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Quantitative Image Analysis at Chronic Lung Allograft Dysfunction Onset Predicts Mortality
S Samuel Weigt1, Grace-Hyun J Kim2, Heather D Jones3
1Department of Medicine, University of California Los Angeles, Los Angeles, CA.
Transplantation
|September 17, 2021
Summary
Quantitative image analysis of CT scans can precisely identify chronic lung allograft dysfunction (CLAD) phenotypes. This method reveals distinct radiographic patterns associated with different CLAD types and their impact on survival outcomes after lung transplantation.
Area of Science:
- Radiology
- Pulmonary Medicine
- Biomarkers
Background:
- Chronic lung allograft dysfunction (CLAD) is a major complication after lung transplantation.
- Current diagnostic criteria for CLAD phenotypes rely on subjective radiologic interpretation.
- Objective quantification of radiographic features is needed for precise CLAD phenotyping and management.
Purpose of the Study:
- To apply quantitative image analysis (QIA) to chest high-resolution computed tomography (HRCT) scans at the onset of CLAD.
- To demonstrate the ability of QIA to define distinct CLAD radiographic phenotypes.
- To correlate these QIA-defined phenotypes with clinical outcomes, specifically survival.
Main Methods:
- Chest HRCTs from 47 lung transplant recipients with CLAD onset and 47 controls without CLAD were analyzed.
- Quantitative image analysis (QIA) was used to measure the proportion of lung volume affected by interstitial disease and air-trapping.
- QIA scores were compared between CLAD and no-CLAD groups, and among different CLAD phenotypes (BOS, RAS, mixed).
Main Results:
- CLAD onset HRCTs showed significantly more interstitial disease compared to controls.
- Bronchiolitis obliterans syndrome (BOS) phenotypes had less interstitial disease but more air-trapping than restrictive allograft syndrome (RAS) and mixed CLAD.
- QIA-assigned phenotypes indicated a higher relative risk of death for mixed CLAD (RR 11.81), followed by RAS (RR 6.27), and BOS (RR 3.15).
Conclusions:
- Quantitative image analysis (QIA) of chest HRCT scans at CLAD onset offers a precise method for determining CLAD phenotypes.
- These QIA-derived radiographic phenotypes have significant survival implications.
- QIA holds promise for objective phenotyping and guiding therapeutic decisions in CLAD management.
