Performance of long-term CT monitoring in diagnosing bronchiolitis obliterans after lung transplantation
Section snippets
Patients
Of all adult patients transplanted between December 1996 and March 2001 in our hospital, 40 (21 women and 19 men) had survived for 11 months or more (Table 1). They were all included in the present study. The median age of the patients at transplantation was 51 years (range 18–61 years). In the bilaterally transplanted (BLT) group (29 patients, 16 women and 13 men), the median age was 50 years (range 18–61 years), and in the single lung transplanted (SLT) group (11 patients, 5 women and 6 men)
Results
Patients were followed-up for a median of 36 months (range 11–84 months). A total of 292 inspiratory, technically successful HRCT examinations were performed and examined. Expiratory scans with MinIP-reconstruction had been performed in 225 of these examinations. The number of expiratory scans with MinIP-reconstruction was lower than inspiratory HRCT scans because expiratory scans were not performed in any patient at the 1 month's and in 10 patients at the 3 months’ follow-up examination. At
Discussion
Early diagnosis of BOS in lung transplanted patients is important, because prompt initiation of therapy may help to preserve lung function [3]. However, in most of our patients, air trapping was detected concomitantly with or later than the development of BOS as diagnosed clinically with the aid of respiratory function tests. Therefore, CT according to our protocol had limited clinical value in the early diagnosis of BOS. Our findings were in agreement with previous studies, which documented
Acknowledgement
We thank Arnold Berstad for helpful assistance in reviewing the manuscript.
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Cited by (21)
Noninvasive methods for detection of chronic lung allograft dysfunction in lung transplantation
2020, Transplantation ReviewsCitation Excerpt :In later stages, bronchiectasis, traction, central and peripheral consolidation, architectural deformation, volume loss and hilum retraction were more obvious [48]. As a conventional imaging technique, the sensitivity of CT for detecting early small airway and interstitial changes is controversial [49,50]. Konen et al. [51] found that air trapping before other clinical manifestations is a reliable indicator of the early stages of BOS.
Lobe-wise assessment of lung volume and density distribution in lung transplant patients and value for early detection of bronchiolitis obliterans syndrome
2018, European Journal of RadiologyCitation Excerpt :Some studies in lung transplant patients have shown a correlation between morphological lung changes and the presence of BOS [17,18]. Nevertheless, these findings are not sufficient in order to reliably diagnose BOS before it results in clinically apparent functional impairment [15,19,20]. Quantitative computed tomography is increasingly being used in the characterization of lung disease, especially in chronic obstructive pulmonary disease [21,22].
Machine Learning Algorithms Utilizing Quantitative CT Features May Predict Eventual Onset of Bronchiolitis Obliterans Syndrome After Lung Transplantation
2018, Academic RadiologyCitation Excerpt :We hypothesize that these findings reflect an increase in the extent of air trapping and peribronchiolar fibrosis related to the progressive airflow obstruction, which characterizes the BOS phenotype of CLAD after LTx. Previous studies have also shown evidence of air trapping on expiratory CT scans and have pointed this as an indicator of the small airway disease that underlies BOS (1,16,20). On the other hand, changes in lung structure and airways for the non-BOS cohort were more evident at TLC and in an opposite direction (decrease in central airway volume), illustrating that for these patients, the nonsustained decline in FEV1 is not associated with obliterative bronchiolitis (as would be expected with BOS), but rather with large airway bronchial wall thickening (resulting in decreases in central airways luminal volume), reflecting bronchitis or interstitial edema, as these changes were by definition reversible (eg, these patients recovered their FEV1 and did not develop BOS).
CT at onset of chronic lung allograft dysfunction in lung transplant patients predicts development of the restrictive phenotype and survival
2017, European Journal of RadiologyCitation Excerpt :Previous studies reported bronchiectasis, air trapping, consolidations, ground glass opacities and reticular changes in lung transplant patients with BOS [5,7,9,23]. These imaging findings alone were not sufficient to diagnose BOS reliably before it becomes clinically apparent [24–27]. Recently, different phenotypes of CLAD were described [10–12] and CT came more into the focus to differentiate between restrictive and non-restrictive phenotypes [14,19].
Imaging of Small Airways Disease and Chronic Obstructive Pulmonary Disease
2008, Clinics in Chest MedicineCitation Excerpt :In lung transplant recipients, constrictive bronchiolitis occurs as a manifestation of chronic rejection. The CT features of post-transplant bronchiolitis obliterans include bronchial dilation, decreased lung attenuation, and expiratory air trapping [7,54–62]. Of these, the most sensitive manifestations are bronchial dilation and expiratory air trapping.
Findings on High Resolution Computed Tomography in Symptomatic Veterans with Deployment-Related Lung Disease
2023, Journal of Thoracic Imaging