How useful is computed tomography in the diagnosis and assessment of bronchiectasis?

doi:10.1016/S0009-9260(86)80261-6

Clinical Radiology

Volume 37, Issue 4, January–November 1986, Pages 321-325

https://doi.org/10.1016/S0009-9260(86)80261-6 Get rights and content

A study was performed to determine the value of computed tomography (CT) in the diagnosis and assessment of cylindrical and mild varicose bronchiectasis. Fifteen patients, in whom bronchography had shown such bronchiectasis in 34 of 73 lobes that could be assessed, were examined by CT. A control group of 12 subjects in whom there was no clinical or plain radiographic suspicion of bronchiectasis was also studied. Computed tomography (CT) was considered to show bronchiectasis in 28 lobes, 27 of which were bronchiectatic as shown by bronchography. Of 45 lobes where CT was not thought to show bronchiectasis, bronchography demonstrated 38 normal and seven bronchiectatic lobes. All lobes in the control group were interpreted as normal. Using bronchography as the definitive investigation for cylindrical or mild varicose bronchiectasis, CT has a sensitivity of 79% and a specificity of 99% in the diagnosis of the disease. The high specificity indicates that a diagnosis of cylindrical or mild varicose bronchiectasis by CT is reliable but CT is too insensitive to be used as a screening test.

