Bronchiolitis Obliterans After Lung Transplantation: Materials and Methods

In: Bronchiolitis

30 Mar 2014

The 10 patients with no pathologic evidence of BO or clinical evidence of airways obstruction consisted of 8 female patients and 2 male patients with a group mean age of 34 years (range, 16 to 52 years). Their mean time from transplantation was 3.6 years (range, 0.7 to 11.6 years). Their last previous normal transbron-chial biopsy specimens had occurred a mean interval of 100 days (range, 1 to 203 days) from time of study assessment. In all 10 patients, pulmonary symptoms and spirometric results, including FEVX and forced expiratory flow rate between 25% and 75% of the FVC (FEF25_75), obtained a mean interval of 2.5 days (range, 0 to 10 days) from time of CT assessment, were stable with no evidence for development of airways disease. Preoperative indications for transplantation were as follows: Eisenmenger’s syndrome (n=5); congenital heart disease (n=2); cystic fibrosis (n=l); primary pulmonary hypertension (n=l); and bronchiectasis (n=l).
Thirteen HRCT examinations were obtained on one scanner (Somatom Plus-S Siemens Medical Systems; Iselin, NJ) and eight HRCT examinations on another scanner (HiSpeed Advantage; General Electric Medical Systems; Milwaukee). Each HRCT examination consisted of five 1.0-mm collimation images obtained during both deep inspiration and full expiration, respectively, with the patient lying in a supine position. Images were obtained at the levels of the aortic arch, midway between the aortic arch and tracheal carina, tracheal carina, midway between the tracheal carina and the right hemidiaphragm, and 1 cm above the right hemidiaphragm. No IV contrast was administered. All images were reconstructed using a high-spatial-resolution algorithm and displayed at standard (level —700, width 1,500) and narrow (level —700, width 1,000) lung window settings.
The HRCT scans were reviewed by two radiologists who had no knowledge of clinical or pathologic data other than history of previous transplantation, and age and sex of the patient; readings were done in consensus. During analysis of each CT examination, inspiratory images were reviewed before expiratory images and images displayed at standard before narrow window settings. The inspiratory images were assessed for the presence of bronchiectasis according to previously established CT criteria. The presence and lobar distribution of a mosaic lung pattern, defined as areas of heterogeneous lung attenuation in a lobular or multilobular distribution, were noted. In patients with a mosaic pattern, the extent of low-attenuation regions as a percentage of cross-sectional lung surface area on the five inspiratory images was scored using a 5-point scale: 0 (no low attenuation regions); 1 (<10% of lung affected); 2 (10 to 25%); 3 (>25 to 50%); and 4 (>50%).

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