Low-dose computed tomography volumetry for subtyping chronic lung allograft dysfunction

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• 作者：Tomohito Saito ; MD ; PhD^a ; ^b ; Miho Horie ; MSc^c ; Masaaki Sato ; MD ; PhD^a ; ^d ; Daisuke Nakajima ; MD^a ; ^d ; Hassan Shoushtarizadeh ; MD^c ; Matthew Binnie ; MD^e ; Sassan Azad ; CRE^a ; David M. Hwang ; MD ; PhD^a ; Tiago N. Machuca ; MD ; PhD^a ; Thomas K. Waddell ; MD ; PhD^a ; Lianne G. Singer ; MD^e ; Marcelo Cypel ; MD ; MSc^a ; Mingyao Liu ; MD ; MSc^a ; ^e ; Narinder S. Paul ; MD^c ; Shaf Keshavjee ; MD ; MSc^a ; ^b ; ^{shaf.keshavjee@uhn.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：bronchiolitis obliterans syndrome ; chronic lung allograft dysfunction ; computed tomography volumetry ; restrictive allograft syndrome ; total lung capacity
• 刊名：Journal of Heart and Lung Transplantation
• 出版年：2016
• 出版时间：January 2016
• 年：2016
• 卷：35
• 期：1
• 页码：59-66
• 全文大小：740 K

文摘

The long-term success of lung transplantation is challenged by the development of chronic lung allograft dysfunction (CLAD) and its distinct subtypes of bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS). However, the current diagnostic criteria for CLAD subtypes rely on total lung capacity (TLC), which is not always measured during routine post-transplant assessment. Our aim was to investigate the utility of low-dose 3-dimensional computed tomography (CT) lung volumetry for differentiating RAS from BOS.

Methods

This study was a retrospective evaluation of 63 patients who had developed CLAD after bilateral lung or heart‒lung transplantation between 2006 and 2011, including 44 BOS and 19 RAS cases. Median post-transplant follow-up was 65 months in BOS and 27 months in RAS. The median interval between baseline and the disease-onset time-point for CT volumetry was 11 months in both BOS and RAS. Chronologic changes and diagnostic accuracy of CT lung volume (measured as percent of baseline) were investigated.

Results

RAS showed a significant decrease in CT lung volume at disease onset compared with baseline (mean 3,916 ml vs 3,055 ml when excluding opacities, p < 0.0001), whereas BOS showed no significant post-transplant change (mean 4,318 ml vs 4,396 ml, p = 0.214). The area under the receiver operating characteristic curve of CT lung volume for differentiating RAS from BOS was 0.959 (95% confidence interval 0.912 to 1.01, p < 0.0001) and the calculated accuracy was 0.938 at a threshold of 85%.

Conclusion

In bilateral lung or heart‒lung transplant patients with CLAD, low-dose CT volumetry is a useful tool to differentiate patients who develop RAS from those who develop BOS.