Imaging in cystic fibrosis and non-cystic fibrosis bronchiectasis

Bronchiectasis is defined as a permanent and progressive dilation of the airways, typically as a result of inflammation, infection, and subsequent repair. It typically presents with chronic cough, suppurative sputum production, and airway dilation. High-resolution computed tomography (HRCT) is now well established as the primary imaging tool for its investigation. Cystic fibrosis (CF) remains the most common autosomal recessive inherited disorder worldwide and its pulmonary hallmark is bronchiectasis. Although CF and non-CF bronchiectasis are different clinical entities, they are typically imaged using HRCT and share many imaging aspects, and also some differences. Several important recent CT technology developments have improved the detection and characterization of bronchiectasis and its complications. Many CT aspects of radiation exposure have also undergone important enhancements in recent years resulting in significant dose reductions. This is particularly relevant in a pulmonary disease such as bronchiectasis, which often undergoes serial HRCT surveillance in contemporary practice. Several new CT clinical applications in bronchiectasis have been recently advanced, and CT is now being increasingly incorporated into investigative algorithms to assess bronchiectasis treatment effects. In this review, we assess the latest imaging features of CF and non-CF bronchiectasis, discuss radiation dose reducing methods and technology of the latest scanners, describe recent CT clinical applications, and explore the use of CT as a treatment surrogate in CF and non-CF bronchiectasis.