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Application of chest high-resolution computer tomography in young children with cystic fibrosis
J M Marchant1, J P Masel, F L Dickinson
1Department of Respiratory Medicine, Mater Children's Hospital, South Brisbane, Queensland, Australia.
Insights
The Bhalla scoring system better correlates with lung function in young children with cystic fibrosis (CF) compared to the Nathanson score. This study suggests lower lobe involvement is more common in pediatric CF lung disease.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Medical Imaging
Background:
- High-resolution computed tomography (HRCT) is crucial for early detection of lung disease in cystic fibrosis (CF).
- Established scoring systems like Bhalla and Nathanson describe CF lung disease, but their comparative utility in young children is unclear.
- Objective markers for CF lung disease are limited in children under 12 years old.
Purpose of the Study:
- To compare the Bhalla and Nathanson scoring systems for describing CF lung disease in children under 12 years.
- To determine which scoring system better correlates with pulmonary function tests (PFTs) in this pediatric cohort.
- To characterize the distribution of lung disease in young children with CF.
Main Methods:
- Retrospective review of clinical data, PFTs, and HRCT scans from 16 children under 12 years with CF.
- Application and comparison of the Bhalla and Nathanson scoring systems to HRCT findings.
- Correlation analysis between scoring system results and forced expiratory volume in 1 second (FEV1).
Main Results:
- The Bhalla scoring system demonstrated a stronger correlation with FEV1 (r = -0.65, P = 0.012) than the Nathanson score (r = 0.53, P = 0.05).
- All 16 children exhibited bronchiectasis, with 5 showing normal PFTs.
- Lower lobes were universally affected, and upper lobe involvement was absent in 5 children, particularly those under 7 years old.
Conclusions:
- The Bhalla scoring system is more appropriate for assessing CF lung disease in young children compared to the Nathanson system.
- In pediatric CF, lung disease commonly affects lower lobes, challenging the traditional view of upper lobe predominance.
- HRCT findings, particularly using the Bhalla score, provide valuable insights into CF progression in young children.
Abstract:
SUMMARY. High-resolution computed tomography (HRCT) of the chest permits early detection of lung disease; two relevant scoring systems (Bhalla and Nathanson) have been developed to describe CF lung disease. Comparisons between the two scoring systems have not been made, and it is not known which system is more appropriate for young children, i.e., the age group where other objective markers are scarce. We reviewed the clinical findings, pulmonary function data, and HRCT of 16 children aged less than 12 years. The Bhalla scoring system had a better correlation with FEV(1) (r = -0.65, P = 0.012) than the Nathanson score (r = 0.53, P = 0.05). All children had bronchiectasis, including 5 with normal pulmonary function tests. The lower lobes were universally involved, and 5 children did not have any upper lobe disease. Four of these 5 children were aged less than 7 years. We conclude that the Bhalla scoring system is more applicable to young children than is the Nathanson system. Also, in this group of young children with CF, lower lobes are more commonly involved than upper lobes, which is in contrast to the classical teaching that CF lung disease begins in the upper lobes.
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