Bronchiectasis detected with thin-section CT as a predictor of chronic lung allograft rejection.
OBJECTIVE
To evaluate bronchiectasis detected with thin-section computed tomography (CT) as a potential early finding of chronic lung allograft rejection.


METHODS
Forty patients were studied at least 6 months after transplantation. Follow-up CT scans were obtained 6-48 months after transplantation and were retrospectively reviewed for evidence and anatomic extent of bronchiectasis. Irreversible dysfunction of the lung transplant, called the bronchiolitis obliterans syndrome (BOS), was staged according to pulmonary function testing. Pathologic proof of bronchiolitis obliterans was obtained.


RESULTS
BOS occurred in 14 (35%) of the 40 patients. When considering bronchiectasis preceding BOS, bronchiectasis was a predictor of chronic rejection with a sensitivity of 14%, a specificity of 77%, a positive predictive value of 25%, and a negative predictive value of 63%. Bronchiectasis appeared concomitantly with BOS in eight (67%) of 12 patients.


CONCLUSIONS
The diagnosis of chronic rejection relies on the degree of impairment of pulmonary function. When the diagnosis is only suspected on the basis of minimal impairment, CT can aid in the diagnosis of rejection by depicting early pulmonary changes.
Loubeyre
P
P
Department of Radiology, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France.
Revel
D
D
Delignette
A
A
Wiesendanger
T
T
Philit
F
F
Bertocchi
M
M
Loire
R
R
Mornex
J F
JF
D000293:Adolescent; D000328:Adult; D001987:Bronchiectasis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D001989:Bronchiolitis Obliterans / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D006801:Humans; D016040:Lung Transplantation; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012129:Respiratory Function Tests; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*