Parametric Response Mapping of Bronchiolitis Obliterans Syndrome Progression After Lung Transplantation |
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| Authors: | S. E. Verleden R. Vos E. Vandermeulen D. Ruttens H. Bellon T. Heigl D. E. Van Raemdonck G. M. Verleden V. Lama B. D. Ross B. M. Vanaudenaerde |
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| Affiliation: | 1. Lung Transplant Unit, Department of Clinical and Experimental Medicine, KU Leuven, Leuven, Belgium;2. Pneumology Department, University of Michigan, Ann Arbor, MI;3. Radiology Department, University of Michigan, Ann Arbor, MI |
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| 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 Tpre to 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. |
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| Keywords: | clinical research/practice lung transplantation/pulmonology bronchiolitis obliterans (BOS) diagnostic techniques and imaging: computed tomography |
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