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Published ahead of print on February 15, 2007, doi:10.1164/rccm.200603-343OC
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American Journal of Respiratory and Critical Care Medicine Vol 175. pp. 943-950, (2007)
© 2007 American Thoracic Society
doi: 10.1164/rccm.200603-343OC

Original Article

Computed Tomography Reflects Lower Airway Inflammation and Tracks Changes in Early Cystic Fibrosis

Stephanie D. Davis1, Lynn A. Fordham2, Alan S. Brody3, Terry L. Noah1, George Z. Retsch-Bogart1, Bahjat F. Qaqish4, Bonnie C. Yankaskas2, Robin C. Johnson1 and Margaret W. Leigh1

1 Division of Pulmonology, Department of Pediatrics, and 2 Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; 3 Department of Radiology, Cincinnati Children's Hospital, Cincinnati, Ohio; and 4 Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill

Correspondence and requests for reprints should be addressed to Stephanie D. Davis, M.D., Division of Pediatric Pulmonology, 130 Mason Farm Road, Campus Box 7220, Chapel Hill, NC 27599-7220. E-mail: sddavis{at}med.unc.edu

Rationale: Detecting and tracking early cystic fibrosis (CF) lung disease are difficult due to lack of sensitive markers of airway dysfunction.

Objectives: The goals were to detect regional distribution of airway disease through high-resolution computed tomography, correlate abnormalities to lower airway inflammation/infection, and compare computed tomography findings before and after intravenous antibiotic therapy in children with CF younger than 4 years experiencing a pulmonary exacerbation.

Methods: High-resolution computed tomography was performed in 17 children scheduled for bronchoscopy. The radiologist identified the lobes with the "greatest" and "least" disease based on computed tomography, and bronchoalveolar lavage was performed in these areas. In 13 subjects, imaging was repeated after antibiotic completion. Modified Brody scores were assigned by two radiologists.

Measurements and Main Results: The lobe with greatest disease was predominantly localized to the right and had higher modified Brody scores, indicating more severe abnormalities (p < 0.01), compared with the lobe with least disease. The total modified Brody score (p < 0.01), hyperinflation subscore (p < 0.01), and bronchial dilatation/bronchiectasis subscore (p < 0.01) improved after antibiotics and intensified airway clearance. Interleukin-8 levels (p < 0.01) and % neutrophils (p = 0.04) were increased in the lobe with greatest disease compared with the lobe with least disease.

Conclusions: These results indicate that, in young children with CF experiencing a pulmonary exacerbation, computed tomography detects regional differences in airway inflammation, may be a sensitive outcome to evaluate therapeutic interventions, and identifies early lung disease as being more prominent on the right.

Key Words: infant • child • computed tomography scanners, X-ray • bronchoalveolar lavage • bronchopneumonia


AT A GLANCE COMMENTARY

Scientific Knowledge on the Subject
Detecting and tracking early cystic fibrosis lung disease are difficult. Bronchoalveolar lavage fluid in infants has identified the presence of infection and inflammation.

What This Study Adds to the Field
In young children with cystic fibrosis, computed tomography detects regional differences in airway inflammation. It may be a sensitive outcome to evaluate therapies, and identifies early lung disease as being prominent on the right side.

 



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