Bronchiolitis Obliterans after Allogenic Bone Marrow Transplantation: HRCT Findings

Abstract

ObjectiveTo evaluate the high resolution computed tomography (HRCT) findings of bronchiolitis obliterans (BO) after bone marrow transplantation (BMT).Materials and MethodsDuring the past three years, 11 patients were diagnosed as having BO after BMT when they developed irreversible air flow obstruction, with an FEV1 value of less than 80% of the baseline value, without any clinical evidence of infection. All 11 patients underwent HRCT, of whom eight also underwent follow-up HRCT. The HRCT images were assessed retrospectively for the presence of decreased lung attenuation, segmental or subsegmental bronchial dilatation, diminution of peripheral vascularity, centrilobular nodules, and branching linear structure on the inspiratory images. The lobar distribution of the decreased lung attenuation and bronchial dilatation was also examined. The presence of air trapping was investigated on the expiratory images. The interval changes of the HRCT findings were evaluated in those patients who had follow-up images.ResultsAbnormal HRCT findings were present in all cases; the most common abnormalities were decreased lung attenuation (n=11), subsegmental bronchial dilatation (n=6), diminution of peripheral vascularity (n=6), centrilobular nodules or branching linear structure (n=3), and segmental bronchial dilatation (n=3). Expiratory air trapping was noted in all patients. The decreased lung attenuation and bronchial dilatations were more frequent or extensive in the lower lobes. Interval changes were found in all patients with follow-up HRCT: increased extent of decreased lung attenuation (n=7); newly developed or progressed bronchial dilatation (n=4); and increased lung volume (n=3).ConclusionHRCT scans are abnormal in patients with BO, with the most commonly observed finding being areas of decreased lung attenuation. While the HRCT findings are not specific, it is believed that their common features can assist in the diagnosis of BO in BMT recipients.

Combined inhaled steroids and bronchodilatators in obstructive airway disease after allogeneic stem cell transplantation

“…4 Moreover, although the accuracy of lung HRCT for the diagnosis of BO post SCT has not been precisely evaluated, air trapping was always present in these patients in two small series. 10,11 Different radiological scores have been proposed for the quantification of air trapping on expiratory slices. 18,[20][21][22] However, limitations to these scoring systems exist, mainly due to sensitivity and specificity for disease progression and Table 3 Evolution of dyspnea evaluated by NYHA Classification at last follow-up…”

“…9 Available lung HRCT in small series of patients with post-SCT BO showed air trapping at full expiration in all cases, strongly suggesting that lung HRCT should be considered for diagnosis of this disease. 10,11 Furthermore, lung HRCT may allow identification of patients at an earlier stage of BO, before the development of a significant airflow obstruction on pulmonary function tests.…”

High-dose corticosteroid therapy for bronchiolitis obliterans after bone marrow transplantation in children

“…12 These criteria were modified to include the following five criteria: (1) airway obstruction7hypoxaemia not normalizing after b-2 agonist treatment, [13][14][15] (2) absence of pulmonary infiltrates, (3) absence of infectious organisms in blood and respiratory secretion7bronchoal-veolar lavage, (4) reduction in FEV 1 in the absence of airway restriction (in patients cooperating in pulmonary function measurements), 14,15 (5) bronchial dilatation and mosaic pattern of attenuation on high-resolution CT scan. [16][17][18] Patients fulfilling at least four of five criteria were diagnosed as BO and treated with high-dose pulse corticosteroid therapy (methylprednisolone 10 mg/kg body weight/day) for 3 days. Courses of pulse therapy were repeated on a monthly basis in patients with continuous symptoms up to a maximum of six cycles.…”

Bronchiolitis obliterans following haematopoietic stem cell transplantation

“…High-resolution computed tomography (HRCT) of the chest is much more sensitive in detecting signs of BO and is the radiological procedure of choice in evaluating these patients [40][41][42]. While the study may still be normal in the early stages of BO, it usually shows signs of hyperinflation with areas of decreased attenuation.…”

“…Some studies demonstrated that the presence of expiratory air trapping preceded the PFT criteria for BO [44]. In a study of 11 patients with BO following HSCT who underwent HRCT of the chest, all were found to have abnormal findings, and all patients had progression of radiological findings over time [41]. The most common finding was decreased lung attention, especially in the lower lobes, and expiratory air trapping (n511).…”