Assessment of Early Bronchiectasis in Young Children With Cystic Fibrosis Is Dependent on Lung Volume
Assessment of Early Bronchiectasis in Young Children With Cystic Fibrosis Is Dependent on Lung Volume
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DOI：
10.1378/chest.12-2589
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发表时间：
2013-10-01
期刊：
影响因子：
9.6
通讯作者：
Stick, Stephen M.
中科院分区：
文献类型：
--
作者：
Mott, Lauren S.;Graniel, Karla G.;Stick, Stephen M.
目的：本研究的目的是确定对囊性纤维化 (CF) 幼儿的早期 CT 扫描检测到的支气管扩张的评估是否取决于肺容量。方法：本研究经医院伦理委员会批准，纳入了来自新生儿筛查人群的 40 名 CF 幼儿，在临床稳定的全身麻醉下进行配对容量控制吸气和呼气容积胸部 CT 扫描。通过吸气和呼气时的半定量 CT 扫描评分来评估支气管扩张，并通过敏感性和组内相关系数分析以及 Bland-Altman 图，将呼气 CT 扫描检测支气管扩张的敏感性与吸气 CT 扫描进行比较。在 10 名儿童中获得了匹配的吸气和呼气气道血管测量值，并使用具有广义估计方程的线性回归模型检查了调整年龄和血管尺寸后肺容量和气道：血管比率之间的关系。通过 Wilcoxon 符号秩检验比较所有 40 名儿童吸气和呼气时可见气道的数量。结果：呼气扫描检测支气管扩张的敏感性较差 (0.46)，低估了疾病程度 (P < .001)。气道：吸气时血管比率始终较高，与年龄和血管大小无关 (P < .001)，与年龄无关，吸气时可见的气道明显多于呼气时可见的气道（中位数分别为 71 比 28；P < .001）。结论：对于患有 CF 的幼儿，胸部 CT 扫描对早期支气管扩张的放射学评估取决于肺容量；因此，呼气扫描可能不适合评估该人群的支气管扩张。 CT 图像采集期间的肺体积应标准化，以评估幼儿的气道尺寸。
Objective: The aim of this study was to determine whether assessment of early CT scan-detected bronchiectasis in young children with cystic fibrosis (CF) depends on lung volume.Methods: This study, approved by the hospital ethics committee, included 40 young children with CF from a newborn screened population contributing paired volume-controlled inspiratory and expiratory volumetric chest CT scans acquired under general anesthesia while clinically stable. Bronchiectasis was assessed with a semiquantitative CT scan score in inspiration and expiration, and the sensitivity of the expiratory CT scan to detect bronchiectasis was compared with the inspiratory CT scan by sensitivity and intraclass correlation coefficient analysis and Bland-Altman plots. Matched inspiratory and expiratory airway-vessel measurements were obtained in a subset of 10 children, and the relationship between lung volume and airway: vessel ratio after adjusting for age and vessel size was examined with the use of a linear regression model with generalized estimating equations. The number of visible airways in inspiration and expiration was compared in all 40 children by Wilcoxon signed rank test.Results: Expiratory scans had poor sensitivity (0.46) to detect bronchiectasis, underestimating disease extent (P < .001). Airway: vessel ratios were consistently higher in inspiration, independent of age and vessel size (P < .001), with significantly more airways visible in inspiration than in expiration, independent of age (median, 71 vs 28, respectively; P < .001).Conclusions: In young children with CF, radiologic assessment of early bronchiectasis with chest CT scan depends on lung volume; thus, expiratory scans may not be appropriate for evaluating bronchiectasis in this population. Lung volume during CT image acquisition should be standardized to evaluate airway dimensions in young children.