Kistik fibrozisli çocuklarda toraks bilgisayarlı tomografi bulgularının klinik bulgular ile korelasyonunun değerlendirilmesi

Year 2019, , 235 - 244, 06.02.2020

Fatma Sarıoğlu Seda Şirin Handan Güleryüz Suna Asilsoy

https://doi.org/10.5505/deutfd.2019.93898

Abstract

Amaç: Çalışmamızın amacı kistik fibrozisli çocuklarda toraks bilgisayarlı tomografi (BT) bulgularının klinik bulgular ile korelasyonunu araştırmaktır.
Gereç ve Yöntem: Hastanemizin Çocuk Sağlığı ve Hastalıkları Anabilim Dalı arşivi 2005-2019 yılları arasında izlenen kistik fibrozis (KF) hastalarını saptamak amacıyla retrospektif olarak tarandı. Kistik fibrozis tanısı almış, 0-18 yaş arasındaki 49 hastanın toraks BT görüntüleri retrospektif olarak değerlendirildi. BT’de bronşiektazi, peribronşial kalınlaşma, mukus tıkacı, sakkülasyon, abse, bül, amfizem, kollaps ve konsolidasyon varlığı değerlendirildi. Hastaların BT bulguları ile Bhalla skorlamasına göre puan elde edildi. Hastaların yaş, cinsiyet, vücut ağırlığı, boy, vücut kitle indeksi ve kültür sonuçları arşiv kayıt sisteminden kaydedildi. Ayrıca 49 hastanın 35 tanesinin solunum fonksiyon testi sonuçları kaydedildi. İstatistiksel analiz için korelasyon testleri uygulandı ve p değerinin 0,05’in altında olması anlamlı kabul edildi.
Bulgular: Kırk dokuz hastanın (24 erkek, 25 kız) yaşları 1-17 (ortalama 9,33±4,82) arasındaydı. BT’de en sık bulgular sırasıyla peribronşial kalınlaşma (%85,7), kollaps/konsolidasyon (%75,5) ve bronşiektazi (%73,4) idi. Hastaların FEV1 (p<0,001), FVC (p=0,002), FEV1/FVC (p=0,032) ve FEF25-75 (p=0,013) sonuçları ile BT skorları arasında negatif yönde korelasyon saptandı. Kültürde Pseudomonas aureginosa üremesi ile BT skoru arasında korelasyon bulundu (p<0,001). Ayrıca kültürde Pseudomonas aureginosa (p<0,001) ve/veya Staphylococcus aureus (p=0,001) üreyen hastaların BT skorları ile üremeyen hastaların BT skorları arasında anlamlı farklılık bulundu.
Sonuç: Kistik fibrozisli çocuklarda toraks BT bulguları, solunum fonksiyon testleri ve kültür sonuçlarıyla korelasyon göstermektedir. BT hastaların klinik takibinde önemli olup, Bhalla skoru KF hastalarını değerlendirmede kullanılabilecek skorlama yöntemidir.

Keywords

Kistik fibrozis, çocuk, bilgisayarlı tomografi, akciğer

THE ASSESSMENT OF THE CORRELATION BETWEEN THORAX COMPUTED TOMOGRAPHY AND CLINICAL FINDINGS IN CHILDREN WITH CYSTIC FIBROSIS

Abstract

Objective: The aim of this study is to evaluate the correlation between thorax computed tomography (CT) and clinical findings in children with cystic fibrosis.
Materials and Methods: The archive of our hospital between 2005 and 2019 was reviewed retrospectively. Forty-nine children with cystic fibrosis were included. By using thorax CT, bronchiectasis, peribronchial thickening, mucus plugging, sacculation, abscess, bulla, emphysema, collaps, and consolidation were evaluated retrospectively. The patients’ CT findings were scored according to Bhalla scoring system. The clinical findings of the children (age, sex, weight, height, body mass index, and the result of sputum or deep throat culture) were recorded. Respiratory function test results were also recorded in 35 of 49 patients who had been evaluated with spirometry. Correlation analysis was performed and a p value less than 0.05 was considered statistically significant.
Results: Forty-nine children (24 girls, 25 boys) were between 1-17 years (mean 9.33±4.82). The most common CT findings were peribronchial thickening (85.7%), collaps/consolidation (75.5%), and bronchiectasis (73.4%). There were significant correlations between the CT scores and FEV1 (p<0,001), FVC (p=0.002), FEV1/FVC (p=0.032), FEF25-75 (p=0.013), and Pseudomonas aureginosa growth in the culture (p<0.001). There was a significant difference in the CT scores between patients with Pseudomonas aureginosa (p<0.001) and/or Staphylococcus aureus (p=0.001) overgrowth and noovergrowth in the culture.
Conclusion: The thorax CT and clinical findings showed correlations in children with cystic fibrosis. Bhalla scoring system is a useful method to evaluate the cystic fibrosis patients in follow-up.

