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Objective: The aim of the study was to determine whether various causes of bronchiectasis can be differentiated by the pattern and distribution of abnormalities seen on high-resolution CT., Materials and Methods: The retrospective study included 82 consecutive patients who had a specific diagnosis of bronchiectasis proven by appropriate clinical and laboratory criteria. All patients underwent high-resolution CT scanning (1- to 1.5-mm collimation). The CT scans were assessed for the presence, extent, type, and anatomic distribution of bronchiectasis by two independent observers who were not aware of the clinical data. The observers recorded their most likely diagnosis and the degree of confidence in that diagnosis., Results: The two independent observers made a correct diagnosis in 61% of cases (100/164 interpretations). On average, a correct diagnosis was made in 19 (68%) of 28 cases of cystic fibrosis, 16 (67%) of 24 cases of previous tuberculosis, six (43%) of 14 cases of previous childhood infection, five (56%) of nine cases of allergic bronchopulmonary aspergillosis, and four (57%) of seven cases of other causes of bronchiectasis. We found moderate agreement between the observers for the correct diagnosis (kappa = .53) and good agreement for the presence or absence of bronchiectasis in each lobe (kappa = .71)., Conclusion: The pattern and distribution of abnormalities revealed by high-resolution CT in patients with bronchiectasis are influenced by the underlying cause. Bilateral, predominantly upper lobe, bronchiectasis is seen most commonly in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis, unilateral upper lobe predominance in patients with tuberculosis, and lower lobe predominance in patients after childhood viral infection.

Objective: Informed consent is now required for the majority of radiologic procedures, but few studies have evaluated the efficacy of informed consent protocols. We compared our standard consent protocol of obtaining consent prior to percutaneous lung biopsy with a modified protocol by using patients' recall of procedure risks after the biopsy as an indicator of patients' comprehension., Subjects and Methods: The study sample consisted of 50 patients who underwent percutaneous lung biopsy between December 1992 and June 1994. Twenty-seven patients received our standard informed consent procedure in which four important procedure risks were described briefly using our standard method. Twenty-three patients underwent a consent procedure that had the following modification. After the four procedure risks were described, the patient was tested verbally until all risks could be recited to the physician. This change required 5 additional min at most. In both protocols, efficacy of the procedure was evaluated by testing patient recall 4 hr after consent was obtained. We also assessed any effect that might have been introduced by differences between the groups, age, sex, time between consent and recall, and complications during the procedure., Results: Patients' recall was significantly better in the modified consent group than in the standard group (p = .005). This result could not be attributed to differences in age, sex, or time between consent and recall. There was a trend for improved recall in patients with complications. This trend did not appear to influence our principal finding., Conclusion: The standard consent procedure for lung biopsy appears inadequate when patients' recall of procedure risks later is used as a measure of the patients' comprehension. Based on this study, the informed consent process may be improved substantially by teaching patients to recite the procedure risks to the physician as part of the informed consent protocol.

Objective: Aortic valve calcification that is visualized on chest radiographs is considered a marker for clinically significant aortic stenosis, but the clinical importance of this finding on CT is unknown. Accordingly, we studied the prevalence and clinical relevance of aortic valve calcification found incidentally on CT scans of the chest., Materials and Methods: After comparing computer records of chest CTs and echocardiograms, we identified 109 patients who underwent both studies during a 2-year period. Two thoracic radiologists reviewed the CT scans to identify and quantify aortic valve calcification. The quantity of aortic valve calcification was graded on a scale of 1 to 3, with grade 3 indicating the most severe calcification. The prevalence of calcification was correlated with patient age and sex. The findings on CT were correlated with hemodynamic data from echocardiography. At echocardiography, a peak aortic valve gradient of greater than 25 mm Hg was defined as abnormal., Results: Aortic valve calcification was noted on CT scans in 33 (30%) of the 109 patients. Aortic valve calcification shown by CT was significantly more common in patients more than 65 years old (p < .01). Five (15%) of 33 patients with aortic valve calcification shown by CT had abnormal aortic valve gradients at echocardiography. In contrast, none of 76 patients without aortic valve calcification shown by CT had abnormal aortic valve gradients (p < .01). All five patients with abnormal aortic valve gradients had moderate quantities of aortic valve calcification seen on CT scans. Two of the five were younger than 55 years old., Conclusion: Aortic valve calcification is a common finding on CT scans and is usually clinically insignificant. Nevertheless, some patients with aortic valve calcification on CT have aortic stenosis, particularly those younger than 55 years old and those with moderately dense aortic valve calcification shown by CT. These patients may benefit from hemodynamic assessment of the aortic valve by echocardiography.