Parametric Response Mapping of Bronchiolitis Obliterans Syndrome Progression After Lung Transplantation

Verleden, Stijn E.; Vos, Robin; Vandermeulen, Elly; Ruttens, David; Bellon, Hannelore; Heigl, Tobias; Raemdonck, Dirk Van; Verleden, Geert M.; Lama, Vibha N.; Ross, Brian D.; Galbán, Craig J.; Vanaudenaerde, Bart M.

doi:10.1111/ajt.13945

Cited by 38 publications

(38 citation statements)

References 22 publications

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“…In this study, we investigated the utility of CT-based anatomical modeling using MORFEUS approach in combination with longitudinal inspiratory LDCT in detection and characterization of RAS. Image registration techniques have been used to evaluate the changes longitudinally using PRM for identifying patients with BOS, 16,26 and also Jacobian analysis 19 has been used to measure regional tissue expansion. In our study, there was no statistically significant difference in surface vector displacement between the upper and lower lung sections for patients with RAS.…”

Section: Discussionmentioning

confidence: 99%

The role of biomechanical anatomical modeling via computed tomography for identification of restrictive allograft syndrome

Horie

Saito

Moseley

et al. 2017

Clinical Transplantation

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Chronic lung allograft dysfunction (CLAD) reduces long-term graft survival. It is important to distinguish CLAD subtypes: bronchiolitis obliterans syndrome (BOS) and restrictive allograft syndrome (RAS) as RAS has a worse prognosis and accurate subtyping could facilitate targeted treatments. However, the current diagnosis of CLAD subtypes is based on pulmonary function test (PFT) results that reflect global estimates of lung function; anatomical modeling based on computed tomography (CT) has the potential to provide detailed analysis of global and regional lung function. The purpose of this study is to evaluate the utility of CT-based anatomical modeling for the identification of RAS. This retrospective study included 51 patients (CLAD: 17 BOS and 17 RAS, control: 17 No-CLAD). CT data were assessed using a biomechanical model-based platform (MORFEUS) to characterize changes in lung deformation between baseline and disease onset. Lung deformation demonstrated high sensitivity and specificity (>80%) in differentiating RAS from BOS (P<.0001) and No-CLAD (P<.0001). There were matching radiological reading and inward deformation abnormalities in 79% of lung sections in patients with RAS. Anatomical modeling is complementary to conventional assessment in the diagnosis of RAS and potentially provides quantitative data that can help in the characterization and detailed assessment of heterogeneous lung parenchymal disease.

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Section: Discussionmentioning

confidence: 99%

The role of biomechanical anatomical modeling via computed tomography for identification of restrictive allograft syndrome

Horie

Saito

Moseley

et al. 2017

Clinical Transplantation

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“…Verleden and colleagues investigated disease progression in BOS patients using parametric response mapping (PRM) which is a voxel‐based analysis of lung density on paired inspiratory and expiratory CT images. In this study, quantification of functional small airway disease (PRM fSAD ) using the PRM method was associated with disease progression.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, quantitative imaging may overcome the limitation of interobserver variability which could be caused by differences in experience levels of the reviewing radiologists. 12,13 Verleden and colleagues 14 investigated disease progression in BOS patients using parametric response mapping (PRM) which is a voxel-based analysis of lung density on paired inspiratory and expiratory CT images. In this study, quantification of functional small airway disease (PRM fSAD ) using the PRM method was associated with disease progression.…”

