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Radiographic Outcomes in Pediatric Bronchiectasis and Factors Associated with Reversibility
Dustin R Mills1,2,3, Ian B Masters1,4, Stephanie T Yerkovich4,5
1Department of Respiratory and Sleep Medicine and.
Insights
Pediatric bronchiectasis is often reversible, with 40% of children showing complete radiographic resolution. Younger age, less severe initial symptoms, and absence of Pseudomonas aeruginosa infection predict better outcomes.
Area of Science:
- Pediatric Pulmonology
- Radiology
- Infectious Diseases
Background:
- Bronchiectasis in children was traditionally considered irreversible.
- Recent small studies suggest potential reversibility.
- Factors influencing radiographic resolution remain undefined.
Purpose of the Study:
- To determine the extent of bronchiectasis reversibility in a large pediatric cohort.
- To identify factors associated with radiographic resolution on chest high-resolution computed tomography (cHRCT).
Main Methods:
- Retrospective analysis of 142 children with repeat cHRCT scans (2010-2021).
- Exclusion criteria: cystic fibrosis, surgery, traction bronchiectasis, lobar opacification.
- Scoring using modified Reiff score (MRS); resolution defined by normal bronchoarterial ratio on follow-up cHRCT.
Main Results:
- Radiographic resolution observed in 40.1% (57/142), improvement in 39.4% (56/142).
- Pseudomonas aeruginosa (PsA) infection was strongly associated with lack of resolution.
- Younger age, lower MRS, and fewer exacerbations predicted resolution in PsA-negative patients.
Conclusions:
- This large cohort confirms bronchiectasis is often reversible in children with proper management.
- Younger children and those with less severe initial cHRCT findings are more likely to achieve resolution.
- PsA infection significantly reduces the likelihood of radiographic reversibility.
Abstract:
Rationale: Conventionally considered irreversible, bronchiectasis has been demonstrated to be reversible in children in small studies. However, the factors associated with radiographic reversibility of bronchiectasis have yet to be defined. Objectives: In a large cohort of children with bronchiectasis, we aimed to determine: 1) if and to what extent bronchiectasis is reversible and 2) factors associated with radiographic chest high-resolution computed tomography (cHRCT) resolution. Methods: We identified children with bronchiectasis who had a repeat multidetector cHRCT scan between 2010 and 2021. We excluded those with cystic fibrosis, surgical pulmonary resection, traction bronchiectasis only, or lobar opacification. Measurements and Main Results: cHRCT scans were scored using the modified Reiff score (MRS) with a pediatric correction. Resolution was defined as an absence of abnormal bronchoarterial ratio (>0.8) on the second cHRCT scan. We included 142 children (median age, 5 years; IQR, 2.6-7.4). Inter- and intrarater agreement in MRSs was excellent (weighted κ = 0.83-0.86 and 0.95, respectively). There was radiographic resolution in 57 of 142 patients (40.1%), improvement in 56 of 142 (39.4%), and no change or worsening in 29 of 142 (20.4%). Pseudomonas aeruginosa (PsA) was absolutely associated with a lack of resolution. On multivariable regression, in those without PsA cultured, younger age at the time of diagnosis (risk ratio [RR], 0.94; 95% confidence interval [CI], 0.88-0.99), lower MRS (RR, 0.89; 95% CI, 0.82-0.97), and lower annual rate of exacerbations requiring intravenous antibiotic therapy (RR, 0.60; 95% CI, 0.37-0.98) increased the likelihood of radiographic resolution. Conclusions: This first large cohort confirms that bronchiectasis in children is often reversible with appropriate management. Younger children and those with lesser radiographic severity at diagnosis were most likely to exhibit radiographic reversibility, whereas those with PsA infection were least likely.
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