BRONCHIOLITIS OBLITERANS FOLLOWING LUNG TRANSPLANTATION: EARLY DETECTION USING CT

Pim A de Jong ¹, Jonathan D Dodd ², Harvey O Coxson ², Claudine Storness-Bliss ³, Peter D Paré ⁴, John R Mayo ⁵ and Robert D Levy ^6*

¹ Meander Medical Centre, Department of Radiology, Amersfoort, Netherlands
² University of British Columbia, Department of Radiology, Vancouver, BC, Canada
³ University of British Columbia, Departments of Medicine and Radiology, Vancouver, BC, Canada
⁴ James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, Vancouver, BC, Canada
⁵ University of British Columbia, Department of Radiology, Vancouver, BC, Canada
⁶ University of British Columbia, Department of Medicine, Vancouver, BC, Canada

^* To whom correspondence should be addressed. E-mail: rlevy{at}providencehealth.bc.ca.

Accepted 21 April 2006

Abstract

Background: CT scanning may enable earlier diagnosis of chronic lung allograft dysfunction than FEV₁. Our aims were to determine intra- and interobserver agreement of composite and air trapping CT-scores, to examine the association of FEV₁ with composite and air trapping CT-score and to relate baseline composite CT-score to changes in FEV₁ and changes in composite CT-score over one year.

Methods: Lung function and baseline post-transplant CT and subsequent annual follow-ups were analyzed in 38 lung transplant recipients. Scans were randomly scored by two observers for: bronchiectasis; mucous plugging; airway wall thickening; consolidation; mosaic pattern; and air trapping, and re-scored after one month. CT-scores were expressed on a 0-100 scale and correlated to FEV₁ as a percentage of the post-transplant baseline value.

Results: The mean interval (±SD) between baseline and follow-up CT was 11.2±4.7 months. Inter- and intraobserver agreement was good for both the composite and air trapping CT-score. There was a significant association between FEV₁ and composite CT-score, whereby each unit worsening in baseline composite CT-score predicted a 1.55% and 1.37% (p<0.0001) and a 1.25 and 1.12 unit (p<0.0001) worsening over the following year in FEV₁ and composite CT-score for observer 1 and 2, respectively.

Conclusion: Our findings indicate a potential role for a composite CT scoring system in the early detection of BO.

Keywords: BO, BOS, CT, FEV1, lung transplant

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