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Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients: Use of Spirometrically Gated CT¹

¹ From the Department of Radiology, Charité, Campus Virchow-Klinikum, Humboldt-University, Augustenburger Platz 1, 13353 Berlin, Germany (F.D.K., T.W., R.F.); and Department of Cardiothoracic and Vascular Surgery, German Heart Institute, Berlin, Germany (R.E., R.H.). From the 2001 RSNA scientific assembly. Received August 14, 2001; revision requested October 10; revision received January 9, 2002; accepted February 20. Address correspondence to F.D.K. (e-mail: friedrich.knollmann@charite.de).

PURPOSE: To assess the potential use of spirometrically gated lung computed tomographic (CT) findings in the diagnosis of bronchiolitis obliterans syndrome after lung transplantation.

MATERIALS AND METHODS: Forty-nine lung transplant recipients were examined at least 8 months after surgery with spirometrically gated thin-section CT of the lung. In addition to visual signs of small-airway disease at CT, mean lung attenuation and the SD were numerically determined and compared with the results of lung function testing at the time of the CT examination and 1 year later by using factorial analysis of variance.

RESULTS: Mean lung attenuation was significantly lower in patients who developed bronchiolitis obliterans syndrome within 1 year after the CT study (-837 HU ± 3) than in patients with persistent normal lung function (-812 HU ± 3, P < .001). With an optimal threshold, sensitivity was 69%, specificity was 71%, and accuracy was 84%. Visual analysis did not significantly contribute to the prognostic power of CT.

CONCLUSION: Spirometrically gated CT measurements of lung attenuation can be used to predict the onset of bronchiolitis obliterans syndrome after lung transplantation.

© RSNA, 2002

Index terms: Bronchiolitis obliterans, 60.2191 • Computed tomography (CT), quantitative, 60.1211 • Computed tomography (CT), thin-section, 60.12118 • Lung, transplantation, 60.458

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