Lobe-wise assessment of lung volume and density distribution in lung transplant patients and value for early detection of bronchiolitis obliterans syndrome. Issue 106 (September 2018)

• Record Type: Journal Article
• Authors: Dettmer, S.; Suhling, H.; Klingenberg, I.; Otten, O.; Kaireit, T.; Fuge, J.; Kuhnigk, J.M.; Gottlieb, J.; Haverich, A.; Welte, T.; Wacker, F.; Vogel-Claussen, J.; Shin, H.O.
• Is Part Of: European journal of radiology. Issue 106(2018)
• Page Start: 137
• Page End: 144
• Publication Date: 2018-09
• Subjects: BOS Bronchiolitis obliterans syndrome -- CLAD chronic lung allograft dysfunction -- E/I expiration/inspiration ratio -- FWHM full width half maximum -- HAV high attenuation values -- LAV low attenuation values -- LLL left lower lobe -- LUL left upper lobe -- MLD mean lung density -- P10 10th percentile -- P20 20th percentile -- P30 30th percentile -- P40 40th percentile -- P50 50th percentile -- RAS restrictive allograft syndrome -- RLL right lower lobe -- RUL right upper lobe -- SD standard deviation; Lung transplantation -- Chronic lung allograft dysfunction -- Bronchiolitis obliterans syndrome -- Quantitative lung analysis; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2018.07.016
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Changes of lung density differed significantly between patients with / without early BOS. BOS patients had increased lung volume and decreased lung density. Changes indicate increased inflation and were pronounced in the lower lung lobes. Abstract: Purpose: To evaluate quantitative computed tomography (CT) measurements of the lung parenchyma in lung transplant (LTx) patients for early detection of the bronchiolitis obliterans syndrome (BOS). Materials and Methods: 359 CT scans of 122 lung transplant patients were evaluated. Measurements of lung volume and density were performed for the whole lung and separately for each lobe. For longitudinal analysis the difference between the baseline at 6 months after LTx and follow-up examinations was calculated. Patients with and without BOS (matched 1:2) were compared at two different time points, the last examination before the BOS onset and the first examination within one year after BOS onset. Results: 30 patients developed BOS during the follow-up period. Longitudinal changes in the lung volume and lung density measured on CT differed significantly between those patients with and without early BOS, in particular the difference of the inspiratory and expiratory lung volume (p < 0.001), the ratio of the expiratory and inspiratory lung volume (p < 0.001-p = 0.001) and MLD (p < 0.001-p = 0.001), the volume on expiration (p < 0.001-p = 0.007), the MLD on expiration (p < 0.001-p = 0.007), and the percentiles on expiration (p < 0.001-p = 0.002) with an increase of lung volume and a decrease of lung density. Changes were pronounced in the lower lobes. Before BOS onset, patients with and without future development of BOS showed no significant differences. Conclusion: Longitudinal changes of lung volume and lung density measured on CT start markedly at BOS onset with increased lung volume and decreased lung density indicating increased inflation levels. Even though this method may help to diagnose BOS at onset it is not useful as a predictor for BOS before disease onset.