Berstad Audun E, Aaløkken Trond Mogens, Kolbenstvedt Alf, Bjørtuft Oystein
Department of Radiology, Rikshospitalet University Hospital, Sognsvannsveien 20, N-0027 Oslo, Norway.
Eur J Radiol. 2006 Apr;58(1):124-31. doi: 10.1016/j.ejrad.2005.11.013. Epub 2006 Jan 4.
The purpose of the study was to evaluate the ability of CT, including expiratory scans with minimum intensity projection in predicting the development of bronchiolitis obliterans syndrome after lung transplantation.
Forty consecutive patients, 29 bilateral and 11 single lung transplanted, were followed-up with regular scans for a median of 36 months. Air trapping was evaluated on expiratory scans constructed from two short spiral scans with minimum intensity projection-technique, one at the level of the carina and the other midway between the right diaphragm and the carina. Air trapping was scored on a 16-point scale. Bronchiolitis obliterans syndrome was diagnosed according to established clinical criteria and quantified spirometrically.
Bronchiolitis obliterans syndrome developed in 17 patients (43%) after a median of 12 months. Air trapping and bronchiectasis was seen before the diagnosis of bronchiolitis obliterans syndrome in only two and one patient, respectively. Interobserver agreement for air trapping score was good (kappa = 0.65). Air trapping scores performed significantly better than that achieved by chance alone in determining the presence of bronchiolitis obliterans syndrome (P = 0.0025). An air trapping score of 4 or more provided the best results with regard to sensitivity and specificity in diagnosing bronchiolitis obliterans syndrome. The sensitivity, specificity, positive and negative predictive values of an air trapping of 4 or more in the diagnosis of bronchiolitis obliterans syndrome were 77, 74, 68 and 81%, respectively.
Expiratory CT scans with minimum intensity projection-reconstruction did not predict the development of bronchiolitis obliterans syndrome in most patients. The findings seriously limit the clinical usefulness of long-term CT monitoring for diagnosing bronchiolitis obliterans syndrome after lung transplantation.
本研究旨在评估CT（包括采用最小密度投影的呼气期扫描）预测肺移植后闭塞性细支气管炎综合征发生的能力。
连续纳入40例患者，其中29例行双侧肺移植，11例行单肺移植，定期进行扫描随访，中位随访时间为36个月。采用最小密度投影技术，通过两次短螺旋扫描构建呼气期扫描图像，分别在隆突水平以及右膈与隆突之间的中点水平评估气体陷闭情况。气体陷闭情况采用16分制评分。闭塞性细支气管炎综合征根据既定的临床标准进行诊断，并通过肺量计进行定量评估。
17例患者（43%）在中位时间12个月后发生闭塞性细支气管炎综合征。在闭塞性细支气管炎综合征诊断前，仅分别有2例和1例患者出现气体陷闭和支气管扩张。气体陷闭评分的观察者间一致性良好（kappa = 0.65）。在确定闭塞性细支气管炎综合征的存在方面，气体陷闭评分的表现显著优于单纯靠随机猜测（P = 0.0025）。气体陷闭评分为4分或更高时，在诊断闭塞性细支气管炎综合征方面的敏感性和特异性最佳。气体陷闭评分为4分或更高时，诊断闭塞性细支气管炎综合征的敏感性、特异性、阳性预测值和阴性预测值分别为77%、74%、68%和81%。
采用最小密度投影重建的呼气期CT扫描不能预测大多数患者闭塞性细支气管炎综合征的发生。这些结果严重限制了长期CT监测在诊断肺移植后闭塞性细支气管炎综合征方面的临床实用性。
