Bhalla et al developed a score for patients with cystic fibrosis using thin-section CT scans of the lung. This can help identify the severity of disease in a patient and monitor its progression over time. The authors are from the Medical University of South Carolina, University of Medicine and Dentistry of New Jersey, and New York University Medical Center.
Parameters:
(1) severity of bronchiectasis
(2) peribronchial thickening
(3) extent of bronchiectasis, expressed in number of bronchopulmonary segments
(4) extent of mucus plugging, expressed in number of bronchopulmonary segments
(5) sacculations or abscesses, expressed in number of bronchopulmonary segments
(6) extent of emphysema, expressed in number of bronchopulmonary segments
(7) generations of bronchial divisions involved with bronchiectasis and/or plugging (with main stem bronchus considered the first generation)
(8) number and laterality of bullae
(9) collapse and/or consolidation
|
Parameter |
Finding |
Points |
|
severity of bronchiectasis |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
peribronchial thickening |
none |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
extent of bronchiectasis |
0 |
0 |
|
|
1 to 5 bronchopulmonary segments (BPS) |
1 |
|
|
6 - 9 BPS |
2 |
|
|
>= 10 |
3 |
|
extent of mucus plugging |
0 |
0 |
|
|
1 to 5 BPS |
1 |
|
|
6 - 9 BPS |
2 |
|
|
>= 10 |
3 |
|
sacculations or abscesses |
0 |
0 |
|
|
1 to 5 BPS |
1 |
|
|
6 - 9 BPS |
2 |
|
|
>= 10 |
3 |
|
extent of emphysema |
none |
0 |
|
|
1 - 5 BPS |
1 |
|
|
>= 6 BPS |
2 |
|
generations of bronchial divisions involved |
none |
0 |
|
|
up to 4th generation |
1 |
|
|
involves 5th generation |
2 |
|
|
involves 6th or greater generation |
3 |
|
number and laterality of bullae |
none |
0 |
|
|
1 - 4 and unilateral |
1 |
|
|
1 - 4 and bilateral |
2 |
|
|
>= 5 |
3 |
|
collapse and/or consolidation |
none |
0 |
|
|
subsegmental |
1 |
|
|
segmental or lobar |
2 |
where:
• Severity of bronchiectasis was based on the ratio of the luminal diameter of the bronchus to the diameter of the adjacent blood vessel. A ratio > 1 and < 2 is considered mild; a ratio >= 2 and <= 3 is moderate; a ratio > 3 is severe.
• Severity of peribronchial thickening was based on the ratio of the wall thickness of the bronchus to the diameter of the adjacent blood vessel. A ratio = 1 is considered mild; a ratio > 1 and <= 2 is moderate; a ratio > 2 is severe.
• If there is a range of findings in bronchiectasis and peribronchial thickening, then the most frequently identified severity is scored.
• Based on the images shown in the paper it appears that contrast is being used. The vessel measurement appears to be the diameter of the intraluminal contrast.
total score =
= SUM(points for all 9 parameters)
Interpretation:
• minimum score: 0
• maximum score: 25
• The higher the score the more severe the disease.
• The score can be incorporated into the Doershuk modification of the Shwachman-Kulczycki clinical score.
Specialty: Pulmonology, Genetics, Gastroenterology
