title: Value of high-resolution computed tomography in routine evaluation of lung transplantation recipients during development of bronchiolitis obliterans syndrome.
abstract: BACKGROUND
  Chronic rejection is a major long-term complication after lung transplantation. The purpose of our study was to evaluate the role of repeated high-resolution computed tomographic examinations in monitoring the development of bronchiolitis obliterans syndrome after lung transplantation.
  
  
  METHODS
  A total of 126 high-resolution computed tomographic examination in 13 lung transplant recipients was analyzed. During a mean follow-up period of 23 months, bronchiolitis obliterans syndrome developed in eight of the patients. A scoring system from 0 to 10 based on the number of chronic changes on high-resolution computed tomography was developed, and the score of each patient was compared with decline in the forced expiratory volume in 1 second and maximal forced expiratory flow rate of 50% of the forced vital capacity.
  
  
  RESULTS
  The score of chronic changes, measured at 1 year after transplantation, correlated inversely with the values of forced expiratory volume in 1 second and maximal forced expiratory flow rate at 50% of the forced vital capacity (p < 0.05). Stage I bronchiolitis obliterans syndrome was associated with scores of 4 to 6 (mean 5.0), stage 2 with scores of 6 to 9 (mean 7.0), and stage 3 with scores of 6 to 9 (mean 7.7). The sensitivity of high-resolution computed tomography was 93% and its specificity was 92% when five chronic changes were used as a cutoff level.
  
  
  CONCLUSIONS
  The progress of chronic changes on high-resolution computed tomography occurs concurrently with the development of bronchiolitis obliterans syndrome. High-resolution computed tomography may provide additional morphologic information for noninvasive evaluation of chronic lung rejection.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Helsinki University Central Hospital, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Ikonen
authors.forename: L
authors.initials: L
authors.lastname: Kivisaari
authors.forename: A L
authors.initials: AL
authors.lastname: Harjula
authors.forename: A
authors.initials: A
authors.lastname: Lehtola
authors.forename: L
authors.initials: L
authors.lastname: Heikkilä
authors.forename: V L
authors.initials: VL
authors.lastname: Kinnula
authors.forename: K
authors.initials: K
authors.lastname: Kyösola
authors.forename: J
authors.initials: J
authors.lastname: Savola
authors.forename: J
authors.initials: J
authors.lastname: Sipponen
authors.forename: K
authors.initials: K
authors.lastname: Verkkala
authors.forename: S P
authors.initials: SP
authors.lastname: Mattila
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D002908:Chronic Disease; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D016040:Lung Transplantation / Q000009:adverse effects / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013577:Syndrome; D014057:Tomography, X-Ray Computed