Sargent M A, Cairns R A, Murdoch M J, Nadel H R, Wensley D, Schultz K R
Department of Radiology, British Columbia's Children's Hospital, Vancouver, Canada.
AJR Am J Roentgenol. 1995 Mar;164(3):693-6. doi: 10.2214/ajr.164.3.7863896.
Obstructive lung disease is a major complication of bone marrow transplantation related to graft-versus-host disease. The purpose of this study was to determine the usefulness of high-resolution CT to evaluate obstructive lung disease occurring in children after bone marrow transplantation.
Ten high-resolution CT scans of the lungs were obtained in seven children who developed chronic obstructive lung disease after bone marrow transplantation. All seven patients had chronic graft-versus-host disease. Spirometry, the gold standard test, confirmed airflow obstruction in each case, five prior to high-resolution CT. Two patients were too young to have spirometry until 10 and 15 months respectively after successful high-resolution CT. Selected images from these studies were randomized with similar images from five control subjects and reviewed blindly. All images from scans in patients with obstructive lung disease were analyzed retrospectively for parenchymal hypoattenuation, bronchial dilatation, bronchial wall thickening, and abnormal parenchymal opacity. Expiratory air-trapping was assessed on cine high-resolution CT done in four cases.
Three blinded observers each correctly identified all five controls among 15 high-resolution CT examinations. No scan from a patient with obstructive lung disease was considered normal. Areas of parenchymal hypoattenuation affected 35 of 35 lobes of the lung. Expiratory air-trapping was shown by cine high-resolution CT. Subsegmental or segmental bronchial dilatation was seen in 23 of 25 lobes in five patients. Bronchial wall thickening was not a prominent feature. Increasing abnormality was demonstrated in three patients on follow-up high-resolution CT. The high-resolution CT abnormalities were similar to those reported in patients with bronchiolitis obliterans.
High-resolution CT of the lungs can show extensive abnormality in children who develop chronic obstructive lung disease after bone marrow transplantation. High-resolution CT is a useful noninvasive technique in the evaluation of this disease.
阻塞性肺病是骨髓移植与移植物抗宿主病相关的主要并发症。本研究的目的是确定高分辨率CT在评估骨髓移植后儿童发生的阻塞性肺病中的实用性。
对7例骨髓移植后发生慢性阻塞性肺病的儿童进行了10次肺部高分辨率CT扫描。所有7例患者均患有慢性移植物抗宿主病。肺功能测定作为金标准检测，在每例患者中均证实存在气流阻塞，其中5例在高分辨率CT检查之前就已确诊。有2例患者年龄太小，直到高分辨率CT检查成功后分别在10个月和15个月时才有条件进行肺功能测定。这些研究中的选定图像与来自5名对照受试者的类似图像随机混合，并进行盲法评审。对阻塞性肺病患者扫描的所有图像进行回顾性分析，以观察实质低密度、支气管扩张、支气管壁增厚和实质异常混浊。对4例患者进行的动态高分辨率CT评估呼气性气体潴留情况。
3名盲法观察者在15次高分辨率CT检查中均正确识别出所有5名对照者。阻塞性肺病患者的扫描结果均未被视为正常。实质低密度区域累及35个肺叶中的35个。动态高分辨率CT显示有呼气性气体潴留。5例患者的25个肺叶中有23个可见亚段或段支气管扩张。支气管壁增厚不是突出特征。3例患者在随访高分辨率CT检查中显示异常情况加重。高分辨率CT异常情况与闭塞性细支气管炎患者所报告的情况相似。
肺部高分辨率CT可显示骨髓移植后发生慢性阻塞性肺病儿童的广泛异常情况。高分辨率CT是评估该疾病的一种有用的非侵入性技术。
