Early Bronchiolitis Obliterans Following Lung Transplantation: Accuracy of Expiratory Thin-Section CT for Diagnosis

Lee, Ell Seong; Gotway, Michael B.; Reddy, Gautham P.; Golden, Jeffrey A.; Keith, Fraser M.; Webb, W. Richard

doi:10.1148/radiology.216.2.r00au21472

Cited by 117 publications

(64 citation statements)

References 9 publications

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“…Nevertheless, there is considerable heterogeneity between series concerning which test (transbronchial biopsy, pulmonary function testing, expiratory HRCT) is the most accurate for the detection of obliterative bronchiolitis in post-transplant patients. A recent study suggests that air-trapping on expiratory CT is not as specific or sensitive as previously thought [71]; the air-trapping score in patients with biopsy proven obliterative bronchiolitis was not significantly different to biopsy negative patients with airflow limitation. However, given the patchy nature of the disease, a negative transbronchial biopsy does not necessarily preclude obliterative bronchiolitis [75] and expiratory HRCT may show evidence of obliterative bronchiolitis in some biopsy negative cases [71].…”

Section: Constrictive (Obliterative) Bronchiolitismentioning

confidence: 73%

Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

146

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Diseases affecting the small airways are difficult to detect by traditional diagnostic tests. Widespread involvement is needed before symptoms and abnormalities on pulmonary function testing or chest radiography become apparent. Obstruction of the bronchioles may be detected indirectly by computed tomography (CT) because regional under-ventilation results in reduced perfusion which in turn is shown as a mosaic attenuation pattern of the lung parenchyma. When there is inflammation of the bronchioles with accompanying exudate, the airways may become directly visible on CT, for example in cases of diffuse panbronchiolitis.Quantification of the various morphological features of small airways disease is possible from CT images and this increased precision has aided investigations of structure/function relationships.An understanding of the pathology and microscopic distribution of disease in relation to the airways allows some prediction of the likely computed tomography appearances in this wide spectrum of conditions, and thus helps to refine the differential diagnosis.

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Section: Constrictive (Obliterative) Bronchiolitismentioning

confidence: 73%

Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

146

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“…High-resolution computed tomography (HRCT) may detect diagnostically useful pleuroparenchymal changes and/or air trapping to which routine chest radiography is insensitive [87][88][89][90][91][92][93][94]. Bronchoscopy with transbronchial lung biopsy (TBLB) and BAL is useful to detect infection or other entities that may be the cause of functional decline.…”

Section: Diagnosis Of Bosmentioning

confidence: 99%

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

et al. 2014

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Bronchiolitis obliterans syndrome (BOS) is a major complication of lung transplantation that is associated with poor survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society convened a committee of international experts to describe and/or provide recommendations for 1) the definition of BOS, 2) the risk factors for developing BOS, 3) the diagnosis of BOS, and 4) the management and prevention of BOS.A pragmatic evidence synthesis was performed to identify all unique citations related to BOS published from 1980 through to March, 2013. The expert committee discussed the available research evidence upon which the updated definition of BOS, identified risk factors and recommendations are based. The committee followed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) approach to develop specific clinical recommendations.The term BOS should be used to describe a delayed allograft dysfunction with persistent decline in forced expiratory volume in 1 s that is not caused by other known and potentially reversible causes of posttransplant loss of lung function. The committee formulated specific recommendations about the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and about re-transplantation in patients with suspected and confirmed BOS.The diagnosis of BOS requires the careful exclusion of other post-transplant complications that can cause delayed lung allograft dysfunction, and several risk factors have been identified that have a significant association with the onset of BOS. Currently available therapies have not been proven to result in significant benefit in the prevention or treatment of BOS. Adequately designed and executed randomised controlled trials that properly measure and report all patient-important outcomes are needed to identify optimal therapies for established BOS and effective strategies for its prevention. Executive summaryMany lung transplant recipients develop delayed allograft dysfunction that has been traditionally referred to as bronchiolitis obliterans syndrome (BOS), which is thought to be caused by inflammation, destruction and fibrosis of small airways in the lung allograft that leads to obliterative bronchiolitis (OB). Because a definitive diagnosis of OB is difficult to make without a surgical lung biopsy, a decrease in the forced expiratory volume in 1 s (FEV1) has been used as a surrogate marker to identify patients who develop a syndrome of significant and persistent loss of lung allograft function with onset three or more months following transplantation. However, it is now recognised that numerous factors apart from OB can lead to a delayed onset, significant decline in lung function, and these causes of delayed onset graft dysfunction must be carefully excluded when a diagnosis of BOS is made. In general, BOS responds poorly to therapeutic interventions but may stabilise, and some patients may have a significant improvement in FEV1 with certain ther...

