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1 From the Department of Radiology, Stanford University Medical Center, Stanford, Calif
2 From the Department of Radiology, Royal University Hospital, Saskatoon, Saskatchewan, Canada
3 From the Department of Pulmonary and Critical Care, Oshner Clinic, New Orleans
4 From the Department of Pulmonary and Critical Care, Wayne State University School of Medicine, Detroit
5 From the Department of Pathology, Stanford University Medical Center, Stanford, Calif
6 From the Department of Cardiothoracic Surgery, Stanford University Medical Center, Stanford, Calif
7 From the Department of Pulmonary and Critical Care, Stanford University Medical Center, Stanford, Calif
Objective: The objective of this study was to determine if air trapping, as detected on expiratory high-resolution CT (HRCT), is useful as an indicator of bronchiolitis obliterans (BO) in lung transplant recipients.
Materials and methods: Corresponding inspiratory and expiratory HRCT images at five different levels and spirometry were obtained in 21 lung transplant recipients. Eleven patients had BO proved by transbronchial biopsy specimens; the remaining 10 patients had no pathologic or functional evidence of airways disease. Two "blinded" observers assessed the inspiratory images for the presence of bronchiectasis and mosaic pattern of lung attenuation, and the expiratory images for presence and extent of air trapping. Statistical comparison of the frequency of HRCT findings between patients with and without BO was performed using Fisher's Exact Test.
Results: On inspiratory images, bronchiectasis and mosaic pattern of lung attenuation were present in 4 (36%) and 7 (64%) of 11 patients with BO, and 2 (20%) and 1 (10%) of 10 patients without BO (p>0.05 and p<0.05), respectively. The sensitivity, specificity, and accuracy of bronchiectasis and mosaic pattern for BO were 36%, 80%, and 57%, and 64%, 90%, and 70%, respectively. On expiratory images, air trapping was found in 10 of 11 (91%) patients with BO compared to 2 of 10 (20%) patients without BO (p<0.002). Air trapping was found to have a sensitivity of 91%, specificity of 80%, and accuracy of 86% for BO. Air trapping was identified in one patient with BO who had normal results of baseline spirometric function tests.
Conclusion: Air trapping, as detected on expiratory HRCT, was the most sensitive and accurate radiologic indicator of BO in the lung transplant population.
Key Words: chronic allograft rejection • computed tomography • lung transplantation
Submitted on April 23, 1997
Accepted on July 18, 1997
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