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Sharifi H, Guenther ZD, Leung ANC, Johnston L, Lai YK, Hsu JL, Guo HH. Head-to-head Comparison of Qualitative Radiologist Assessment With Automated Quantitative Computed Tomography Analysis for Bronchiolitis Obliterans Syndrome After Hematopoietic Cell Transplantation. J Thorac Imaging 2022; 37:109-116. [PMID: 33999570 DOI: 10.1097/rti.0000000000000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Computed tomography (CT) findings of bronchiolitis obliterans syndrome (BOS) can be nonspecific and variable. This study aims to measure the incremental value of automated quantitative lung CT analysis to clinical CT interpretation. A head-to-head comparison of quantitative CT lung density analysis by parametric response mapping (PRM) with qualitative radiologist performance in BOS diagnosis was performed. MATERIALS AND METHODS Inspiratory and end-expiratory CTs of 65 patients referred to a post-bone marrow transplant lung graft-versus-host-disease clinic were reviewed by 3 thoracic radiologists for the presence of mosaic attenuation, centrilobular opacities, airways dilation, and bronchial wall thickening. Radiologists' majority consensus diagnosis of BOS was compared with automated PRM air trapping quantification and to the gold-standard diagnosis of BOS as per National Institutes of Health (NIH) consensus criteria. RESULTS Using a previously established threshold of 28% air trapping on PRM, the diagnostic performance for BOS was as follows: sensitivity 56% and specificity 94% (area under the receiver operator curve [AUC]=0.75). Radiologist review of inspiratory CT images alone resulted in a sensitivity of 80% and a specificity of 69% (AUC=0.74). When radiologists assessed both inspiratory and end-expiratory CT images in combination, the sensitivity was 92% and the specificity was 59% (AUC=0.75). The highest performance was observed when the quantitative PRM report was reviewed alongside inspiratory and end-expiratory CT images, with a sensitivity of 92% and a specificity of 73% (AUC=0.83). CONCLUSIONS In the CT diagnosis of BOS, qualitative expert radiologist interpretation was noninferior to quantitative PRM. The highest level of diagnostic performance was achieved by the combination of quantitative PRM measurements with qualitative image feature assessments.
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Affiliation(s)
- Husham Sharifi
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine
| | | | - Ann N C Leung
- Department of Radiology, Stanford University School of Medicine
| | - Laura Johnston
- Department of Medicine, Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA
| | - Yu K Lai
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine
| | - Joe L Hsu
- Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine
| | - H Henry Guo
- Department of Radiology, Stanford University School of Medicine
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2
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Rayment JH, Sandoval RA, Roden JP, Schultz KR. Multiple breath washout testing to identify pulmonary chronic graft versus host disease in children after haematopoietic stem cell transplantation. Transplant Cell Ther 2022; 28:328.e1-328.e7. [DOI: 10.1016/j.jtct.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
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Kogo M, Matsumoto H, Tanabe N, Chen-Yoshikawa TF, Nakajima N, Yoshizawa A, Oguma T, Sato S, Nomura N, Morimoto C, Sunadome H, Gotoh S, Ohsumi A, Date H, Hirai T. The importance of central airway dilatation in patients with bronchiolitis obliterans. ERJ Open Res 2021; 7:00123-2021. [PMID: 34708115 PMCID: PMC8542961 DOI: 10.1183/23120541.00123-2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background Bronchiolitis obliterans (BO) is a clinical syndrome characterised by progressive small airway obstruction, causing significant morbidity and mortality. Central airway dilatation is one of its radiological characteristics, but little is known about the clinical and pathological associations between airway dilatation and BO. Methods This retrospective study consecutively included patients who underwent lung transplantation due to BO at Kyoto University Hospital from 2009 to 2019. Demographic and histopathological findings of the resected lungs were compared between patients with and without airway dilatation measured by chest computed tomography (CT) at registration for lung transplantation. Results Of a total of 38 included patients (median age, 30 years), 34 (89%) had a history of hematopoietic stem-cell transplantation, and 22 (58%) had airway dilatation based on CT. Patients with airway dilatation had a higher frequency of Pseudomonas aeruginosa isolation with greater residual volume than those without airway dilatation. Quantitative CT analysis revealed an increase in lung volume to predictive total lung capacity and a percentage of low attenuation volume <−950 HU at inspiration in association with the extent of airway dilatation. Airway dilatation on CT was associated with an increased number of bronchioles with concentric narrowing of the lumen and thickening of the subepithelium of the walls on histology. Conclusions In patients with BO, airway dilatation may reflect increased residual volume or air trapping and pathological extent of obstructive bronchioles, accompanied by a risk of Pseudomonas aeruginosa isolation. More attention should be paid to the development of airway dilatation in the management of BO. In patients with bronchiolitis obliterans (BO), airway dilatation may reflect air trapping and the pathological extent of obstructive bronchioles. More attention should be paid to airway dilatation in the management of BO.https://bit.ly/3w7cRV6
