Miller W T, Kotloff R M, Blumenthal N P, Aronchick J M, Gefter W B, Miller W T
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA.
J Thorac Imaging. 2001 Apr;16(2):76-80. doi: 10.1097/00005382-200104000-00002.
This study was undertaken to evaluate the efficacy of high resolution computed tomography (HRCT) in predicting the development of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients. Fifty lung transplant patients who were clinically stable and without evidence of BOS were evaluated for the presence of four HRCT features reported to be associated with bronchiolitis obliterans: mosaic attenuation on inspiratory CT (mosaic perfusion), mosaic attenuation on expiratory CT (air trapping), bronchiectasis, and tree-in-bud opacities. CT exams were part of an annual surveillance process with the hope of predicting subsequent development of BOS. Diagnosis of BOS was made in 9 of 50 patients as indicated by a fall in FEV1 of greater than 20% of a stable baseline. None of the radiographic features associated with clinically established BOS were both sensitive and specific in the prediction of BOS. Air trapping demonstrated moderate sensitivity (56%, 5/9) and moderate specificity (76%, 35/46) for prediction of BOS in the year following the CT exam. Bronchiectasis, the most reliable indicator of the presence of BOS was a poor predictor of subsequent BOS with an 11% (1/9) sensitivity but had high specificity (96%, 44/46). No high resolution CT features accurately predicted the development of BOS.
本研究旨在评估高分辨率计算机断层扫描（HRCT）在预测肺移植受者闭塞性细支气管炎综合征（BOS）发生方面的疗效。对50例临床稳定且无BOS证据的肺移植患者进行评估，以确定是否存在据报道与闭塞性细支气管炎相关的四种HRCT特征：吸气CT上的马赛克样衰减（马赛克灌注）、呼气CT上的马赛克样衰减（空气潴留）、支气管扩张和树芽征。CT检查是年度监测过程的一部分，希望能预测BOS的后续发生。50例患者中有9例被诊断为BOS，表现为FEV1较稳定基线下降超过20%。与临床确诊的BOS相关的影像学特征在预测BOS时均不具有敏感性和特异性。空气潴留对CT检查后一年BOS的预测显示出中等敏感性（56%，5/9）和中等特异性（76%，35/46）。支气管扩张是BOS存在的最可靠指标，但对后续BOS的预测较差，敏感性为11%（1/9），但特异性较高（96%，44/46）。没有高分辨率CT特征能准确预测BOS的发生。