Keywords

Cystic fibrosis, pediatrics, computed tomography, lung

References

• 1. Dodge JA, Lewis PA, Stanton M, Wilsher J. Cystic fibrosis mortality and survival in the UK: 1947–2003. Eur Respir J. 2007; 29:522-6.
• 2. Murphy KP, Maher MM, O'Connor OJ. Imaging of Cystic Fibrosis and Pediatric Bronchiectasis. AJR Am J Roentgenol. 2016;206:448-54.
• 3. Khan TZ, Wagener JS, Bost T, et al. Early pulmonary inflammation in infants with cystic fibrosis. AM j Respir Crit Care Med. 1995;151:1075-82.
• 4. Carpio C, Albi G, Rayon-Aledo JC, et al. Changes in structural lung disease in cystic fibrosis children over 4 years as evaluated by high-resolution computed tomography. Eur Radiol. 2015;25:3577-85.
• 5. Kolodziej M, de Veer MJ, Cholewa M, Egan GF, Thompson BR. Lung function imaging methods in cystic fibrosis pulmonary disease. Respir Res. 2017;18:96.
• 6. Brody AS, Klein JS, Molina PL, Quan J, Bean JA, Wilmott RW. High resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests. J Pediatr. 2004;145:32-8.
• 7. Bhalla M, Turcios N, Aponte V, Jenkins M, Leitman BS, McCauley DI, et al. Cystic fibrosis: scoring system with thin-section CT. Radiology. 1991;179:783-8.
• 8. Sasihuseyinoglu AS, Altıntaş DU, Soyupak S, Dogruel D, Yılmaz M, Serbes M, et al. Evaluation of high resolution computed tomography findings of cystic fibrosis. Korean J Intern Med. 2019;34:335-43.
• 9. Brody AS, Molina PL, Klein JS, Rothman BS, Ramagopal M, Swartz DR. High-resolution computed tomography of the chest in children with cystic fibrosis: support for use as an outcome surrogate. Pediatr Radio.l 1999;29:731-5.
• 10. Brand PL, van der Ent CK. The practical application and interpretation of simple lung function tests in cystic fibrosis. J R Soc Med. 1999;92 Suppl 37:2-12.
• 11. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319-38.
• 12. Helbich TH, Heinz-Peer G, Fleischmann D, Wojnarowski C, Wunderbaldinger P, Huber S, Eichler I, Herold CJ. Evolution of CT findings in patients with cystic fibrosis. AJR Am J Roentgenol. 1999;173:81-8.
• 13. Maffessanti M, Candusso M, Brizzi F, Piovesana F. Cystic fibrosis in children: HRCT findings and distribution of disease. J Thorac Imaging. 1996;11:27-38.
• 14. Nathanson I, Conboy K, Murphy S, Afshani E, Kuhn JP.Ultrafast computerized tomography of the chest in cystic fibrosis: a new scoring system. Pediatr Pulmonol. 1991;11:81-6.
• 15. Santamaria F, Grillo G, Guidi G, Rotondo A, Raia V, de Ritis G, Sarnelli P, Caterino M, Greco L. Cystic fibrosis: when should high-resolution computed tomography of the chest be obtained? Pediatrics. 1998;101: 908-13.
• 16. Robinson TE, Leung AN, Northway WH, Blankenberg FG, Bloch DA, Oehlert JW, Al-Dabbagh H, Hubli S, Moss RB. Spirometer-triggered high-resolution computed tomography and pulmonary function measurements during an acute exacerbation in patients with cystic fibrosis. J Pediatr. 2001;138:553-9.
• 17. Robinson TE, Leung AN, Northway WH, Blankenberg FG, Chan FP, Bloch DA, Holmes TH, Moss RB. Composite spirometric–computed tomography outcome measure in early cystic fibrosis lung disease. Am J Respir Crit Care Med. 2003;168:588-93.
• 18. Bonnel AS, Song SM, Kesavarju K, Newaskar M, Paxton CJ, Bloch DA, Moss RB, Robinson TE. Quantitative air-trapping analysis in children with mild cystic fibrosis lung disease. Pediatr Pulmonol. 2004;38:396-405.
• 19. de Jong PA, Tiddens HA. Cystic fibrosis specific computed tomography scoring. Proc Am Thorac Soc. 2007;4:338-42.
• 20. Marchant JM, Masel JP, Dickinson FL, Masters IB, Chang AB. Application of chest high-resolution computer tomography in young children with cystic fibrosis. Pediatr Pulmonol. 2001;31:24-9.
• 21. Brody AS, Sucharew H, Campbell JD, Millard SP, Molina PL, Klein JS, Quan J. Computed tomography correlates with pulmonary exacerbations in children with cystic fibrosis. Am J Respir Crit Care Med. 2005;172:1128-32.
• 22. Shah RM, Sexauer W, Ostrum BJ, Fiel SB, Friedman AC. High-resolution CT in the acute exacerbation of cystic fibrosis: evaluation of acute findings, reversibility of those findings, and clinical correlation. AJR Am J Roentgenol. 1997;169:375-80.
• 23. Staitieh BS, Ioachimescu OC. Interpretation of pulmonary function tests: beyond the basics. J Investig Med. 2017;65:301-10.
• 24. Beydon N, Amsallem F, Bellet M, Boulé M, Chaussain M, Denjean A, et al. Pulmonary function tests in preschool children with cystic fibrosis. Am J Respir Crit Care Med. 2002;166:1099-104.
• 25. Emerson J, Rosenfeld M, McNamara S, Ramsey B, Gibson RL. Pseudomonas aeruginosa and other predictors of mortality and morbidity in young children with cystic fibrosis. Pediatr Pulmonol. 2002;34:91-100.
• 26. Robinson TE, Leung AN, Chen X, Moss RB, Emond MJ.Cystic fibrosis HRCT scores correlate strongly with Pseudomonas infection. Pediatr Pulmonol. 2009;44:1107-17.