Jonathan Dermot Dodd MD, Presenter: Nothing to Disclose

Pim A de Jong, Abstract Co-Author: Nothing to Disclose

Robert D Levy, Abstract Co-Author: Nothing to Disclose

Harvey Owen Coxson PhD, Abstract Co-Author: Nothing to Disclose

John Robert Mayo MD, Abstract Co-Author: Nothing to Disclose

To evaluate whether helical high-resolution multidetector CT (MDCT) is more accurate than conventional high-resolution CT (HRCT) in detecting the structural changes of bronchiolitis obliterans syndrome (BOS) in lung transplant recipients.

Twenty-four lung transplant recipients (13 males/11 females, mean age 53, range 28-71) underwent 16-slice MDCT as part of annual assessment. Eight image sets were reconstructed from 1mm contiguous MDCT slices: transverse/sagittal/coronal sections in inspiration and expiration; inspiratory HRCT (1mm slices every 10mm) and expiratory HRCT (1mm slices at 3 selected levels) derived from the MDCT image sets. Two independent observers retrospectively, randomly scored for bronchiectasis, mucus plugging, air wall thickening, mosaic perfusion and air trapping (scale 0-5). Lobar scores for each abnormality were added to give a composite score. Individual observer scores were averaged. Univariate (Spearman) and multivariate analysis was performed between spirometry and all image sets. The intraclass correlation coefficient assessed interobserver agreement. Data given=mean±SD.

Interobserver agreement was good for transverse and sagittal MDCT and HRCT, (0.85, 0.86, 0.86 respectively). There was no significant difference in the total scores between image sets (transverse:15.5±15, sagittal:13.4±13, coronal:13.0±9, and HRCT:14.4±15), but on average there were more structural abnormalities detected using MDCT. Of 198 lobes, MDCT detected 1.5 more with central and 8 with peripheral bronchiectasis, 2.5 more with central and 1 with peripheral mucus plugging, 2.5 more with peripheral wall thickening, 0.5 more with mosaic perfusion and 10 more with air trapping that were not detected with HRCT. Transverse, sagittal and coronal MDCT correlated significantly with FEV1 (R=0.60, 0.50, 0.63 respectively, p<.01) whereas HRCT did not. Multiple regression analysis demonstrated transverse MDCT was the only independent predictor of airflow obstruction (R2=0.42, p<.001).

16-slice high-resolution MDCT detects more structural lung abnormalities than conventional HRCT and is an independent predictor of the clinical diagnosis of BOS.

Dodd, J, de Jong, P, Levy, R, Coxson, H, Mayo, J, Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients: Detection Using Helical High-Resolution Multidetector CT versus Conventional High-Resolution CT.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4404493.html