Knollmann Friedrich D, Kapell Susanne, Lehmkuhl Hans, Schulz Bernhard, Böttcher Heidi, Hetzer Roland, Felix Roland
Department of Radiology, Charité, Campus Virchow-Klinikum, Humboldt-University, Berlin, Germany.
Chest. 2004 Aug;126(2):447-56. doi: 10.1378/chest.126.2.447.
To determine the diagnostic capabilities of dynamic high-resolution electron-beam (HREB) CT scanning for diagnosing bronchiolitis obliterans syndrome (BOS) in lung transplant recipients.
At the time of follow-up examinations after lung transplantation, 52 patients were examined by dynamic HREB CT scan. Visual signs of small airway disease were assessed and compared with lung function. For numerical analysis, the mean lung attenuation and its SD were determined and compared with the course of lung function tests.
On visual analysis, significant parenchymal attenuation inhomogeneities were present in eight of nine patients with manifest BOS, and in two of four patients who developed BOS during follow-up. Thirteen of 20 patients with persistent normal lung function displayed homogeneous lung attenuation. On numerical analysis, mean lung attenuation was significantly lower in patients who developed BOS during follow-up than in patients with persistent normal lung function (both in expiration and inspiration, p < 0.0001). With an optimal threshold, the sensitivity was 100% (4 of 4 patients) and the specificity was 90% (19 of 20 patients). In patients with BOS at the time of the CT scan examination, parenchymal attenuation was less homogeneous than in patients with persistent normal lung function (p < 0.0001). With an optimal threshold, the sensitivity was 78% (7 of 9 patients) and the specificity was 85% (17 of 20 patients).
Dynamic HREB CT of lung transplant recipients correlates well with lung function criteria of BOS at the time of the CT examination and with the subsequent progression to BOS.
确定动态高分辨率电子束(HREB)CT扫描对诊断肺移植受者闭塞性细支气管炎综合征(BOS)的诊断能力。
在肺移植后的随访检查时,对52例患者进行了动态HREB CT扫描。评估小气道疾病的视觉征象并与肺功能进行比较。进行数值分析时,测定平均肺衰减及其标准差,并与肺功能测试过程进行比较。
视觉分析显示,9例明显患有BOS的患者中有8例存在明显的实质衰减不均匀,4例在随访期间发生BOS的患者中有2例存在此情况。20例肺功能持续正常的患者中有13例肺衰减均匀。数值分析显示,随访期间发生BOS的患者的平均肺衰减明显低于肺功能持续正常的患者(呼气和吸气时均p<0.0001)。采用最佳阈值时,敏感性为100%(4例患者中的4例),特异性为90%(20例患者中的19例)。在CT扫描检查时患有BOS的患者中,实质衰减比肺功能持续正常的患者更不均匀(p<0.0001)。采用最佳阈值时,敏感性为78%(9例患者中的7例),特异性为85%(20例患者中的17例)。
肺移植受者的动态HREB CT与CT检查时BOS的肺功能标准以及随后进展为BOS的情况密切相关。