Radiological features of bronchiectasis

Imaging plays a crucial role in the diagnosis and monitoring of bronchiectasis and the management of complications. Chest radiography is useful as an initial screening tool and during acute exacerbations, but has limited sensitivity and specificity. High-resolution computed tomography (HRCT) is the reference standard for diagnosis and quantification of bronchiectasis, providing detailed morphological information. Computed tomography (CT) is also valuable in diagnosing and managing complications. Routine surveillance using HRCT has been mooted, particularly in cystic fibrosis (CF), where advances in treatment have increased life expectancy considerably, but cumulative radiation dose remains a concern. Pulmonary magnetic resonance imaging is an evolving technique that provides both structural and functional information. Its advantage is the lack of ionising radiation. Limitations include cost, availability and its inferior spatial resolution compared to CT. The technique requires further evaluation, but has potential benefits where serial follow-up imaging is being considered, such as in CF. Evaluation of mucociliary clearance using radionuclide scintigraphy may be of value, particularly in drug development.