Quantification of Pathologic Air Trapping in Lung Transplant Patients Using CT Density Mapping: Comparison with Other CT Air Trapping Measures

Solyanik, Olga; Hollmann, Patrick; Dettmer, Sabine; Kaireit, Till F.; Schaefer-Prokop, Cornelia; Wacker, Frank; Vogel‐Claussen, Jens; Shin, Hoen‐oh

doi:10.1371/journal.pone.0139102

Cited by 23 publications

(25 citation statements)

References 29 publications

(54 reference statements)

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“…It has been reported that expiratory CT can detect air trapping which is frequently observed in obstructive change. 18 - 21 Therefore, I/E CT volumetry was able to detect not only restrictive change but also obstructive change. In BOS patients, inspiratory lung volume was gradually increased, and expiratory lung volume was also increased by emphysematous change.…”

Section: Discussionmentioning

confidence: 97%

Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation

Saito

Chen‐Yoshikawa

Nakamoto

et al. 2018

Transplantation Direct

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BackgroundEarly diagnosis of unilateral chronic lung allograft dysfunction (CLAD) is difficult because the unaffected contralateral lung functions as a reservoir in bilateral living-donor lobar lung transplantation (LDLLT). We previously reported the usefulness of 133Xe ventilation scintigraphy for detection of unilateral change, but the supply of 133Xe has been stopped globally. The present study aimed to examine the usefulness of inspiratory and expiratory computed tomography (I/E CT) volumetry for detection of unilateral change in CLAD patients.MethodsThis was a retrospective single-center, observational study using prospectively collected data. A total of 58 patients who underwent bilateral LDLLT from August 2008 to February 2017 were analyzed. Respiratory function tests, I/E CT were prospectively conducted. ΔLung volume was defined as the value obtained by subtracting expiratory lung volume from inspiratory lung volume.ResultsFourteen (24%) cases were clinically diagnosed with CLAD, of which 10 (71%) were diagnosed as unilateral CLAD. ΔLung volume of bilateral lungs strongly correlated with forced vital capacity (r = 0.92, P < 0.01) and forced expiratory volume in 1 second (r = 0.80, P < 0.01). Regardless the phenotypes (bronchiolitis obliterans syndrome or restrictive allograft syndrome) of CLAD, Δlung volume onset/baseline significantly decreased compared with that in the non-CLAD group. Among the 10 unilateral CLAD patients, 3 with clinically suspected unilateral rejection yet did not show a 20% decline in forced expiratory volume in 1 second. In 2 of these, Δlung volume of unilateral lungs on the rejection side decreased by 20% or more.ConclusionsOur findings suggest that I/E CT volumetry may be useful for assessment and early diagnosis of unilateral CLAD after bilateral LDLLT.

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Section: Discussionmentioning

confidence: 97%

Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation

Saito

Chen‐Yoshikawa

Nakamoto

et al. 2018

Transplantation Direct

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“…There were several limitations in this study. First, we did not have routine expiratory CT performed at the time of the inspiratory CT; therefore, we could not assess air‐trapping, which could have been a useful parameter to assess patient survival for BOS. In addition, we evaluated only the lungs and we did not analyze the density changes in the pleura, which could be a useful factor for RAS patients .…”

Section: Discussionmentioning

confidence: 99%

Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival

Horie

Salazar²,

Saito

et al. 2018

Clinical Transplantation

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Chronic lung allograft dysfunction (CLAD) is a major cause of mortality in lung transplant recipients. CLAD can be sub-divided into at least 2 subtypes with distinct mortality risk characteristics: restrictive allograft syndrome (RAS), which demonstrates increased overall computed tomography (CT) lung density in contrast with bronchiolitis obliterans syndrome (BOS), which demonstrates reduced overall CT lung density. This study aimed to evaluate a reader-independent quantitative density metric (QDM) derived from CT histograms to associate with CLAD survival. A retrospective study evaluated CT scans corresponding to CLAD onset using pulmonary function tests in 74 patients (23 RAS, 51 BOS). Two different QDM values (QDM1 and QDM2) were calculated using CT lung density histograms. Calculation of QDM1 includes the extreme edges of the histogram. Calculation of QDM2 includes the central region of the histogram. Kaplan-Meier analysis and Cox regression analysis were used for CLAD prognosis. Higher QDM values were significantly associated with decreased survival. The hazard ratio for death was 3.2 times higher at the 75th percentile compared to the 25th percentile using QDM1 in a univariate model. QDM may associate with CLAD patient prognosis.

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“…Recently, Solyanik et al compared 3 methods of quantifying air trapping in LTx patients (18). Their approach differed from the present study in that multiple measurements within the same patients were not obtained.…”

Section: Discussionmentioning

confidence: 99%

Parametric Response Mapping of Bronchiolitis Obliterans Syndrome Progression After Lung Transplantation

Verleden

Vos

Vandermeulen

et al. 2016

American Journal of Transplantation

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Bronchiolitis obliterans syndrome (BOS) remains a major complication after lung transplantation. Air trapping and mosaic attenuation are typical radiological features of BOS, however quantitative evaluation remains troublesome. We evaluated parametric response mapping (PRM, voxel-to-voxel comparison of inspiratory and expiratory CT scans) in lung transplant recipients diagnosed with BOS (n=20) and time-matched stable lung transplant recipients (n=20). Serial PRM measurements were performed pre-diagnosis, at time of BOS diagnosis and post-diagnosis (Tpre, T0 and Tpost respectively); or at a post-operatively matched time in stable patients. PRM results were correlated with pulmonary function and confirmed by microCT analysis of end-stage explanted lung tissue. We observed by PRM an increase in functional small airway disease (fSAD), from Tpre to T0 (p=0.006) and a concurrent decrease in healthy parenchyma (p=0.02) in the BOS group. This change in PRM continued to Tpost, which was significantly different compared to the stable patients (p=0.0002). At BOS diagnosis, the increase in fSAD was strongly associated with a decrease in FEV1 (p=0.011). MicroCT confirmed the presence of airway obliteration in a sample of a BOS patient identified with 67% fSAD by PRM. We demonstrated the use of PRM as an adequate readout to monitor BOS progression in lung transplant recipients.

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Quantification of Pathologic Air Trapping in Lung Transplant Patients Using CT Density Mapping: Comparison with Other CT Air Trapping Measures

Cited by 23 publications

References 29 publications

Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation

Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation

Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival

Parametric Response Mapping of Bronchiolitis Obliterans Syndrome Progression After Lung Transplantation

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