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confidence: 99%

Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival

Horie

Salazar²,

Saito

et al. 2018

Clinical Transplantation

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Chronic lung allograft dysfunction (CLAD) is a major cause of mortality in lung transplant recipients. CLAD can be sub-divided into at least 2 subtypes with distinct mortality risk characteristics: restrictive allograft syndrome (RAS), which demonstrates increased overall computed tomography (CT) lung density in contrast with bronchiolitis obliterans syndrome (BOS), which demonstrates reduced overall CT lung density. This study aimed to evaluate a reader-independent quantitative density metric (QDM) derived from CT histograms to associate with CLAD survival. A retrospective study evaluated CT scans corresponding to CLAD onset using pulmonary function tests in 74 patients (23 RAS, 51 BOS). Two different QDM values (QDM1 and QDM2) were calculated using CT lung density histograms. Calculation of QDM1 includes the extreme edges of the histogram. Calculation of QDM2 includes the central region of the histogram. Kaplan-Meier analysis and Cox regression analysis were used for CLAD prognosis. Higher QDM values were significantly associated with decreased survival. The hazard ratio for death was 3.2 times higher at the 75th percentile compared to the 25th percentile using QDM1 in a univariate model. QDM may associate with CLAD patient prognosis.

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“…8 Parametric response mapping (voxel-wise comparison of corresponding inspiratory and expiratory CT images), which quantifies small airway disease in progressing CLAD, has been recently reported, 9 with some evidence suggesting prognostic relevance. 8 Parametric response mapping (voxel-wise comparison of corresponding inspiratory and expiratory CT images), which quantifies small airway disease in progressing CLAD, has been recently reported, 9 with some evidence suggesting prognostic relevance.…”

Section: Introductionmentioning

confidence: 99%

“…Computed tomography (CT) has been proposed as an adjunct to improve early CLAD detection, 7 although subsequent reports have proved less conclusive. 8 Parametric response mapping (voxel-wise comparison of corresponding inspiratory and expiratory CT images), which quantifies small airway disease in progressing CLAD, has been recently reported, 9 with some evidence suggesting prognostic relevance. 10 Widespread implementation of surveillance CT scanning after LTx remains controversial, due to limited availability and concerns about exposure to ionizing radiation.…”

Section: Introductionmentioning

confidence: 99%

Detection of chronic lung allograft dysfunction using ventilation-weighted Fourier decomposition MRI

Voskrebenzev

Greer

Gutberlet

et al. 2018

American Journal of Transplantation

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Chronic lung allograft dysfunction (CLAD) remains the leading cause of morbidity and mortality after lung transplantation. Diagnosis requires spirometric change, which becomes increasingly difficult with advancing CLAD. Fourier decomposition magnetic resonance imaging (FD-MRI) permits acquisition of ventilated-weighted images during free-breathing. This study evaluates FD-MRI in detecting CLAD in selected patients after bilateral lung transplantation (DLTx). DLTx recipients demonstrating CLAD at various stages participated. Radiologists remained blinded to clinical status until completion of image analysis. Image acquisition used a 1.5-T MR scanner using a spoiled gradient echo sequence. After FD processing and regional fractional ventilation (RFV) quantification, the volume defect percentage at 2 thresholds (VDP ), median lung RFV and quartile coefficient of dispersion (QCD) were calculated. Sixty-two patients participated. CLAD was present in 29/62 (47%) patients, of whom 17/62 (27%) had forced expiratory volume in 1 second ≤65% at image acquisition. VDP was higher among these participants compared to other groups (P < .001). Increased VDP was associated with subsequent graft loss, with values >2% showing reduced survival, independent of degree of graft dysfunction (P = .005). VDP discriminated between presence or absence of CLAD (area under the curve = 0.71; P = .03). QCD increased significantly with advancing disease (P < .001). In conclusion, FD-MRI-derived parameters demonstrate potential in quantitative CLAD diagnosis and assessment after DLTx.

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Parametric Response Mapping of Bronchiolitis Obliterans Syndrome Progression After Lung Transplantation

Cited by 38 publications

References 22 publications

The role of biomechanical anatomical modeling via computed tomography for identification of restrictive allograft syndrome

The role of biomechanical anatomical modeling via computed tomography for identification of restrictive allograft syndrome

Quantitative chest CT for subtyping chronic lung allograft dysfunction and its association with survival

Detection of chronic lung allograft dysfunction using ventilation-weighted Fourier decomposition MRI

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