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Parametric Response Mapping of Bronchiolitis Obliterans Syndrome Progression After Lung Transplantation
Author(s) -
Verleden S. E.,
Vos R.,
Vandermeulen E.,
Ruttens D.,
Bellon H.,
Heigl T.,
Van Raemdonck D. E.,
Verleden G. M.,
Lama V.,
Ross B. D.,
Galbán C. J.,
Vanaudenaerde B. M.
Publication year - 2016
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13945
Subject(s) - bronchiolitis obliterans , medicine , air trapping , lung transplantation , lung , airway , parenchyma , lung volumes , pulmonary function testing , transplantation , stage (stratigraphy) , nuclear medicine , pathology , radiology , surgery , paleontology , biology
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 (T pre , T 0 , and T post , respectively), or at a postoperatively matched time in stable patients. PRM results were correlated with pulmonary function and confirmed by micro CT analysis of end‐stage explanted lung tissue. Using PRM , we observed an increase in functional small airway disease ( fSAD ), from T pre to T 0 (p = 0.006) and a concurrent decrease in healthy parenchyma (p = 0.02) in the BOS group. This change in PRM continued to T post , 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.