Macori F, Iacari V, Falchetto Osti M, Potente G, Anaveri G
Istituto di Radiologia, Università degli Studi La Sapienza, Roma.
Radiol Med. 1998 Jul-Aug;96(1-2):42-7.
High Resolution Computed Tomography (HRCT) has been used by many authors to study the early complications of lung transplantation. Bronchoscopy, transbronchial biopsy and the clinical parameters are the tools of choice to diagnose such complications; HRCT showed excellent sensitivity (100%) and good specificity (93%) especially in detecting bronchial stenoses. We report the preliminary results of HRCT in detecting early/late complications in lung transplant recipients.
Sixteen lung transplant recipients (5 single and 11 double transplants) were examined with HRCT at the Servizio Speciale Diagnostica V of "La Sapienza" University (Rome, Italy). The CT findings were compared with the results of bronchoscopy and respiratory function tests. The patients (8 men and 8 women; age range: 18-57 years, mean: 37.5) had cystic fibrosis (9), emphysema (3), alpha-1-antitrypsin deficiency (1), idiopathic pulmonary fibrosis (2), and bronchiectasis (1).
During the follow-up, one patient died of pulmonary edema. CT findings were normal in 3 patients and mild pleural effusion was seen in 2. The other HRCT findings were: bronchial stenosis in 5 cases (which was bilateral in 1) and bronchial dehiscence in 1 patient; four cases of infection (1 CMV, 1 aspecific bacterial pneumonia, 1 Chlamydia psittacea and 1 Aspergillosis) and one of brochiolitis obliterans. A patient was treated for acute and one for chronic rejection. A CMV infection involved only the native lung in a patient. CT is easy to perform and a repeatable and well-tolerated tool with high sensitivity (100%) and good specificity (93%) in the early diagnosis of complications, particularly bronchial stenoses, which complications are often missed at bronchoscopy or clinically silent. CT should be always performed before bronchoscopy because it can provide valuable information for bronchoscopy targeting.
In agreement with other authors we consider HRCT a very useful tool in the early diagnosis of the complications following lung transplantation.
许多作者已使用高分辨率计算机断层扫描（HRCT）来研究肺移植的早期并发症。支气管镜检查、经支气管活检和临床参数是诊断此类并发症的首选工具；HRCT显示出极佳的敏感性（100%）和良好的特异性（93%），尤其是在检测支气管狭窄方面。我们报告了HRCT在检测肺移植受者早期/晚期并发症方面的初步结果。
在意大利罗马“La Sapienza”大学的特殊诊断服务五科，对16例肺移植受者（5例单肺移植和11例双肺移植）进行了HRCT检查。将CT检查结果与支气管镜检查结果和呼吸功能测试结果进行比较。患者（8名男性和8名女性；年龄范围：18 - 57岁，平均37.5岁）患有囊性纤维化（9例）、肺气肿（3例）、α-1抗胰蛋白酶缺乏症（1例）、特发性肺纤维化（2例）和支气管扩张症（1例）。
在随访期间，1例患者死于肺水肿。3例患者的CT检查结果正常，2例可见轻度胸腔积液。其他HRCT检查结果包括：5例支气管狭窄（其中1例为双侧）和1例支气管裂开；4例感染（1例巨细胞病毒感染、1例非特异性细菌性肺炎、1例鹦鹉热衣原体感染和1例曲霉菌感染）以及1例闭塞性细支气管炎。1例患者接受了急性排斥反应治疗，1例接受了慢性排斥反应治疗。1例患者的巨细胞病毒感染仅累及原生肺。CT操作简便，是一种可重复且耐受性良好的工具，在并发症的早期诊断中具有高敏感性（100%）和良好的特异性（93%），尤其是支气管狭窄，而这些并发症在支气管镜检查时常常被遗漏或临床上无明显症状。在进行支气管镜检查之前应始终进行CT检查，因为它可为支气管镜检查的靶点提供有价值的信息。
与其他作者一致，我们认为HRCT是肺移植后并发症早期诊断的非常有用的工具。
