title: Parametric response mapping as an indicator of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation.
abstract: The management of bronchiolitis obliterans syndrome (BOS) after hematopoietic cell transplantation presents many challenges, both diagnostically and therapeutically. We developed a computed tomography (CT) voxel-wise methodology termed parametric response mapping (PRM) that quantifies normal parenchyma, functional small airway disease (PRM(fSAD)), emphysema, and parenchymal disease as relative lung volumes. We now investigate the use of PRM as an imaging biomarker in the diagnosis of BOS. PRM was applied to CT data from 4 patient cohorts: acute infection (n = 11), BOS at onset (n = 34), BOS plus infection (n = 9), and age-matched, nontransplant control subjects (n = 23). Pulmonary function tests and bronchoalveolar lavage were used for group classification. Mean values for PRM(fSAD) were significantly greater in patients with BOS (38% ± 2%) when compared with those with infection alone (17% ± 4%, P < .0001) and age-matched control subjects (8.4% ± 1%, P < .0001). Patients with BOS had similar PRM(fSAD) profiles, whether a concurrent infection was present or not. An optimal cut-point for PRM(fSAD) of 28% of the total lung volume was identified, with values >28% highly indicative of BOS occurrence. PRM may provide a major advance in our ability to identify the small airway obstruction that characterizes BOS, even in the presence of concurrent infection.
authors: Department of Radiology, University of Michigan, Ann Arbor, Michigan. Electronic address: cgalban@med.umich.edu.
authors: Craig J
authors: CJ
authors: Galbán
authors: Department of Radiology, University of Michigan, Ann Arbor, Michigan.
authors: Jennifer L
authors: JL
authors: Boes
authors: Department of Radiology, University of Michigan, Ann Arbor, Michigan.
authors: Maria
authors: M
authors: Bule
authors: Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan.
authors: Carrie L
authors: CL
authors: Kitko
authors: Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors: Daniel R
authors: DR
authors: Couriel
authors: Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
authors: Timothy D
authors: TD
authors: Johnson
authors: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors: Vihba
authors: V
authors: Lama
authors: Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors: Eef D
authors: ED
authors: Telenga
authors: Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors: Maarten
authors: M
authors: van den Berge
authors: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors: Alnawaz
authors: A
authors: Rehemtulla
authors: Department of Radiology, University of Michigan, Ann Arbor, Michigan.
authors: Ella A
authors: EA
authors: Kazerooni
authors: Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan.
authors: Michael J
authors: MJ
authors: Ponkowski
authors: Department of Radiology, University of Michigan, Ann Arbor, Michigan.
authors: Brian D
authors: BD
authors: Ross
authors: Blood and Marrow Transplant Program, University of Michigan, Ann Arbor, Michigan; Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
authors: Gregory A
authors: GA
authors: Yanik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001989:Bronchiolitis Obliterans / Q000000981:diagnostic imaging* / Q000209:etiology / Q000276:immunology / Q000382:microbiology; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D016022:Case-Control Studies; D002648:Child; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000276:immunology / Q000382:microbiology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000276:immunology / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000627:therapeutic use; D011446:Prospective Studies; D012129:Respiratory Function Tests; D013577:Syndrome; D014057:Tomography, X-Ray Computed / Q000379:methods*; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous
chemical_list: D019653:Myeloablative Agonists
keywords: Bronchiolitis obliterans syndrome; Pulmonary; Transplantation