Bronchiectasis Radiology Index Score
Understanding the Reiff and Modified Reiff Scoring Systems
The Reiff score (and its modified version) is a semi-quantitative CT scoring system that evaluates three key components: bronchiectasis extent, bronchial wall thickening severity, and bronchial wall dilatation severity across all lung lobes. 1
Components of the Reiff Score
The scoring system evaluates:
- Bronchiectasis extent: Assessed by counting the number of bronchopulmonary segments affected across all lung lobes 1
- Bronchial wall thickening severity: Graded on a scale from 0 (none) to 3 (severe) for each anatomical level 2
- Bronchial wall dilatation severity: Similarly graded from 0 (none) to 3 (severe), taking into account the degree of airways dilatation 2
Calculation Method
The Modified Reiff score is calculated by evaluating each lung lobe separately and then summing the scores across all affected regions. 3 The assessment involves:
- Examining high-resolution CT (HRCT) scans at standardized anatomical levels 2
- Scoring each lobe for the presence and severity of bronchiectasis 1
- Quantifying bronchial wall changes using the 0-3 grading scale 2
- Summing individual component scores to generate a total score 1
Clinical Significance and Disease Severity Correlation
Radiologic-Clinical Correlations
Higher Modified Reiff scores correlate significantly with worse disease severity markers including lower FEV1, more frequent exacerbations requiring hospitalization, and greater dyspnea symptoms. 3 Specifically:
- Patients with obstructive ventilatory disorders demonstrate significantly higher Modified Reiff scores [median 6 (IQR 3-10)] compared to those with normal ventilation 3
- The score correlates with both FACED and Bronchiectasis Severity Index (BSI) scores 3
- More severe radiologic findings on the Modified Reiff score are associated with more severe lung function impairment 3
Important Clinical Caveat
Normal pulmonary function tests may coexist with significant HRCT abnormalities and elevated Reiff scores, meaning spirometry alone is not an accurate method for assessing bronchial structural damage severity in bronchiectasis. 1 This underscores why radiologic scoring remains essential for comprehensive disease assessment.
Practical Application in Management
When to Use CT Scoring
Non-contrast HRCT with thin-section (1.5 mm) imaging is the reference standard for detecting and quantifying bronchiectasis, as chest radiography is insensitive (up to 34% false-negative rate). 4 The British Thoracic Society recommends HRCT as the examination of choice for evaluating suspected bronchiectasis 2, 4
Prognostic Value
CT findings of bronchiectasis involving ≥3 lobes are associated with poorer outcomes and incorporated into severity scores with high predictive value for exacerbations, hospitalizations, and mortality. 2 The radiologic extent directly influences:
- Risk stratification for future exacerbations 2
- Hospitalization rates over 1-4 years 2
- Mortality predictions 2
- Treatment eligibility decisions 2
Limitations of the Reiff Score
While the Reiff score provides objective quantification, no semi-quantitative visual scoring system has been shown to be superior to other visual methods, and literature on clinical practice use remains limited. 2 Alternative simplified systems like BRICS (Bronchiectasis Radiologically Indexed CT Score) focus on just two parameters—bronchial dilatation and emphysema extent—and may be more practical for routine clinical use 5
Follow-Up Imaging Strategy
Follow-up HRCT within 12 months is advisable for patients with progressive pulmonary fibrosis or clinical/functional decline; side-by-side comparison with baseline scans is strongly recommended to reduce variability. 2, 6 Multi-planar reconstruction on sagittal and coronal planes should be evaluated to increase diagnostic confidence 2