Bone subtraction radiography in adult patients with cystic fibrosis.

Background Bone subtraction radiography allows reading pulmonary changes of chest radiographs more accurately without superimposition of bones. Purpose To evaluate the value of bone subtraction chest radiography using dual energy (DE) bone subtracted lung images compared to conventional radiographs (CR) in adult patients with cystic fibrosis (CF). Material and Methods Forty-nine DE radiographs of 24 patients (16 men) with CF (mean age, 32 years; age range, 18-71 years) were included. Lung function tests were performed within 10 days of the radiographs. Two radiologists evaluated all CR, DE, and CR + DE radiographs using the modified Chrispin-Norman score (CNS) and a five-point score for the confidence. Findings were statistically evaluated by Friedman ANOVA and Wilcoxon matched-pairs test. Results There was significant difference of CNS between CR and DE ( P = 0.044) as well as CR and CR + DE ( P < 0.001). CNS of CR images showed moderate correlation with FEV1% (R = 0.287, P = 0.046) while DE and CR + DE correlated poorly with FEV1% (R = 0.023, P = 0.874 and R = 0.04, P = 0.785). A higher confidence was achieved with bone-subtracted radiographs compared to radiographs alone (median, CR 3.3, DE 3.9, CR + DE 4.1, for both P < 0.001). Conclusion DE radiographs are reliable for the evaluation of adult patients with CF in acute exacerbation. For yearly surveillance, CR and DE radiographs may play a limited role. However, in clinical routine, DE radiographs are useful for adult CF patients and may depict more accurately inflammatory changes than CR.