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Acute Rejection Following Lung Transplantation: Limitations in Accuracy of Thin-Section CT for Diagnosis¹

¹ From the Departments of Radiology (M.B.G.), Thoracic Imaging Section (M.B.G., S.K.D., D.S., G.P.R., W.R.W.), Pulmonary and Critical Care Medicine (J.A.G.), and Surgery (F.M.K.), San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, Rm 1X 55A, Box 1325, San Francisco, CA 94110. Received January 30, 2001; revision requested March 6; revision received April 3; accepted May 2. Address correspondence to M.B.G. (e-mail: michael.gotway@radiology.ucsf.edu).

PURPOSE: To evaluate the sensitivity, specificity, predictive values, and accuracy of thin-section computed tomography (CT) for the diagnosis of acute rejection following lung transplantation and to determine whether any individual CT abnormalities are associated with histopathologically proved acute rejection.

MATERIALS AND METHODS: Thin-section CT studies from 64 lung transplant recipients were retrospectively reviewed. CT studies were temporally correlated with various grades of biopsy-proved acute rejection (n = 34); 30 other CT studies were from a control group with no histopathologic evidence of acute rejection. Acute rejection was diagnosed as present or absent, and the diagnostic was calculated.

RESULTS: The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT for the diagnosis of acute rejection were as follows: 35%, 73%, 60%, 50%, 53%, respectively. No individual CT finding was significantly associated with acute rejection. The sensitivity of CT for the detection of various grades of acute rejection was 17% for grade A1, 50% for grade A2, and 20% for grade A3. The combination of volume loss and septal thickening, with or without pleural effusion, was never seen in the absence of acute rejection.

CONCLUSION: Thin-section CT has limited accuracy for the diagnosis of acute rejection following lung transplantation, and no individual CT finding is significantly associated with this diagnosis.

Index terms: Computed tomography (CT), thin-section, 60.12118 • Lung, transplantation

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