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Cystic Fibrosis: Usefulness of Thoracic CT in the Examination of Patients before Lung Transplantation¹

¹ From the Departments of Radiology (E.M.M., H.P.M., J.J.E, P.C.G.), Medicine (S.M.P., V.F.T.), Pathology (T.A.S.), and Surgery (R.D.D.), Duke University Medical Center, Box 3808, Erwin Rd, Durham, NC 27710. From the 1998 RSNA scientific assembly. Received July 14, 1998; revision requested September 10; final revision received December 9; accepted March 29, 1999. Address reprint requests to H.P.M. (e-mail: mcada003@mc.duke.edu).

PURPOSE: To evaluate the usefulness of thoracic computed tomography (CT) in the pre–lung transplantation examination of patients with cystic fibrosis (CF).

MATERIALS AND METHODS: Fifty-six patients (age range, 12–42 years) with CF were evaluated for possible lung transplantation from 1991 to 1997. Twenty-six of these patients underwent bilateral lung transplantation, 19 were awaiting transplantation at the time of the study, seven died before transplantation, and four were excluded for psychosocial concerns. Preoperative chest radiographic and CT findings were reviewed and correlated with clinical, operative, and pathology records.

RESULTS: In seven patients, discrete, 1–2-cm pulmonary nodules were detected at CT. Five of these patients underwent transplantation; the nodules were found to be mucous impactions. No malignancy was found in any of the patients who underwent transplantation. Pretransplantation sputum cultures grew Aspergillus fumigatus in seven patients, none of whom had radiologic findings suggestive of Aspergillus infection. Radiographic or CT findings were suggestive of mycetoma in five cases, but no such tumors were found at transplantation. The accuracies of chest radiography and CT for the detection of pleural disease in 48 hemithoraces were 81% (n = 39) and 69% (n = 33), respectively. The radiologic findings of pleural thickening did not influence the surgical approach in any patient.

CONCLUSION: Thoracic CT has little utility in the routine pre–lung transplantation examination of patients with CF.

Index terms: Computed tomography (CT), utilization, 60.12111, 60.12118 • Fibrosis, cystic, 60.252 • Pleura, diseases, 66.252

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