title: Bronchiolitis obliterans syndrome in heart-lung transplant recipients: diagnosis with expiratory CT.
abstract: OBJECTIVE
  To determine the test performance and longitudinal evolution of air trapping for diagnosing bronchiolitis obliterans syndrome (BOS).
  
  
  METHODS
  Over 7 years, 111 combined inspiratory and expiratory computed tomographic examinations were performed in eight healthy control subjects and 38 heart-lung transplant recipients. Functional impairment was assessed with the BOS classification. Receiver operating characteristic (ROC) analysis was performed to determine the optimal threshold of air trapping to distinguish between patients with and those without BOS and to compute sensitivity and specificity for diagnosing BOS.
  
  
  RESULTS
  The extent of air trapping increased with BOS severity (P =.001). A threshold of 32% of air trapping is optimal for distinguishing between patients with and those without BOS and provides a sensitivity of 83%, a specificity of 89%, and an accuracy of 88%. The prevalence of BOS and positive predictive value of air trapping increased with postoperative time, but the negative predictive value of air trapping remained high throughout the study. Patients without BOS who had air trapping exceeding 32% of the parenchyma were at significantly increased risk of developing BOS (P =.004).
  
  
  CONCLUSIONS
  At the threshold of 32%, air trapping is sensitive, specific, and accurate for diagnosing BOS. Patients with air trapping below 32% are unlikely to have BOS. Air trapping exceeding 32% may be an early indicator of future BOS.
authors.affiliation: Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA. alexander.bankier@uniie.ac.at
authors.forename: A A
authors.initials: AA
authors.lastname: Bankier
authors.forename: A
authors.initials: A
authors.lastname: Van Muylem
authors.forename: C
authors.initials: C
authors.lastname: Knoop
authors.forename: M
authors.initials: M
authors.lastname: Estenne
authors.forename: P A
authors.initials: PA
authors.lastname: Gevenois
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D016041:Heart-Lung Transplantation; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D015588:Observer Variation; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013997:Time Factors; D014057:Tomography, X-Ray Computed