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Affiliation(s)
- Mariko Kogo
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisako Matsumoto
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,These authors contributed equally to this work
| | - Naoya Tanabe
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,These authors contributed equally to this work
| | | | - Naoki Nakajima
- Dept of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiko Yoshizawa
- Dept of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsuyoshi Oguma
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Susumu Sato
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Natsuko Nomura
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Chie Morimoto
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hironobu Sunadome
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shimpei Gotoh
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akihiro Ohsumi
- Dept of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroshi Date
- Dept of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toyohiro Hirai
- Dept of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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4
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José RJ, Hall J, Brown JS. De novo bronchiectasis in haematological malignancies: patient characteristics, risk factors and survival. ERJ Open Res 2019; 5:00166-2019. [PMID: 31720297 PMCID: PMC6826250 DOI: 10.1183/23120541.00166-2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/19/2019] [Indexed: 11/08/2022] Open
Abstract
Patients with haematological malignancies often develop secondary immunodeficiency and respiratory infections that could predispose towards bronchiectasis, and this is supported by case reports and a previous small case series of 22 patients [1–4]. To improve understanding of this association we performed a retrospective review of patients with clinically significant bronchiectasis (defined as radiological evidence of bronchiectasis plus chronic productive cough or recurrent respiratory tract infections requiring antibiotic therapy) and haematological malignancy attending our respiratory clinic at a UK teaching hospital between January 2014 and April 2018. Patients were investigated according to the British Thoracic Society guideline [5]. Bronchiectasis occurs de novo in haematological malignancy and is associated with significant mortality and morbidity. Rituximab predisposes to IgG deficiency and survival time is significantly associated with age, FEV1 % and stem cell transplantation.http://bit.ly/2KZwCZt
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Affiliation(s)
- Ricardo J José
- Centre for Inflammation and Tissue Repair, UCL Respiratory, London, UK.,Dept of Respiratory Medicine, University College London Hospital, London, UK
| | - Jocelin Hall
- Centre for Inflammation and Tissue Repair, UCL Respiratory, London, UK.,Dept of Respiratory Medicine, University College London Hospital, London, UK
| | - Jeremy S Brown
- Centre for Inflammation and Tissue Repair, UCL Respiratory, London, UK.,Dept of Respiratory Medicine, University College London Hospital, London, UK
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5
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Bergeron A, Cheng GS. Bronchiolitis Obliterans Syndrome and Other Late Pulmonary Complications After Allogeneic Hematopoietic Stem Cell Transplantation. Clin Chest Med 2017; 38:607-621. [PMID: 29128013 DOI: 10.1016/j.ccm.2017.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
As more individuals survive their hematologic malignancies after allogeneic hematopoietic stem cell transplantation (HSCT), there is growing appreciation of the late organ complications of this curative procedure for malignant and nonmalignant hematologic disorders. Late noninfectious pulmonary complications encompass all aspects of the bronchopulmonary anatomy. There have been recent advances in the diagnostic recognition and management of bronchiolitis obliterans syndrome, which is recognized as a pulmonary manifestation of chronic graft-versus-host disease. Organizing pneumonia and other interstitial lung diseases are increasingly recognized. This article provides an update on these entities as well as pleural and pulmonary vascular disease after allogeneic HSCT.
