Computed tomography reflects lower airway inflammation and tracks changes in early cystic fibrosis.
BACKGROUND
Detecting and tracking early cystic fibrosis (CF) lung disease are difficult due to lack of sensitive markers of airway dysfunction.


OBJECTIVE
The goals were to detect regional distribution of airway disease through high-resolution computed tomography, correlate abnormalities to lower airway inflammation/infection, and compare computed tomography findings before and after intravenous antibiotic therapy in children with CF younger than 4 years experiencing a pulmonary exacerbation.


METHODS
High-resolution computed tomography was performed in 17 children scheduled for bronchoscopy. The radiologist identified the lobes with the "greatest" and "least" disease based on computed tomography, and bronchoalveolar lavage was performed in these areas. In 13 subjects, imaging was repeated after antibiotic completion. Modified Brody scores were assigned by two radiologists.


RESULTS
The lobe with greatest disease was predominantly localized to the right and had higher modified Brody scores, indicating more severe abnormalities (p < 0.01), compared with the lobe with least disease. The total modified Brody score (p < 0.01), hyperinflation subscore (p < 0.01), and bronchial dilatation/bronchiectasis subscore (p < 0.01) improved after antibiotics and intensified airway clearance. Interleukin-8 levels (p < 0.01) and % neutrophils (p = 0.04) were increased in the lobe with greatest disease compared with the lobe with least disease.


CONCLUSIONS
These results indicate that, in young children with CF experiencing a pulmonary exacerbation, computed tomography detects regional differences in airway inflammation, may be a sensitive outcome to evaluate therapeutic interventions, and identifies early lung disease as being more prominent on the right.
Davis
Stephanie D
SD
Division of Pediatric Pulmonology, Chapel Hill, NC 27599-7220, USA. sddavis@med.unc.edu
Fordham
Lynn A
LA
Brody
Alan S
AS
Noah
Terry L
TL
Retsch-Bogart
George Z
GZ
Qaqish
Bahjat F
BF
Yankaskas
Bonnie C
BC
Johnson
Robin C
RC
Leigh
Margaret W
MW
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000378:metabolism; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016209:Interleukin-8 / Q000378:metabolism; D008297:Male; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D015415:Biomarkers; D016209:Interleukin-8