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Bronchiolitis obliterans after lung transplantation: detection using expiratory HRCT
A N Leung1, K Fisher, V Valentine
1Department of Radiology, Stanford University Medical Center, Calif 94305-5105, USA.
Chest
|March 14, 1998
Summary
Air trapping on expiratory CT scans is a highly accurate indicator of bronchiolitis obliterans (BO) in lung transplant recipients. This finding is more sensitive and precise than other imaging signs for diagnosing BO.
Area of Science:
- Pulmonary Medicine
- Radiology
- Transplant Surgery
Background:
- Bronchiolitis obliterans (BO) is a major cause of graft dysfunction after lung transplantation.
- Early detection of BO is crucial for patient management and graft survival.
Purpose of the Study:
- To evaluate the utility of air trapping, identified via expiratory high-resolution computed tomography (HRCT), as an early diagnostic marker for BO in lung transplant recipients.
- To compare the diagnostic performance of air trapping with other HRCT findings like bronchiectasis and mosaic attenuation.
Main Methods:
- A cohort of 21 lung transplant recipients underwent inspiratory and expiratory HRCT and spirometry.
- Radiologists assessed HRCT images for bronchiectasis, mosaic attenuation, and air trapping.
- Findings were correlated with transbronchial biopsy results to confirm or exclude BO.
Main Results:
- Air trapping on expiratory HRCT showed a sensitivity of 91%, specificity of 80%, and accuracy of 86% for detecting BO.
- In contrast, bronchiectasis and mosaic pattern had lower sensitivity and accuracy.
- Air trapping was detected even in one patient with normal spirometry, highlighting its sensitivity for early changes.
Conclusions:
- Expiratory HRCT demonstrating air trapping is the most sensitive and accurate radiologic tool for identifying bronchiolitis obliterans in lung transplant patients.
- Air trapping can serve as a valuable, non-invasive indicator of BO, potentially preceding functional decline detected by spirometry.