IMPLEMENTING THE BRODY SCORING SYSTEM IN THE EVALUATION OF SEVERITY OF PULMONARY CHANGES IN CYSTIC FIBROSIS ON HIGH RESOLUTION COMPUTED TOMOGRAPHY
Keywords:
cystic fibrosis(CF), Brody Scoring System(BSS), High Resolution Computed Tomography(HRCT), air trapping, mucus plugging, bronchiectasisAbstract
This study aims to perform an in- depth evaluation on High Resolution Computed Tomography (HRCT)
exams in patients diagnosed with cystic fibrosis(CF), taking into consideration the gravity and prevalence of lung
parenchymal findings by implementing the Brody Scoring System (BSS).
We assessed and scored the HRCT exams of 11 patients diagnosed with cystic fibrosis with the mean age of 13, 5 (4
to 23 years old), by using the Brody Scoring System. All 11 patients underwent a HRCT according to appropriate
diagnostic protocol on a 64- slice Somatom Definition AS+ Computed Tomograph (Siemens Healthineers, USA) on
which we graded the prevalence, severity and extent of several findings in all 6 lobes in central and peripheral
locations, including air trapping, peribronchial wall thickening, mucous plugging, bronchiectasis and the most
common parenchymal findings like ground glass opacities, consolidation and cysts.
Considering the habitual nature of the disease, bronchiectasis, mucous plugging and peribronchial wall thickening
were the most consistent findings, whereas the others were less frequently encountered. The highest Brody score
was affiliated with bronchiectasis and mucus plugging. There was a significant statistical difference between
variables and predominant location only with mucous plugging and peripheral lung zones and common parenchymal
findings were usually located in the upper right lobe, followed by the lower lobes on both sides.
High Resolution Computed Tomography has an important diagnostic role in the timely assessment of prevalence,
severity and extent of a spectrum of lung parenchymal changes in cystic fibrosis, whereas by using the readily
available semi- quantitative scoring systems, gives an accurate estimation of the clinical status of the patients and
predicts complications and unwanted outcomes.
References
Baltieri, S. (2014). Evaluation of lung disease progression with CT Brody score in patients with cystic fibrosis (CF).
Behrman, R., & Saunders, W. B.(2004). Nelson Textbook of Pediatrics. Philadelphia: WB Saunders.
Bell, S. C., Mall, M. A., Gutierrez, H., Macek, M., Madge; et al. (2020). The future of cystic fibrosis care: a
global perspective. The Lancet. Respiratory medicine, 8(1), 65–124.
Bell, S. C., Mall, M. A., Gutierrez, H., Macek, M., Madge, S.; et al. (2005). Cystic fibrosis is no longer an important
cause of childhood death in the UK. Archives of disease in childhood, 90(5), 547.
Bhalla, M., Turcios, N., Aponte, V., Jenkins, M., Leitman, B. S., McCauley, D. I., & Naidich, D. P. (1991). Cystic
fibrosis: scoring system with thin-section CT. Radiology, 179(3), 783–788.
Bortoluzzi, C. F.,Volpi, S., D’Orazio, C. et al. (2014). Bronchiectasts at early chest computed tomography in
children with cystic fibrosis are associated with increased risk of subsequent pulmonary exacerbations and
chronic pseudomonas infection. J Cyst Fibros, 13(5):564-571.
Castellani, C. et al. (2018). ECFS best practice guidelines: the 2018 revision. J. Cyst. Fibros.17, 153–178.
Drevinek, P., Farrell, P. M., Gravelle, A. M., & Ratjen, F. (2020). The future of cystic fibrosis care: a global
perspective. The Lancet. Respiratory medicine, 8(1), 65–124.
Goris, M. L., Zhu, H. J., Blankenberg, F., Chan, F., & Robinson, T. E. (2003). An Automated Approach to Quantitative Air Trapping Measurements in Mild Cystic Fibrosis. Chest, 123:1655-63.
Gunnell, E. T. et al. (2019). Initial clinical evaluation of stationary digital chest tomosynthesis in adult patients with
cystic fibrosis. Eur. Radiol. 29, p1665–1673.
Van Straten, M., Brody, S. A., Ernst, C., Guillerman, P. et al. (2020). Guidance for computed tomography (CT) imaging of the lungs for patients with cystic fibrosis (CF) in research studies. Journal of Cystic Fibrosis. Vol. 19(2), p176- 183.
Martinez,T. M., Llapur, C. J., Williams, T. H., Coates, C., Gunderman, R., Cohen, M. D. et al. (2005). High-resolution computed tomography imaging of airway disease in infants with cystic fibrosis. Am J Respir Crit Care Med. 172(20059):1133–8.
Mayo, J. R. (2009). CT evaluation of diffuse infiltrative lung disease: dose considerations and optimal technique. J
Thorac Imaging., 24, 252-259.
Meltzer, C., Gilljam, M., Vikgren, J., Norrlund, R. R. at al. (2021). QUANTIFICATION OF PULMONARY
PATHOLOGY IN CYSTIC FIBROSIS–COMPARISON BETWEEN DIGITAL CHEST TOMOSYNTHESIS
AND COMPUTED TOMOGRAPHY, Radiation Protection Dosimetry, Vol.195(3-4), p434–442
Mott, L. S., Park, J., Murray, C. P., Gangell, C. L., de Klerk, N. H., Robinson, P. J., Robertson, C. F., Ranganathan,
S. C., Sly, P. D., Stick, S. M., & AREST CF (2012). Progression of early structural lung disease in young
children with cystic fibrosis assessed using CT. Thorax, 67(6), 509–516.
Ramsey, B. W., Banks-Schlegel, S., Accurso, F. J., Boucher, R. C., Cutting, G. R., Engelhardt, J. F., Guggino, W. Karp, B., Knowles, C. L., Kolls, M. R., LiPuma, J. K., Lynch, J. J., McCray, S., Rubenstein, P. B., Jr, Singh, R. C., Sorscher, P. K., E., & Welsh, M. (2012). Future directions in early cystic fibrosis lung disease research: an NHLBI workshop report. American journal of respiratory and critical care medicine, 185(8), 887–892.
Stephenson, A. L., Tom, M., Berthiaume, Y., Singer, L. G., Aaron, S. D., Whitmore, G. A., & Stanojevic, S. (2015).
A contemporary survival analysis of individuals with cystic fibrosis: a cohort study. The European respiratory
journal, 45(3), 670–679.
Stephenson, A. L., Stanojevic, S., Sykes, J., & Burgel, P. R. (2017). The changing epidemiology and demography of cystic fibrosis. Presse Med ;46(6 Pt 2):e87–e95.
Verschakelen, J. A. (2010). The role of high-resolution computed tomography in the work-up of interstitial lung
disease. Curr Opin Pulm Med., 16, 503-510.
Webb, W. R. (2005). Airway disease: Bronchiectasis, chronic bronchitis and bronchiolitis. Thoracic imaging:
pulmonary and cardiovascular radiology. Philadelphia: PA: Lippincott, Williams and Wilkins; p. 527–37
