title: Parametric Response Mapping of Bronchiolitis Obliterans Syndrome Progression After Lung Transplantation.
abstract: Bronchiolitis obliterans syndrome (BOS) remains a major complication after lung transplantation. Air trapping and mosaic attenuation are typical radiological features of BOS; however, quantitative evaluation remains troublesome. We evaluated parametric response mapping (PRM, voxel-to-voxel comparison of inspiratory and expiratory computed tomography [CT] scans) in lung transplant recipients diagnosed with BOS (n = 20) and time-matched stable lung transplant recipients (n = 20). Serial PRM measurements were performed prediagnosis, at time of BOS diagnosis, and postdiagnosis (Tpre, T0, and Tpost, respectively), or at a postoperatively matched time in stable patients. PRM results were correlated with pulmonary function and confirmed by microCT analysis of end-stage explanted lung tissue. Using PRM, we observed an increase in functional small airway disease (fSAD), from Tpreto T0(p = 0.006) and a concurrent decrease in healthy parenchyma (p = 0.02) in the BOS group. This change in PRM continued to Tpost, which was significantly different compared to the stable patients (p = 0.0002). At BOS diagnosis, the increase in fSAD was strongly associated with a decrease in forced expiratory volume in 1 s (p = 0.011). Micro-CT confirmed the presence of airway obliteration in a sample of a BOS patient identified with 67% fSAD by PRM. We demonstrated the use of PRM as an adequate output to monitor BOS progression in lung transplant recipients.
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium. stijn.verleden@med.kuleuven.be.
authors.forename: S E
authors.initials: SE
authors.lastname: Verleden
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: R
authors.identifier: 0000-0002-3468-9251
authors.initials: R
authors.lastname: Vos
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Vandermeulen
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Ruttens
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: H
authors.initials: H
authors.lastname: Bellon
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Heigl
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: D E
authors.initials: DE
authors.lastname: Van Raemdonck
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: G M
authors.initials: GM
authors.lastname: Verleden
authors.affiliation: Pneumology Department, University of Michigan, Ann Arbor, MI.
authors.forename: V
authors.initials: V
authors.lastname: Lama
authors.affiliation: Radiology Department, University of Michigan, Ann Arbor, MI.
authors.forename: B D
authors.initials: BD
authors.lastname: Ross
authors.affiliation: Radiology Department, University of Michigan, Ann Arbor, MI.
authors.forename: C J
authors.initials: CJ
authors.lastname: Galbán
authors.affiliation: Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium.
authors.forename: B M
authors.initials: BM
authors.lastname: Vanaudenaerde
mesh_terms: D000328:Adult; D001989:Bronchiolitis Obliterans / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006084:Graft Rejection / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: bronchiolitis obliterans (BOS); clinical research/practice; diagnostic techniques and imaging: computed tomography; lung transplantation/pulmonology