Korean J Radiol.  2013 Apr;14(2):350-360. 10.3348/kjr.2013.14.2.350.

Bronchopulmonary Dysplasia: New High Resolution Computed Tomography Scoring System and Correlation between the High Resolution Computed Tomography Score and Clinical Severity

• Shin SM
• Kim WS
• Cheon JE
• Kim HS
• Lee W
• Jung AY
• Kim IO
• Choi JH

• KMID: 1482799
• DOI: http://doi.org/10.3348/kjr.2013.14.2.350

Abstract

OBJECTIVE
To develop an high resolution computed tomography (HRCT) scoring system for the assessment of bronchopulmonary dysplasia (BPD) and determine its usefulness as compared with the chest radiographic score.
MATERIALS AND METHODS
Forty-two very low-birth-weight preterm infants with BPD (25 male, 17 female) were prospectively evaluated with HRCT performed at the mean age of 39.1-week postmenstrual age. Clinical severity of BPD was categorized as mild, moderate or severe. The HRCT score (0-36) of each patient was the sum of the number of bronchopulmonary segments with 1) hyperaeration and 2) parenchymal lesions (linear lesions, segmental atelectasis, consolidation and architectural distortion), respectively. We compared the HRCT scores with the chest radiographic scores (the Toce system) in terms of correlation with clinical severity.
RESULTS
The HRCT score had good interobserver (r = 0.969, p < 0.001) and intraobserver (r = 0.986, p < 0.001) reproducibility. The HRCT score showed better correlation (r = 0.646, p < 0.001) with the clinical severity of BPD than the chest radiographic score (r = 0.410, p = 0.007). The hyperaeration score showed better correlation (r = 0.738, p < 0.001) with the clinical severity of BPD than the parenchymal score (r = 0.523, p < 0.001).
CONCLUSION
We have developed a new HRCT scoring system for BPD based on the quantitative evaluation of pulmonary abnormalities of BPD consisting of the hyperaeration score and the parenchymal score. The HRCT score shows better correlation with the clinical severity of BPD than the radiographic score.

Keyword

Bronchopulmonary dysplasia; Scoring system; HRCT; Chest radiography; Preterm infants

MeSH Terms

Bronchopulmonary Dysplasia/*radiography
Female
Gestational Age
Humans
Infant, Newborn
Infant, Premature
Infant, Very Low Birth Weight
Male
Prospective Studies
Reproducibility of Results
Severity of Illness Index
Tomography, X-Ray Computed/*methods

Figure

• 

  Fig. 1 Flow diagram of 42 BPD patients enrolled in this prospective study. BPD = bronchopulmonary dysplasia, VLBW = very low birth weight, M = male, F = female, PMA = postmenstrual age, HRCT = high resolution computed tomography

• 

  Fig. 2 Correlation between radiologic scores and clinical severity in bronchopulmonary dysplasia (BPD) patients.HRCT score (A) shows significant correlation (r = 0.646, p < 0.001) with clinical severity of BPD. Chest radiographic score (B) also shows significant correlation (r = 0.410, p = 0.007) with clinical severity of BPD. HRCT score shows better correlation with clinical severity of BPD than chest radiographic score (p = 0.003). HRCT = high resolution computed tomography

• 

  Fig. 3 Correlation between hyperaeration and parenchymal scores of HRCT and clinical severity.Hyperaeration score (A) shows significant correlation (r = 0.738, p < 0.001) with clinical severity. Parenchymal score (B) shows significant correlation (r = 0.523, p < 0.001) with clinical severity. Hyperaeration score shows better correlation with clinical severity than parenchymal score (p < 0.001). HRCT = high resolution computed tomography

• 

  Fig. 4 Mild bronchopulmonary dysplasia in 41.1-week-old female infant born at 29.9 weeks of gestation with birth weight of 1280 g.Chest radiograph (A) shows mild cardiomegaly and few streaks of abnormal density (radiographic score = 2). Transverse HRCT scan (B) at level of bronchus intermedius shows hyperaeration in anterior segment of right upper lobe (arrow) and parenchymal lesions in anterior and posterior segments of right upper lobe and apicoposterior segment of left upper lobe (arrowheads). Transverse HRCT scan (C) at level of liver dome shows hyperaeration in anteromedial basal segment of left lower lobe and in lingular inferior segment of left upper lobe (arrows). HRCT score was 12 with hyperaeration and parenchymal lesions in 6 segments, respectively. HRCT = high resolution computed tomography

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  Fig. 5 Moderate bronchopulmonary dysplasia in 39.0-week-old male infant born at 29.9 weeks of gestation with birth weight of 620 g.Chest radiograph (A) shows mild cardiomegaly, hyperexpansion (rib count: 15 1/2) and many abnormal strands (radiographic score = 5.5). Transverse HRCT scan (B) at level of carina shows hyperaeration (arrows) and parenchymal lesions in all segments of both upper lobes. Transverse HRCT scan (C) at level of liver dome shows hyperaeration in lateral and posterior basal segments of left lower lobe (arrows), and parenchymal lesions in lateral and posterior basal segment of left lower lobe (arrowheads). HRCT score was 24 with hyperaeration in 13 segments and parenchymal lesions in 11 segments, respectively. HRCT = high resolution computed tomography

• 

  Fig. 6 Severe bronchopulmonary dysplasia in 54.7-week-old male infant born at 25.1 weeks of gestation with birth weight of 820 g.Chest radiograph (A) shows mild cardiomegaly, hyperexpansion (rib count: 16), scattered small abnormal lucencies and many abnormal strands (radiographic score = 6). Transverse HRCT scans at level of carina (B) and liver dome (C) show hyperaeration and parenchymal lesions in all segments seen on scan. HRCT score was 36 with hyperaeration and parenchymal lesions in 18 segments, respectively. HRCT = high resolution computed tomography

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