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Bronchiolitis obliterans following lung transplantation: early detection using computed tomographic scanning
  1. P A de Jong1,2,3,4,5,
  2. J D Dodd2,
  3. H O Coxson2,4,
  4. C Storness-Bliss1,2,
  5. P D Paré1,4,
  6. J R Mayo2,
  7. R D Levy1,3,4
  1. 1Department of Medicine, University of British Columbia, Vancouver, BC, Canada
  2. 2Department of Radiology, University of British Columbia, Vancouver, BC, Canada
  3. 3Department of Radiology, Meander Medical Center, Amersfoort, the Netherlands
  4. 4James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, Vancouver, BC, Canada
  5. 5British Columbia Transplant Society, Vancouver, BC, Canada
  1. Correspondence to:
    Dr R D Levy
    BC Transplant Society, 3rd Floor, West Tower, 555 West 12th Avenue, Vancouver, BC, Canada V5Z 3X7; rlevy{at}


Background: Computed tomographic (CT) scanning may enable earlier diagnosis of chronic lung allograft dysfunction than forced expiratory volume in 1 second (FEV1). A study was undertaken to determine intra-observer and inter-observer agreement of composite and air trapping CT scores, to examine the association of FEV1 with the composite and air trapping CT score, and to relate the baseline composite CT score to changes in FEV1 and changes in the composite CT score over 1 year.

Methods: Lung function and baseline CT scans following transplantation and at subsequent annual follow ups were analysed in 38 lung transplant recipients. Scans were randomly scored by two observers for bronchiectasis, mucus plugging, airway wall thickening, consolidation, mosaic pattern, and air trapping, and re-scored after 1 month. CT scores were expressed on a scale of 0–100 and correlated with FEV1 as a percentage of the post-transplant baseline value.

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

Conclusion: These findings indicate a potential role for a composite CT scoring system in the early detection of bronchiolitis obliterans.

  • BO, bronchiolitis obliterans
  • BOS, bronchiolitis obliterans syndrome
  • CT, computed tomography
  • FEV1, forced expiratory volume in 1 second
  • computed tomography
  • lung function
  • bronchiolitis obliterans
  • lung transplantation

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  • Published Online First 2 May 2006

  • Dr de Jong was supported by a British Columbia Lung Association Fellowship in Respiratory Medicine and a Canadian Institute of Health Research/Michael Smith Foundation Transplant Research Training Award and Dr Coxson is a Parker B Francis Fellow in Pulmonary Research.

  • Conflict of interest: The authors declare no competing interest in the content of this manuscript.

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