Brasfield et al developed a scoring system for grading the radiographic appearance of the lungs in patients with cystic fibrosis. This can be used to monitor the patient over the course of disease and to evaluate the effectiveness of interventions. The authors are from the Children's Hospital and University of Alabama in Birmingham, Alabama.
Parameters:
(1) air trapping: generalized pulmonary overdistention (may include sternal bowing, depression of diaphragm, thoracic kyphosis).
(2) linear markings: line densities due to prominence of bronchus as parallel line densities, sometimes branching or as "end-on" circular densities with thickening of bronchial wall.
(3) nodular cystic lesions: multiple, discrete, small, rounded densities 0.5 cm or larger, with either radiopaque or radiolucent centers; this does not include irregular linear markings.
(4) large lesions: segmental or lobar atelectasis or consolidation; includes acute pneumonia; confluent nodules are not classified as large lesions.
(5) general severity: overall severity of changes on the radiograph.
|
Parameter |
Finding |
Points |
|
air trapping |
absent |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
|
extreme |
4 |
|
linear markings |
absent |
0 |
|
|
mild |
1 |
|
|
moderate |
2 |
|
|
severe |
3 |
|
|
extreme |
4 |
|
nodular cystic lesions |
no quadrants involved |
0 |
|
|
1 quadrant involved |
1 |
|
|
2 quadrant involved |
2 |
|
|
3 quadrant involved |
3 |
|
|
4 quadrant involved |
4 |
|
large lesions |
absent |
0 |
|
|
segmental or lobular |
3 |
|
|
large lesions present (consolidation) |
5 |
|
general severity |
normal |
0 |
|
|
minimal |
1 |
|
|
mild |
2 |
|
|
moderate |
3 |
|
|
severe |
4 |
|
|
complications (cardiomegaly, pneumothorax, etc.) |
5 |
total demerit points =
= SUM(points for all 5 parameters)
total score =
= 25 – (total demerit points)
Interpretation:
• minimum demerit points: 0
• maximum demerit points: 22
• minimum total score: 3
• maximum total score: 25
• The higher the total score, the better the patient's radiographic appearance.
Specialty: Pulmonology, Genetics, Gastroenterology
