technique. The advantage of detecting early changes on CT imaging awaits additional confirmation, at least until early therapeutic interventions affecting significantly the final outcome of the disease are demonstrated. In patients with advanced disease, HRCT may be useful in the evaluation of specific lung changes when more aggressive treatment such as chest surgical interventions is indicated. Given the cost of the procedure and the high radiation dosage compared with CCR, a careful assessment of the cost:benefit ratios of HRCT is strongly recommended in CF.
为囊性纤维化（CF）患者的胸部高分辨率计算机断层扫描（HRCT）提供指征。
我们比较了HRCT和传统胸部X线摄影（CCR）评分，并评估了它们与临床评分及肺功能测试的相关性。
意大利那不勒斯费德里科二世大学儿科学系。
共30例年龄在6.75至24岁的CF患者。
CCR评分与HRCT（r = -0.8）和临床（r = 0.5）评分高度相关，而HRCT总分与临床评分无关。在所有特定的HRCT表现中，只有支气管扩张与临床评分显著相关（r = 0.6）。大多数肺功能测试与CCR和HRCT总分相关，但与HRCT特定改变的评分无关。用力肺活量和CCR评分似乎是HRCT评分的最佳预测指标（复相关系数分别为0.58和0.79）。在轻度肺部疾病患者中，HRCT分别在57%和71%的病例中检测到支气管扩张和空气潴留。在胸部X线片更异常的患者中，HRCT在所有病例中均显示出支气管扩张和空气潴留。
这些发现表明，胸部HRCT在识别有轻度呼吸道症状的CF患者早期肺部异常方面最有用，而对于已确诊的疾病，CCR仍是一线成像技术。在CT成像上检测早期变化的优势有待进一步证实，至少在证明有显著影响疾病最终结局的早期治疗干预措施之前是这样。在晚期疾病患者中，当需要进行更积极的治疗（如胸部手术干预）时，HRCT可能有助于评估特定的肺部改变。鉴于该检查的成本以及与CCR相比的高辐射剂量，强烈建议在CF患者中仔细评估HRCT的成本效益比。
