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Early Bronchiolitis Obliterans Following Lung Transplantation: Accuracy of Expiratory Thin-Section CT for Diagnosis¹

¹ From the Departments of Radiology (E.S.L., M.B.G., G.P.R., W.R.W.) and Cardiothoracic Surgery (F.M.K.) and the Division of Pulmonary and Critical Care Medicine (J.A.G.), University of California, San Francisco; the Department of Radiology, Hallym University School of Medicine, Seoul, South Korea (E.S.L.); and the Department of Radiology, Thoracic Imaging Section, San Francisco General Hospital, Rm 1X 55A, Box 1325, 1001 Potrero Ave, San Francisco, CA 94110 (M.B.G.). Received August 18, 1999; revision requested October 7; revision received December 20; accepted January 12, 2000. Address correspondence to M.B.G. (e-mail: michael.gotway@radiology.ucsf.edu).

View larger version (84K): [in a new window]   Figure 1a. Air trapping in a patient with biopsy-proved bronchiolitis obliterans (group A). True-positive (a) inspiratory and (b) postexpiratory transverse thin-section CT scans in a 63-year-old woman with a right lung transplant for emphysema and a total right lung air-trapping score of 6. Regions of decreased attenuation visible in the right lung base both anteriorly and posteriorly on the postexpiratory image indicate the presence of air trapping (single arrows in b). Subtle areas of relatively increased lung attenuation represent normal, collapsing lung (double arrows in b). Transbronchial biopsy results in this patient demonstrated bronchiolitis obliterans.

View larger version (87K): [in a new window]   Figure 1b. Air trapping in a patient with biopsy-proved bronchiolitis obliterans (group A). True-positive (a) inspiratory and (b) postexpiratory transverse thin-section CT scans in a 63-year-old woman with a right lung transplant for emphysema and a total right lung air-trapping score of 6. Regions of decreased attenuation visible in the right lung base both anteriorly and posteriorly on the postexpiratory image indicate the presence of air trapping (single arrows in b). Subtle areas of relatively increased lung attenuation represent normal, collapsing lung (double arrows in b). Transbronchial biopsy results in this patient demonstrated bronchiolitis obliterans.

View larger version (81K): [in a new window]   Figure 2a. Air trapping in a patient with abnormal PFT findings but normal transbronchial biopsy results (group B1). True-positive (a) inspiratory and (b) postexpiratory transverse thin-section CT scans in a 49-year-old man with a left lung transplant for emphysema and a total left lung air-trapping score of 5. An area of low attenuation occupying a substantial portion of the left lower lobe represents air trapping (arrows in b). PFTs revealed FEF25%-75% of 8% of the value predicted. Transbronchial biopsy performed 7 months later revealed bronchiolitis obliterans.

View larger version (71K): [in a new window]   Figure 2b. Air trapping in a patient with abnormal PFT findings but normal transbronchial biopsy results (group B1). True-positive (a) inspiratory and (b) postexpiratory transverse thin-section CT scans in a 49-year-old man with a left lung transplant for emphysema and a total left lung air-trapping score of 5. An area of low attenuation occupying a substantial portion of the left lower lobe represents air trapping (arrows in b). PFTs revealed FEF25%-75% of 8% of the value predicted. Transbronchial biopsy performed 7 months later revealed bronchiolitis obliterans.

View larger version (35K): [in a new window]   Figure 3a. Air trapping in a patient with stable PFT and normal transbronchial biopsy results (group B2). False-positive (a) inspiratory and (b) postexpiratory transverse thin-section CT scans in a 57-year-old man with a right lung transplant for pulmonary fibrosis and a total right lung air-trapping score of 4. Clear air trapping is visible in the right lower lobe (arrows in b). Initial and subsequent transbronchial biopsy results obtained 1 year later were negative for bronchiolitis obliterans.

View larger version (59K): [in a new window]   Figure 3b. Air trapping in a patient with stable PFT and normal transbronchial biopsy results (group B2). False-positive (a) inspiratory and (b) postexpiratory transverse thin-section CT scans in a 57-year-old man with a right lung transplant for pulmonary fibrosis and a total right lung air-trapping score of 4. Clear air trapping is visible in the right lower lobe (arrows in b). Initial and subsequent transbronchial biopsy results obtained 1 year later were negative for bronchiolitis obliterans.