A New Scoring System for Computed Tomography of the Chest for Assessing the Clinical Status of Bronchopulmonary Dysplasia

Ochiai, Masayuki; Hikino, Shunji; Yabuuchi, Hidetake; Nakayama, Hideki; Sato, Kazuo; Ohga, Shouichi; Hara, Toshiro

doi:10.1016/j.jpeds.2007.05.043

« Previous Next »The Journal of Pediatrics
Volume 152, Issue 1 , Pages 90-95.e3, January 2008

A New Scoring System for Computed Tomography of the Chest for Assessing the Clinical Status of Bronchopulmonary Dysplasia

Masayuki Ochiai, MD
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Reprint requests: Masayuki Ochiai, MD, Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Shunji Hikino, MD, PhD
- Perinatal and Maternity Care Unit, Kyushu University Hospital, Fukuoka, Japan
Hidetake Yabuuchi, MD, PhD
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Hideki Nakayama, MD, PhD
- Department of Neonatology, Fukuoka Municipal Children’s Hospital and Medical Center for Infectious Disease, Fukuoka, Japan
Kazuo Sato, MD, PhD
- Department of Pediatrics, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan.
Shouichi Ohga, MD, PhD
- Perinatal and Maternity Care Unit, Kyushu University Hospital, Fukuoka, Japan
Toshiro Hara, MD, PhD
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Received 12 December 2006; received in revised form 6 April 2007; accepted 25 May 2007. published online 22 October 2007.

Objective

To develop a new scoring system for computed tomography (CT) of the chest for assessing the clinical status of patients with bronchopulmonary dysplasia (BPD) in comparison with a modified Edwards roentgenographic scoring system.

Study design

Preterm infants diagnosed with BPD (n = 42) were assessed prospectively by chest CT scan at the time of discharge. Three radiologists classified the CT findings into 1 of 3 categories—hyperexpansion, emphysema, or fibrous/interstitial abnormalities—and developed a new scoring system. We assessed interobserver reproducibility and investigated whether this classification system reflected the severity of BPD in these patients.

Results

The CT scores had acceptable reproducibility (coefficient of correlation [cc] = 0.721 to 0.839). The subgroup with a more severe form of BPD had a higher CT score. The CT score correlated with the clinical score at 36 weeks of postmenstrual age (cc = 0.367) and the duration of oxygen therapy (cc = 0.537). Patients who were discharged home on oxygen had higher CT scores than patients who were not.

Conclusions

The new chest CT scoring system may have higher objectivity and accuracy in terms of predischarge assessment of clinical status as well as prediction of the prognosis of patients with BPD.

Abbreviations: BPD, Bronchopulmonary dysplasia, cc, Coefficient of correlation, CI, Confidence interval, CT, Computed tomography, FiO₂, Fraction of inspired oxygen, GA, Gestational age, HR-CT, High-resolution computed tomography, IL, Interleukin, NCPAP, Nasal continuous positive airway pressure, NIH, National Institutes of Health, PCO₂, Partial pressure of carbon dioxide, PMA, Postmenstrual age, SpO₂, Oxygen saturation