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“…С помощью КТВР выявляются диагностически значимые плевропаренхиматозные изменения и / или воздушные ловушки, не определяемые на обычной рентгенограмме легких [87][88][89][90][91][92][93][94]. Бронхоскопия с ТББ легочной ткани и БАС используются для диагности ки инфекции или других состояний, которые могут вызвать функциональное ухудшение.…”

Section: диагноз собunclassified

International practical guidelines on diagnosis, prevention and treatment of bronchiolitis obliterans syndrome

Редакционная¹

2015

Pulʹmonologiâ (Mosk.)

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РезюмеСиндром облитерирующего бронхиолита (СОБ) -серьезное осложнение трансплантации легких, при котором сокращается выживае мость больных. Международным обществом по трансплантации легких и сердца, Американским торакальным и Европейским респира торным обществами созданы Международный комитет экспертов для разработки клинических рекомендаций по ведению пациентов с СОБ. В этих Рекомендациях дано определение СОБ, описаны факторы риска, диагностика, ведение больных и профилактика СОБ. Для разработки Рекомендаций собрана доказательная информация по СОБ с 1980 г. до марта 2013 г. Комитетом экспертов обсуждались доступные научные доказательства. Оценка Рекомендаций проводилась по системе GRADE. Термин СОБ относится к поздней дис функции трансплантата с неуклонным снижением объема форсированного выдоха за 1 ю секунду, необъяснимое другими причинами. В данных Рекомендациях обсуждаются вопросы использования системных глюкокортикостероидов, циклоспорина, такролимуса, азит ромицина и ретрансплантации у больных с предполагаемым и подтвержденным СОБ. В случае диагноза СОБ требуется тщательное исключение других посттрансплантационных осложнений с поздней дисфункцией трансплантата. Выявлено несколько факторов рис ка, тесно связанных с развитием СОБ. В настоящее время отсутствует лечение, при помощи которого можно бы предотвратить или существенно повлиять на СОБ. Для поиска оптимальных методов лечения и эффективных мер профилактики необходимы хорошо спланированные рандомизированные контролируемые исследования, в которых прослеживались бы все значимые для пациента пока затели. Ключевые слова: синдром облитерирующего бронхиолита, трансплантация легких, поздняя дисфункция трансплантата, клинические рекомендации, факторы риска, лечение. DOI: 10.18093/0869 0189 2015 25 4 403 424 International practical guidelines on diagnosis, prevention and treatment of bronchiolitis obliterans syndrome SummaryBronchiolitis obliterans syndrome (BOS) is a serious complication of lung transplantation that decreases the patients' survival. The International Society for Heart and Lung Transplantation, American Thoracic Society, and European Respiratory Society developed the current recommenda tions for better definition of BOS, describing risk factors for developing BOS, diagnosis, management and prevention of BOS. The recommenda tions were based on the evidenced data published from 1980 through to March, 2013 and were evaluated according to the GRADE system. The committee discussed the use of systemic corticosteroids, cyclosporine, tacrolimus, azithromycin and re transplantation in patients with BOS. The diagnosis of BOS should be made after exclusion of other post transplant complications that can cause persistent lung function decline. Currently, there is no therapy able to improve significantly or to prevent BOS development. Further randomised controlled trials are needed to search optimal therapies and preventive measures for BOS.

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Early Bronchiolitis Obliterans Following Lung Transplantation: Accuracy of Expiratory Thin-Section CT for Diagnosis

Abstract: Thin-section CT, including expiratory scans, is of limited accuracy in diagnosing early bronchiolitis obliterans after lung transplantation.

Cited by 117 publications

References 9 publications

Small airways diseases: detection and insights with computed tomography

Small airways diseases: detection and insights with computed tomography

An international ISHLT/ATS/ERS clinical practice guideline: diagnosis and management of bronchiolitis obliterans syndrome

International practical guidelines on diagnosis, prevention and treatment of bronchiolitis obliterans syndrome

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