Feasibility of dynamic high resolution electron beam computed tomography for diagnosing of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients

Objectives: Determination of the diagnostic capabilities of DUHR-CT for diagnosing bronchiolitis obliterans syndrome (BOS) in lung transplantation recipients.

Methods: DLTX was performed in 32 patients, HLTX in 14, and SLTX in 6. At the time of inclusion, a mean of 38±28 months (range: 3–97 months) had elapsed since surgery. At the time of follow up examinations after LTX, 52 patients (24 female, mean age: 46±15 years, range: 13–72 years) were examined by DUHR-CT. Images were acquired at the level of the carina, and 2,5 and 5cm both above and below the carina. Visual signs of small airway disease were assessed and compared with lung function.

Results: Significant parenchymal attenuation inhomogeneities were present in 8/9 patients with manifest BOS, and in 2/4 patients who developed BOS during follow up. 13/20 patients with persistent normal lung function displayed homogeneous lung attenuation. Upon numerical analysis, mean lung attenuation was significantly lower in patients who developed BOS during follow up than in patients with persistent normal lung function (p<0,0001). With an optimal threshold, sensitivity was 4/4 (100%), specificity 19/20 (90%). In patients with BOS at the time of the CT examination, parenchymal attenuation was less homogeneous than in patients with persistent normal lung function (p<0,0001). Sensitivity was 7/9 (78%), specificity 17/20 (85%).

Conclusions: Dynamic high-resolution electron-beam CT of LTX recipients correlates well with lung function criteria of BOS and with the subsequent progression to BOS.