Utility of high resolution computed tomography in predicting bronchiolitisobliterans syndrome following tung transplantation - Preliminary findings

This study was undertaken to evaluate the efficacy of high resolution compu ted tomography (HRCT) in predicting the development of bronchiolitis oblite rans syndrome (BOS) in lung transplant recipients. Fifty lung transplant pa tients who were clinically stable and without evidence of BOS were evaluate d for the presence of four HRCT features reported to be associated with bro nchiolitis obliterans: mosaic attenuation on inspiratory CT (mosaic perfusi on), mosaic attenuation on expiratory CT lair trapping), bronchiectasis, an d tree-in-bud opacities. CT exams were part of an annual surveillance proce ss with the hope of predicting subsequent development of BOS. Diagnosis of BOS was made in 9 of 50 patients as indicated by a fall in FEV1 of greater than 20% of a stable baseline. None of the radiographic features associated with clinically established BOS were both sensitive and specific in the pr ediction of BOS. Air trapping demonstrated moderate sensitivity (56%, 5/9) and moderate specificity (76%, 35/46) for prediction of BOS in the year fol lowing the CT exam. Bronchiectasis, the most reliable indicator of the pres ence of BOS was a poor predictor of subsequent BOS with an 11% (1/9) sensit ivity but had high specificity (94%, 44/46). No high resolution CT features accurately predicted the development of BOS.