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Non-CF bronchiectasis: Orphan disease no longer
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Citation Excerpt :
However, chest radiography has limitations with reported sensitivity that ranges from 37% to 87% [14,15] and may not identify early forms of bronchiectasis. On the other hand, computed tomography (HRCT) of the chest has reported sensitivity of 71–96% and specificity of 93–99% [16,17]. The diagnostic chest CT criteria of bronchiectasis include bronchoarterial ratio > one, lack of bronchial tapering and visualization of bronchial airways to within 1–2 cm of the pleura (Figs. 2–4) [18].
Bronchiectasis is a complex, chronic respiratory condition, characterized by frequent cough and exertional dyspnea due to a range of conditions that include inherited mucociliary defects, inhalational airway injury, immunodeficiency states and prior respiratory infections. For years, bronchiectasis was classified as either being caused by cystic fibrosis or non-cystic fibrosis. Non-cystic fibrosis bronchiectasis, once considered an orphan disease, is more prevalent worldwide in part due to greater availability of chest computed tomographic imaging. Identification of the cause of non-cystic fibrosis bronchiectasis with the use of chest imaging, laboratory testing, and microbiologic assessment of airway secretions can lead to initiation of specific therapies aimed at slowing disease progression. Nonpharmacologic therapies such as airway clearance techniques and pulmonary rehabilitation improve patient symptoms. Inhaled corticosteroids should not be routinely prescribed unless concomitant asthma or COPD is present. Inhaled antibiotics prescribed to individuals with >3 exacerbations per year are well tolerated, reduce airway bacteria load and may reduce the frequency of exacerbations. Likewise, chronic macrolide therapy reduces the frequency of exacerbations. Medical therapies for cystic fibrosis bronchiectasis may not be effective in treatment of non-cystic fibrosis bronchiectasis.
Bronchiectasis Revisited: Imaging-Based Pattern Approach to Diagnosis
2019, Current Problems in Diagnostic Radiology
Citation Excerpt :
Bronchiectasis is diagnosed on HRCT on the basis of certain criteria (Table 1 and Fig 1). Most reproducible among these criteria is the measurement of broncho-arterial ratio.6-14 Ancillary findings in bronchiectasis include mucoid impaction in distal smaller airways, leading to bronchiolitis.
Bronchiectasis is one of the causes of non-resolving, persistent or recurrent pulmonary infection which, if uncorrected may have deleterious consequences on the lung parenchyma and pulmonary circulation. High-resolution computed tomography (HRCT) is needed for the confirmation, localization and directing management accordingly.
Bronchiectasis is one of the major cause of morbidity worldwide. Chest radiograph is done at the initial suspicion which is supplemented by HRCT to confirm the diagnosis. Imaging diagnosis supplemented by the recognition of the pattern of involvement is essential to outline the differential diagnosis, map the complications and, hence, guiding the further management. Identification of the causative aetiology may not only prevent its further progression but obviate recurrent insults to the lung parenchyma as well. This article focuses on an algorithmic approach to bronchiectasis based on the distribution on imaging
The BRICS (Bronchiectasis Radiologically Indexed CT Score): A Multicenter Study Score for Use in Idiopathic and Postinfective Bronchiectasis
2018, Chest
The goal of this study was to develop a simplified radiological score that could assess clinical disease severity in bronchiectasis.
The Bronchiectasis Radiologically Indexed CT Score (BRICS) was devised based on a multivariable analysis of the Bhalla score and its ability in predicting clinical parameters of severity. The score was then externally validated in six centers in 302 patients.
A total of 184 high-resolution CT scans were scored for the validation cohort. In a multiple logistic regression model, disease severity markers significantly associated with the Bhalla score were percent predicted FEV₁, sputum purulence, and exacerbations requiring hospital admission. Components of the Bhalla score that were significantly associated with the disease severity markers were bronchial dilatation and number of bronchopulmonary segments with emphysema. The BRICS was developed with these two parameters. The receiver operating-characteristic curve values for BRICS in the derivation cohort were 0.79 for percent predicted FEV₁, 0.71 for sputum purulence, and 0.75 for hospital admissions per year; these values were 0.81, 0.70, and 0.70, respectively, in the validation cohort. Sputum free neutrophil elastase activity was significantly elevated in the group with emphysema on CT imaging.
A simplified CT scoring system can be used as an adjunct to clinical parameters to predict disease severity in patients with idiopathic and postinfective bronchiectasis.
Imaging the airways: Hemoptysis, bronchiectasis, and small airways disease
1999, Clinics in Chest Medicine
Spiral CT: Thoracic applications
1998, European Journal of Radiology
Volumetric CT data acquisition has had a major impact on the practice of computed tomography. This article reviews the current state of knowledge of the applications of this technique to the chest diseases, summarising its clinical impact on the assessment of lung and airways diseases, mediastinal abnormalities (excluding vascular disorders which are covered elsewhere), and in the evaluation of lung cancer patients. The impact of spiral CT on the non-invasive detection of pulmonary thrombo-embolic disease is also considered.
Bronchiectasis
1998, Radiologic Clinics of North America
The term bronchiectasis refers to chronic irreversible dilatation of diseased bronchi. There are many causes of bronchiectasis and the entity should be considered as the final outcome of a number of mechanisms, rather than as a simple diagnostic label.⁶ Because the definition of bronchiectasis is a morphologic one, imaging has a key role in its identification. Over the years, imaging tests have become increasingly accurate in depicting the features of early bronchiectasis. The sensitivity of high-resolution CT (HRCT) contrasts starkly with the limited ability of plain chest radiography to detect even advanced bronchiectasis. HRCT represents a great improvement over previous imaging techniques, but problems with specificity and observer variation remain. New insights into the functional consequences of bronchiectasis are now being provided by HRCT. It seems probable that HRCT will remain the imaging test of choice for the detection of bronchiectasis over the next few years. This article covers the clinical, pathologic, and functional features of bronchiectasis, HRCT technique, the signs of bronchiectasis on chest radiography and HRCT, and causes of misdiagnosis of bronchiectasis.

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How useful is computed tomography in the diagnosis and assessment of bronchiectasis?

Chronic bronchial sepsis and progressive lung damage

British Medical Journal

Assessment of the accuracy and sensitivity of computerised tomography (CT) in the diagnosis of bronchiectasis

Thorax

What is the meaning of bronchographic abnormalities in patients chronically producing sputum?

Thorax

Bronchography via the fibreoptic bronchoscope

Thorax