Department of Medicine, University of California Los Angeles, Los Angeles, CA.
Department of Radiology, University of California Los Angeles, Los Angeles, CA.
Transplantation. 2022 Jun 1;106(6):1253-1261. doi: 10.1097/TP.0000000000003950. Epub 2022 May 23.
Chronic lung allograft dysfunction (CLAD) phenotype determines prognosis and may have therapeutic implications. Despite the clarity achieved by recent consensus statement definitions, their reliance on radiologic interpretation introduces subjectivity. The Center for Computer Vision and Imaging Biomarkers at the University of California, Los Angeles (UCLA) has established protocols for chest high-resolution computed tomography (HRCT)-based computer-aided quantification of both interstitial disease and air-trapping. We applied quantitative image analysis (QIA) at CLAD onset to demonstrate radiographic phenotypes with clinical implications.
We studied 47 first bilateral lung transplant recipients at UCLA with chest HRCT performed within 90 d of CLAD onset and 47 no-CLAD control HRCTs. QIA determined the proportion of lung volume affected by interstitial disease and air-trapping in total lung capacity and residual volume images, respectively. We compared QIA scores between no-CLAD and CLAD, and between phenotypes. We also assigned radiographic phenotypes based solely on QIA, and compared their survival outcomes.
CLAD onset HRCTs had more lung affected by the interstitial disease (P = 0.003) than no-CLAD controls. Bronchiolitis obliterans syndrome (BOS) cases had lower scores for interstitial disease as compared with probable restrictive allograft syndrome (RAS) (P < 0.0001) and mixed CLAD (P = 0.02) phenotypes. BOS cases had more air-trapping than probable RAS (P < 0.0001). Among phenotypes assigned by QIA, the relative risk of death was greatest for mixed (relative risk [RR] 11.81), followed by RAS (RR 6.27) and BOS (RR 3.15).
Chest HRCT QIA at CLAD onset appears promising as a method for precise determination of CLAD phenotypes with survival implications.
慢性肺移植物功能障碍（CLAD）表型决定预后，并可能具有治疗意义。尽管最近的共识声明定义已经明确，但它们依赖于放射学解释，这引入了主观性。加利福尼亚大学洛杉矶分校（UCLA）的计算机视觉和成像生物标志物中心已经建立了基于胸部高分辨率计算机断层扫描（HRCT）的计算机辅助量化间质疾病和空气潴留的协议。我们在 CLAD 发病时应用定量图像分析（QIA）来证明具有临床意义的放射学表型。
我们研究了 UCLA 47 例首次双侧肺移植受者，在 CLAD 发病后 90 天内进行了胸部 HRCT，以及 47 例无 CLAD 对照 HRCT。QIA 确定了间质疾病和空气潴留分别在总肺容量和残气量图像中影响的肺体积比例。我们比较了无 CLAD 和 CLAD 之间以及不同表型之间的 QIA 评分。我们还仅根据 QIA 分配放射学表型，并比较了它们的生存结果。
CLAD 发病时的 HRCT 比无 CLAD 对照组有更多的肺受间质疾病影响（P = 0.003）。与可能的限制性移植物综合征（RAS）（P < 0.0001）和混合 CLAD（P = 0.02）表型相比，闭塞性细支气管炎综合征（BOS）病例的间质疾病评分较低。BOS 病例的空气潴留比可能的 RAS 多（P < 0.0001）。在根据 QIA 分配的表型中，混合表型的死亡相对风险最大（相对风险 [RR] 11.81），其次是 RAS（RR 6.27）和 BOS（RR 3.15）。
CLAD 发病时的胸部 HRCT QIA 似乎是一种有前途的方法，可以精确确定具有生存意义的 CLAD 表型。
