Park C H, Paik H C, Haam S J, Lim B J, Byun M K, Shin J A, Kim H J, Hwang S H, Kim T H
Department of Radiology and Research Institute of Radiological Science, Yonsei University Health System, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
Transplant Proc. 2014 Jun;46(5):1511-6. doi: 10.1016/j.transproceed.2013.12.060.
This study sought to evaluate the high-resolution computed tomography (HRCT) features of acute rejection and to assess the diagnostic accuracy of HRCT for acute rejection considering distribution of lesions in patients with bilateral lung transplantation (BLT).
Between March 2010 and June 2012, 48 transbronchial lung biopsies (TBLBs) and HRCT were performed simultaneously in 26 patients who underwent BLT. We evaluated the presence of ground glass opacity (GGO), consolidation, nodule, bronchial wall thickening, interlobular septal thickening, pleural effusion, atelectasis, bronchiectasis, and cardiomegaly on the HRCT images. The distribution of lesions was analyzed according to bilaterality or upper/lower predominance. Acute rejection was determined on the basis of the pathologic results of TBLB. We evaluated potential correlations of HRCT features with acute rejection, then assessed overall diagnostic accuracy of various HRCT features in combination to diagnose acute rejection in the transplanted lung.
Among the 48 TBLBs, 8 were diagnosed as acute rejection (A1, 4 cases; A2, 2 cases; and A3, 2 cases) pathologically. Two A1 rejections and one A2 rejection appeared normal on computed tomography images. Without considering the distribution of lesions, interlobular septal thickening was significantly associated with acute rejection (P = .010) only. Regarding the distribution of lesions on HRCT images, not only interlobular septal thickening but also GGO was significantly associated with acute rejection (P < .05). The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the HRCT scan in the evaluation of acute rejection were 50%, 97.5%, 80%, 90.1%, and 89.6%, when the bilateral GGO and interlobular septal thickening with lower predominance were considered as the positive finding.
HRCT findings considering lesion distribution could be a useful tool in diagnosing acute rejection in patients with BLT.
本研究旨在评估急性排斥反应的高分辨率计算机断层扫描（HRCT）特征，并考虑双侧肺移植（BLT）患者病变分布情况，评估HRCT对急性排斥反应的诊断准确性。
2010年3月至2012年6月期间，对26例行BLT的患者同时进行了48次经支气管肺活检（TBLB）和HRCT检查。我们在HRCT图像上评估了磨玻璃影（GGO）、实变、结节、支气管壁增厚、小叶间隔增厚、胸腔积液、肺不张、支气管扩张和心脏增大的存在情况。根据双侧性或上/下优势分析病变的分布。根据TBLB的病理结果确定急性排斥反应。我们评估了HRCT特征与急性排斥反应的潜在相关性，然后评估了各种HRCT特征联合诊断移植肺急性排斥反应的总体诊断准确性。
在48次TBLB中，8例经病理诊断为急性排斥反应（A1，4例；A2，2例；A3，2例）。2例A1排斥反应和1例A2排斥反应在计算机断层扫描图像上表现正常。不考虑病变分布时，仅小叶间隔增厚与急性排斥反应显著相关（P = 0.010）。关于HRCT图像上的病变分布，不仅小叶间隔增厚，而且GGO也与急性排斥反应显著相关（P < 0.05）。当将双侧GGO和以较低优势为主的小叶间隔增厚视为阳性发现时，HRCT扫描评估急性排斥反应的敏感性、特异性、阳性预测值、阴性预测值和总体准确性分别为50%、97.5%、80%、90.1%和89.6%。
考虑病变分布的HRCT表现可能是诊断BLT患者急性排斥反应的有用工具。
