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Computed Tomography Scanning Techniques for the Evaluation of Cystic Fibrosis Lung Disease

¹ Center of Excellence in Pulmonary Biology, Division of Pediatric Pulmonary, Stanford University Medical Center, Palo Alto, California

Correspondence and requests for reprints should be addressed to Terry E. Robinson, M.D., Center of Excellence for Pulmonary Biology, Division of Pediatric Pulmonary, Stanford University School of Medicine, 770 Welch Road, Suite 350, Palo Alto, CA 94305-5715. E-mail: ter{at}stanford.edu

ABSTRACT

Multidetector computed tomography (MDCT) scanners allow diagnosis and monitoring of cystic fibrosis (CF) lung disease at substantially lower radiation doses than with prior scanners. Complete spiral chest CT scans are accomplished in less than 10 seconds and scanner advances now allow the acquisition of comprehensive volumetric datasets for three-dimensional reconstruction of the lungs and airways. There are two types of CT scanning protocols currently used to assess CF lung disease: (1) high-resolution CT (HRCT) imaging, in which thin 0.5–1.5-mm slices are obtained every 0.5, 1, or 2 cm from apex to base for inspiratory scans, and limited, spaced HRCT slices obtained for expiratory scans; and (2) complete spiral CT imaging covering the entire lung for inspiratory and expiratory scanning. These scanning protocols allow scoring of CF lung disease and provide CT datasets to quantify airway and air-trapping measurements. CF CT scoring systems typically assess bronchiectasis, bronchial wall thickening, mucus plugging, and atelectasis/consolidation from inspiratory scans, whereas air trapping is scored from expiratory imaging. Recently, CT algorithms have been developed for both HRCT and complete spiral CT imaging to quantify several airway indices, to determine the volume and density of the lung, and to assess regional and global air trapping. CT scans are currently acquired by either controlled-volume scanning techniques (controlled-ventilation infant CT scanning or spirometer-controlled CT scanning in children and adults) or by voluntary breath holds at full inflation and deflation.

Key Words: HRCT • CF • spiral CT • volume control

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