title: Acute rejection following lung transplantation: limitations in accuracy of thin-section CT for diagnosis.
abstract: OBJECTIVE
  To evaluate the sensitivity, specificity, predictive values, and accuracy of thin-section computed tomography (CT) for the diagnosis of acute rejection following lung transplantation and to determine whether any individual CT abnormalities are associated with histopathologically proved acute rejection.
  
  
  METHODS
  Thin-section CT studies from 64 lung transplant recipients were retrospectively reviewed. CT studies were temporally correlated with various grades of biopsy-proved acute rejection (n = 34); 30 other CT studies were from a control group with no histopathologic evidence of acute rejection. Acute rejection was diagnosed as present or absent, and the diagnostic was calculated.
  
  
  RESULTS
  The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT for the diagnosis of acute rejection were as follows: 35%, 73%, 60%, 50%, 53%, respectively. No individual CT finding was significantly associated with acute rejection. The sensitivity of CT for the detection of various grades of acute rejection was 17% for grade A1, 50% for grade A2, and 20% for grade A3. The combination of volume loss and septal thickening, with or without pleural effusion, was never seen in the absence of acute rejection.
  
  
  CONCLUSIONS
  Thin-section CT has limited accuracy for the diagnosis of acute rejection following lung transplantation, and no individual CT finding is significantly associated with this diagnosis.
authors.affiliation: Department of Radiology, San Francisco General Hospital, University of California, San Francisco, 1001 Potrero Ave, Rm 1X 55A, Box 1325, San Francisco, CA 94110, USA. michael.gotway@radiology.ucsf.edu
authors.forename: M B
authors.initials: MB
authors.lastname: Gotway
authors.forename: S K
authors.initials: SK
authors.lastname: Dawn
authors.forename: D
authors.initials: D
authors.lastname: Sellami
authors.forename: J A
authors.initials: JA
authors.lastname: Golden
authors.forename: G P
authors.initials: GP
authors.lastname: Reddy
authors.forename: F M
authors.initials: FM
authors.lastname: Keith
authors.forename: W R
authors.initials: WR
authors.lastname: Webb
mesh_terms: D000208:Acute Disease; D005260:Female; D006084:Graft Rejection / Q000000981:diagnostic imaging*; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*