Published ahead of print on February 15, 2007, doi:10.1164/rccm.200603-343OC
Am. J. Respir. Crit. Care Med., Volume 175, Number 9, May 2007, 943-950
A more recent version of this article appeared on May 1, 2007
Submitted on March 8, 2006
Accepted on February 15, 2007
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 Department of Pediatrics, Division of Pulmonology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
2 Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
3 Department of Radiology, Cincinnati Children's Hospital, Cincinnati, OH, USA,
4 Department of Biostatistics, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
* To whom correspondence should be addressed. E-mail: sddavis{at}med.unc.edu.
Rationale: Detecting and tracking early cystic fibrosis lung disease is difficult due to lack of sensitive markers of airway dysfunction.
Objectives: 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 cystic fibrosis children less than 4 years old 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 to 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 to the lobe with "least" disease.
Conclusions: These results indicate that in young children with cystic fibrosis 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
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