Miho Horie1,2, Liran Levy3,4, Christian Houbois1, Pascal Salazar5, Tomohito Saito6, Mini Pakkal1, Ciara OʼBrien1, Shailaja Sajja7, Kristy Brock8, Kazuhiro Yasufuku4, Shaf Keshavjee2,4,6, Narinder Paul1,2,9, Tereza Martinu4. 1. Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON. 2. Institute for Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON. 3. Latner Thoracic Surgery Research Laboratories, Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON. 4. Toronto Lung Transplant Program, University Health Network, University of Toronto, ON. 5. Vital Images, Minnetonka, MN. 6. Department of Thoracic Surgery, Kansai Medical University, Hirakata, Japan. 7. QIPCM, Techna Institute, University Health Network, University of Toronto, ON. 8. Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX. 9. Department of Medical Imaging, London Health Sciences Centre, London, ON.
Abstract
BACKGROUND: Chronic lung allograft dysfunction (CLAD) limits long-term survival after lung transplantation (LTx). Early detection or prediction of CLAD can lead to changes in patient management that, in turn, may improve prognosis. The purpose of this study was to investigate the utility of quantitative computed tomography (CT) lung density analysis in early prediction of CLAD. METHODS: This retrospective cohort was drawn from all consecutive adult, first LTxs performed between 2006 and 2011. Post-transplant monitoring included scheduled surveillance bronchoscopies with concurrent pulmonary-functions tests and low-dose chest CT. Quantitative density metrics (QDM) derived from CT scans obtained at the time of 10%-19% decline in forced expiratory volume in 1 second (FEV1) were evaluated: 114 bilateral LTx recipients (66 with CLAD and 48 stable) and 23 single LTx recipients (11 with CLAD, 12 stable) were included in the analysis. RESULTS: In both single and double LTx, at the time of 10%-19% drop in FEV1 from baseline, the QDM was higher in patients who developed CLAD within 3 years compared with those patients who remained stable for at least 3.5 years. The area under the receiver operating characteristic curve (AUC) was 0.89 for predicting CLAD in single LTx and 0.63 in bilateral LTx. A multipredictor AUC accounting for FEV1, QDM, presence of consolidation, and ground glass opacities increased the AUC to 0.74 in double LTx. CONCLUSIONS: QDM derived from a CT histogram at the time of early drop in FEV1 may allow prediction of CLAD in patients after single or double LTx.
BACKGROUND:Chronic lung allograft dysfunction (CLAD) limits long-term survival after lung transplantation (LTx). Early detection or prediction of CLAD can lead to changes in patient management that, in turn, may improve prognosis. The purpose of this study was to investigate the utility of quantitative computed tomography (CT) lung density analysis in early prediction of CLAD. METHODS: This retrospective cohort was drawn from all consecutive adult, first LTxs performed between 2006 and 2011. Post-transplant monitoring included scheduled surveillance bronchoscopies with concurrent pulmonary-functions tests and low-dose chest CT. Quantitative density metrics (QDM) derived from CT scans obtained at the time of 10%-19% decline in forced expiratory volume in 1 second (FEV1) were evaluated: 114 bilateral LTx recipients (66 with CLAD and 48 stable) and 23 single LTx recipients (11 with CLAD, 12 stable) were included in the analysis. RESULTS: In both single and double LTx, at the time of 10%-19% drop in FEV1 from baseline, the QDM was higher in patients who developed CLAD within 3 years compared with those patients who remained stable for at least 3.5 years. The area under the receiver operating characteristic curve (AUC) was 0.89 for predicting CLAD in single LTx and 0.63 in bilateral LTx. A multipredictor AUC accounting for FEV1, QDM, presence of consolidation, and ground glass opacities increased the AUC to 0.74 in double LTx. CONCLUSIONS: QDM derived from a CT histogram at the time of early drop in FEV1 may allow prediction of CLAD in patients after single or double LTx.
Authors: Andrew M Courtwright; Anthony M Lamattina; Mai Takahashi; Anil J Trindade; Gary M Hunninghake; Ivan O Rosas; Suneet Agarwal; Benjamin A Raby; Hilary J Goldberg; Souheil El-Chemaly Journal: ERJ Open Res Date: 2020-06-15
Authors: Laura Peräkylä; Antti Nykänen; Anneli Piilonen; Risto Kesävuori; Maija Halme; Peter Raivio Journal: PLoS One Date: 2022-10-12 Impact factor: 3.752
Authors: Elizabeth A Belloli; Tian Gu; Yizhuo Wang; Dharshan Vummidi; Dennis M Lyu; Michael P Combs; Aamer Chughtai; Susan Murray; Craig J Galbán; Vibha N Lama Journal: Am J Respir Crit Care Med Date: 2021-10-15 Impact factor: 30.528