Bronchiolitis obliterans after lung transplantation

Detection using expiratory HRCT

Ann N. Leung, Kendra Fisher, Vincent Valentine, Reda E. Girgis, Gerald J. Berry, Robert C. Robbins, James Theodore

Research output: Contribution to journalArticle

118 Citations (Scopus)

Abstract

Objective: The objective of this study was to determine if air trapping, as detected on expiratory high-resolution CT (HRCT), is useful as an indicator of bronchiolitis obliterans (BO) in lung transplant recipients. Materials and methods: Corresponding inspiratory and expiratory HRCT images at five different levels and spirometry were obtained in 21 lung transplant recipients. Eleven patients had BO proved by transbronchial biopsy specimens; the remaining 10 patients had no pathologic or functional evidence of airways disease. Two 'blinded' observers assessed the inspiratory images for the presence of bronchiectasis and mosaic pattern of lung attenuation, and the expiratory images for presence and extent of air trapping. Statistical comparison of the frequency of HRCT findings between patients with and without BO was performed using Fishers Exact Test. Results: On inspiratory images, bronchiectasis and mosaic pattern of lung attenuation were present in 4 (36%) and 7 (64%) of 11 patients with BO, and 2 (20%) and 1 (10%) of 10 patients without BO (p>0.05 and p<0.05), respectively. The sensitivity, specificity, and accuracy of bronchiectasis and mosaic pattern for BO were 36%, 80%, and 57%, and 64%, 90%, and 70%, respectively. On expiratory images, air trapping was found in 10 of 11 (91%) patients with BO compared to 2 of 10 (20%) patients without BO (p<0.002). Air trapping was found to have a sensitivity of 91%, specificity of 80%, and accuracy of 86% for BO. Air trapping was identified in one patient with BO who had normal results of baseline spirometric function tests. Conclusion: Air trapping, as detected on expiratory HRCT, was the most sensitive and accurate radiologic indicator of BO in the lung transplant population.

Original languageEnglish (US)
Pages (from-to)365-670
Number of pages306
JournalChest
Volume113
Issue number2
StatePublished - 1998
Externally publishedYes

Fingerprint

Bronchiolitis Obliterans
Lung Transplantation
Air
Bronchiectasis
Lung
Sensitivity and Specificity
Spirometry

Keywords

  • Chronic allograft rejection
  • Computed tomography
  • Lung transplantation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Leung, A. N., Fisher, K., Valentine, V., Girgis, R. E., Berry, G. J., Robbins, R. C., & Theodore, J. (1998). Bronchiolitis obliterans after lung transplantation: Detection using expiratory HRCT. Chest, 113(2), 365-670.

Bronchiolitis obliterans after lung transplantation : Detection using expiratory HRCT. / Leung, Ann N.; Fisher, Kendra; Valentine, Vincent; Girgis, Reda E.; Berry, Gerald J.; Robbins, Robert C.; Theodore, James.

In: Chest, Vol. 113, No. 2, 1998, p. 365-670.

Research output: Contribution to journalArticle

Leung, AN, Fisher, K, Valentine, V, Girgis, RE, Berry, GJ, Robbins, RC & Theodore, J 1998, 'Bronchiolitis obliterans after lung transplantation: Detection using expiratory HRCT', Chest, vol. 113, no. 2, pp. 365-670.
Leung AN, Fisher K, Valentine V, Girgis RE, Berry GJ, Robbins RC et al. Bronchiolitis obliterans after lung transplantation: Detection using expiratory HRCT. Chest. 1998;113(2):365-670.
Leung, Ann N. ; Fisher, Kendra ; Valentine, Vincent ; Girgis, Reda E. ; Berry, Gerald J. ; Robbins, Robert C. ; Theodore, James. / Bronchiolitis obliterans after lung transplantation : Detection using expiratory HRCT. In: Chest. 1998 ; Vol. 113, No. 2. pp. 365-670.
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abstract = "Objective: The objective of this study was to determine if air trapping, as detected on expiratory high-resolution CT (HRCT), is useful as an indicator of bronchiolitis obliterans (BO) in lung transplant recipients. Materials and methods: Corresponding inspiratory and expiratory HRCT images at five different levels and spirometry were obtained in 21 lung transplant recipients. Eleven patients had BO proved by transbronchial biopsy specimens; the remaining 10 patients had no pathologic or functional evidence of airways disease. Two 'blinded' observers assessed the inspiratory images for the presence of bronchiectasis and mosaic pattern of lung attenuation, and the expiratory images for presence and extent of air trapping. Statistical comparison of the frequency of HRCT findings between patients with and without BO was performed using Fishers Exact Test. Results: On inspiratory images, bronchiectasis and mosaic pattern of lung attenuation were present in 4 (36{\%}) and 7 (64{\%}) of 11 patients with BO, and 2 (20{\%}) and 1 (10{\%}) of 10 patients without BO (p>0.05 and p<0.05), respectively. The sensitivity, specificity, and accuracy of bronchiectasis and mosaic pattern for BO were 36{\%}, 80{\%}, and 57{\%}, and 64{\%}, 90{\%}, and 70{\%}, respectively. On expiratory images, air trapping was found in 10 of 11 (91{\%}) patients with BO compared to 2 of 10 (20{\%}) patients without BO (p<0.002). Air trapping was found to have a sensitivity of 91{\%}, specificity of 80{\%}, and accuracy of 86{\%} for BO. Air trapping was identified in one patient with BO who had normal results of baseline spirometric function tests. Conclusion: Air trapping, as detected on expiratory HRCT, was the most sensitive and accurate radiologic indicator of BO in the lung transplant population.",
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AU - Berry, Gerald J.

AU - Robbins, Robert C.

AU - Theodore, James

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KW - Chronic allograft rejection

KW - Computed tomography

KW - Lung transplantation

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