[Usefulness of chest X-ray during cystic fibrosis exacerbation in adult patients].
OBJECTIVE
Verify the real usefulness of chest X-ray during clinical exacerbation of cystic fibrosis (FC).


METHODS
The study was based on a group of 46 adult patients affected by FC. For every subject we selected one or more pair of chest films, of which the first was used as reference image (To), whereas the second (T1) was selected among the following controls, either in course of clinical obvious exacerbation, or during another routine control. The 64 pairs of chest films (32 representing phases of clinical stability, 32 documenting evolution towards clinical deterioration) were subjected to evaluation by two radiologists, who were first asked to judge if stability, improvement or worsening of the overall radiographic picture could be observed; then to estimate the improvement, worsening, stability or absence of the 12 radiographic signs, selected among those more frequently correlating with the acute phase of disease.


RESULTS
The comprehensive radiological evaluation, which shows a statistically significant difference (p=0.012) between the two groups considered, weakly correlates with the patient clinical status. Among the patients with exacerbation, the radiographic picture appeared worsened in only 18/32 cases (sensibility 56%, specificity 78%), while on the contrary 7/32 clinically stable patients exhibited a radiographic deterioration. Among the considered radiographic-sings, some were exclusively observed during exacerbation (specificity 100%), but with low sensitivity (pneumothorax: 6%, increment of bronchiectasis: 9%, air space disease 22%); the most common alterations (mucoid impactions and bronchial wall thickening) were observed in both groups of patients.


CONCLUSIONS
Our results demonstrate that there is not a precise correlation between the radiographic picture and the clinical manifestations of exacerbation and confirm the poor usefulness of chest X-ray in such a phase of disease. Chest X-ray is needed to exclude pnemothorax or extensive air space disease, rather then to accurately diagnose exacerbation.
Cortese
G
G
Dipartimento di Scienze Cliniche e Biologiche, Servizio di Radiologia a Direzione Universitaria, Orbassano, Turin, Italy.
Nespoli
P
P
Grosso
B
B
Messore
B
B
De Rose
V
V
Fava
C
C
D000208:Acute Disease; D000328:Adult; D003550:Cystic Fibrosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies