Eva Kocova

Scoring of the radiological picture of idiopathic interstitial pneumonia: a study to verify the reliability of the method

Background Idiopathic pulmonary fibrosis (IPF) is a clinical form of usual interstitial pneumonia (UIP). Computed chest tomography (CT) has a fundamental role in the multidisciplinary diagnostics. However, it has not been verified if and how a subjective opinion of a radiologists or pneumologists can influence the assessment and overall diagnostic summary. Purpose To verify the reliability of the scoring system. Material and Methods Assessment of conformity of the radiological score of high-resolution CT (HRCT) of lungs in patients with IPF was performed by a group of radiologists and pneumologists. Personal data were blinded and the assessment was performed independently using the Dutka/Vasakova scoring system (modification of the Gay system). The final score of the single assessors was then evaluated by means of the paired Spearman’s correlation and analysis of the principal components. Results Two principal components explaining cumulatively a 62% or 73% variability of the assessment of the single assessors were extracted during the analysis. The groups did not differ both in terms of specialty and experience with the assessment of the HRCT findings. Conclusion According to our study, scoring of a radiological image using the Dutka/Vasakova system is a reliable method in the hands of experienced radiologists. Significant differences occur during the assessment performed by pneumologists especially during the evaluation of the alveolar changes.

Nontuberculous Mycobacteriosis (Different Faces of Two Most CommonNontuberculous Mycobacteriosis)

Nontuberculous mycobacteriosis are chronic granulomatous diseases caused by different types of mycobacteria. Plain chest X-ray and high resolution computed tomography are highly nonspecific but absolutely neccesary in detection and follow-up of patients with pulmonary mycobacterial infection. Treatment of infection caused by Mycobacterium avium complex is often successful. However treatement is successful only in 55% of patients with pulmonary infection caused by Mycobacterium abscessus complex. The results of therapy is dependent on sensitivity to macrolides whitch are cornerstones of medical therapy. In our case serie of four patients with cystic fibrosis show that results of therapy in patients with preexistent lung disease can be very different and is not dependent only on type of mycobaterial infection and sensitivity to antimicrobial treatment. In such cases, therapy of Mycobacterium avium complex infection can last even several years.