International guidelines about the appropriate timing and selection of imaging modalities for patients with cystic fibrosis (CF) are needed, according to an article by pulmonologists and radiologists, which was published in European Respiratory Review.

“Timing and selection depends upon the clinical scenario, the patient’s age, lung function and type of treatment,” the authors said. They added that the use of the chest radiograph remains controversial in spite of its ubiquity, and that computed tomography (CT) and magnetic resonance imaging (MRI) should be routinely used to monitor lung disease in patients with CF.

Lung disease is the main cause of death in patients with CF. It is therefore of great importance to assess it in a noninvasive manner. New imaging techniques have been developed that can improve clinical practice, however, they also come with their own challenges.

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In the present article, 21 experts in CF from the 10 largest specialist centers in Italy summarised these challenges and made evidence-based recommendations about imaging assessment to monitor lung disease in CF.

The committee first systematically reviewed the relevant literature and got together to evaluate 167 published papers. An executive subcommittee then developed consensus statements and the committee approved 28 main statements.

For any of the statements to be accepted, an a priori threshold of at least 80% of the votes was needed. Of those 4 were about the first diagnosis, 18 were about follow-up, and 6 were about exacerbations. Some of these statements were statements of facts while others were recommendations and best practice statements.

Future studies should focus on the harmonization of imaging protocols for CT and MRI, the authors said. “The introduction of artificial intelligence imaging analysis may further revolutionise clinical practice by providing fast and reliable quantitative outcomes to assess disease status.”


Ciet P, Bertolo S, Ros M, et al. State-of-the-art review of lung imaging in cystic fibrosis with recommendations for pulmonologists and radiologists from the “iMAging managEment of cySTic fibROsis” (MAESTRO) consortium. Eur Respir Rev. 2022;31(163):210173. doi:10.1183/16000617.0173-2021