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. 2011 Apr;21(4):722-9.
doi: 10.1007/s00330-010-1972-7. Epub 2010 Oct 6.

Modified Chrispin-Norman chest radiography score for cystic fibrosis: observer agreement and correlation with lung function

P A de Jong  1 , J A Achterberg, O A M Kessels, B van Ginneken, L Hogeweg, F J Beek, S W J Terheggen-Lagro
Affiliations

Modified Chrispin-Norman chest radiography score for cystic fibrosis: observer agreement and correlation with lung function

P A de Jong et al. Eur Radiol. 2011 Apr.

Abstract

Objective: To test observer agreement and two strategies for possible improvement (consensus meeting and reference images) for the modified Chrispin-Norman score for children with cystic fibrosis (CF).

Methods: Before and after a consensus meeting and after developing reference images three observers scored sets of 25 chest radiographs from children with CF. Observer agreement was tested for line, ring, mottled and large soft shadows, for overinflation and for the composite modified Chrispin-Norman score. Correlation with lung function was assessed.

Results: Before the consensus meeting agreement between observers 1 and 2 was moderate-good, but with observer 3 agreement was poor-fair. Scores correlated significantly with spirometry for observers 1 and 2 (-0.72<R<-0.42, P < 0.05), but not for observer 3. Agreement with observer 3 improved after the consensus meeting. Reference images improved agreement for overinflation and mottled and large shadows and correlation with lung function, but agreement for the modified Chrispin-Norman score did not improve further.

Conclusion: Consensus meetings and reference images improve among-observer agreement for the modified Chrispin-Norman score, but good agreement was not achieved among all observers for the modified Chrispin-Norman score and for bronchial line and ring shadows.

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Figures

Fig. 1
Fig. 1
Normal chest radiograph quadrants. Figure illustrates normal quadrants as used in the modified Chrispin-Norman score, corresponding normal high-resolution CT images are not shown
Fig. 2
Fig. 2
Illustration of assessment of overinflation in cystic fibrosis with the modified Chrispin-Norman score. Upper chest radiograph shows normal inflation level. The middle of the right hemi diaphragm is above the upper edge of the posterior 10th rib, there is no hyperlucency and the rib cage has a normal shape. Middle panel shows the right mid-diaphragm below the upper edge of the posterior 10th rib, but above the upper edge of the posterior 11th rib (score 1), the lung field was subjectively judged to be hyperlucent (score 2) and the shape of the rib cage abnormal (score 2). We did not obtain consensus on a clear definition for hyperlucent lung and rib cage shape. Subjectively the ribs were elevated and the posterior ribs too much in a horizontal position. The same applies to the lower radiograph. The lower radiograph shows a right mid-diaphragm at the upper edge of the posterior 11th rib (score 2), hyperlucency is not easy to evaluate with the various shadows projecting on the image, the rib cage was judged to be abnormal (score 2)
Fig. 3
Fig. 3
Illustration of bronchial line shadows in cystic fibrosis. Correlation of chest radiograph findings with corresponding high-resolution CT images. Upper two panels illustrate subtle and limited (score 1) bronchial line shadows (arrows) and the lower two panels illustrate obvious and extensive (score 2) bronchial line shadows (arrows). This corresponds to bronchial wall thickening (arrowheads) and/or bronchiectasis (arrows) on HRCT
Fig. 4
Fig. 4
Illustration of ring shadows in cystic fibrosis. Correlation of chest radiograph findings with corresponding high-resolution CT images. Upper panel illustrates subtle and limited (score 1) ring shadows (arrow) and the lower panel illustrates obvious and extensive (score 2) ring shadows (arrows). This corresponds to bronchiectasis (arrows) on HRCT
Fig. 5
Fig. 5
Illustration of mottled shadows in cystic fibrosis. Correlation of chest radiograph findings with corresponding high-resolution CT images. Upper panel illustrates limited (score 1) mottled shadows (arrows) and the lower panel illustrates extensive (score 2) mottled shadows (arrows). Most mottles are smaller than 0.5 cm as originally described by Chrispin and Norman [2], although some small mottles are superimposed and projected as slightly larger mottles
Fig. 6
Fig. 6
Illustration of large soft shadows in cystic fibrosis. Correlation of chest radiograph findings with corresponding high-resolution CT images. Upper panel illustrates limited (score 1) large soft shadows adjacent to the minor fissure (arrows) and the lower panel illustrates extensive (score 2) large soft shadows (arrows). Also note that the left heart border is no longer visible
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