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Affiliation(s)
- Anne Bergeron
- Service de Pneumologie, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, UMR 1153 CRESS, Biostatistics and Clinical Epidemiology Research Team, Paris F-75010, France.
| | - Guang-Shing Cheng
- Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D5-360, Seattle, WA 98105, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington School of Medicine, 1959 NE Pacific, Campus Box 356522, Seattle, WA 98195-6522, USA
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Bergeron A. Late-Onset Noninfectious Pulmonary Complications After Allogeneic Hematopoietic Stem Cell Transplantation. Clin Chest Med 2017; 38:249-262. [DOI: 10.1016/j.ccm.2016.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Labžentytė V, Zemnickienė S, Danila E, Šileikienė V, Zablockis R, Gruslys V. A fast and fatal course of bronchiectasis: an unusual rare expression of chronic graft versus host disease. A case report. Acta Med Litu 2016; 23:54-59. [PMID: 28356792 PMCID: PMC4924631 DOI: 10.6001/actamedica.v23i1.3270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. We report a case of a patient with acute myeloid leukaemia whose treatment with bone marrow transplantation (BMT) was followed by chronic graft versus host disease (GVHD) with lung involvement and bronchiectasis. This report illustrates an unusual course of a fast progression of the bronchiectasis due to BMT. Case description. A 33-year-old female was diagnosed with acute myeloid leukaemia. An allogeneic BMT was performed. One month after the transplantation, acute GVHD with skin involvement occurred. Treatment with prednisolone and mycophenolate mofetil (MMF) has been started. Nine months later, the patient was examined by a pulmonologist due to progressive dyspnoea. A pulmonary computed tomography (CT) scan showed normal parenchyma of the lungs and no changes to the bronchi. A CT scan performed 7 months later revealed bronchiectasis for the first time. No clinical response was associated with the treatment and the patient’s respiratory status progressively deteriorated. During the final hospitalization, a CT scan performed 1 year later revealed huge cystic bronchiectasis in both lungs. Despite the prophylaxis and treatment of GVHD and aggressive antimicrobial therapy, the patient died one year after the diagnosis of bronchiectasis. Conclusions. This case demonstrates that a fast and fatal course of bronchiectasis, that occurs after BMT, should always be considered as a possible manifestation of chronic graft versus host disease (cGVHD) following allogeneic BMT.
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Affiliation(s)
| | | | - Edvardas Danila
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Lithuania.,Centre of Pulmonology and Allergology, Vilnius University Hospital Santariškių Clinics, Lithuania
| | - Virginija Šileikienė
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Lithuania.,Centre of Pulmonology and Allergology, Vilnius University Hospital Santariškių Clinics, Lithuania
| | - Rolandas Zablockis
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Lithuania.,Centre of Pulmonology and Allergology, Vilnius University Hospital Santariškių Clinics, Lithuania
| | - Vygantas Gruslys
- Clinic of Infectious and Chest Diseases, Dermatovenereology and Allergology, Vilnius University, Lithuania.,Centre of Pulmonology and Allergology, Vilnius University Hospital Santariškių Clinics, Lithuania
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8
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Biopsy-verified bronchiolitis obliterans and other noninfectious lung pathologies after allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2014; 21:531-8. [PMID: 25498923 DOI: 10.1016/j.bbmt.2014.12.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 12/01/2014] [Indexed: 11/21/2022]
Abstract
Bronchiolitis obliterans (BO) is a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT). Lung biopsy is the gold standard for diagnosis. This study describes the course of BO and assesses the congruity between biopsy-verified BO and a modified version of the National Institutes of Health's consensus criteria for BO syndrome (BOS) based exclusively on noninvasive measures. We included 44 patients transplanted between 2000 and 2010 who underwent lung biopsy for suspected BO. Of those, 23 were diagnosed with BO and 21 presented other noninfectious pulmonary pathologies, such as cryptogenic organizing pneumonia, diffuse alveolar damage, interstitial pneumonia, and nonspecific interstitial fibrosis. Compared with patients with other noninfectious pulmonary pathologies, BO patients had significantly lower values of forced expiratory volume in 1 second (FEV1), FEV1/forced vital capacity, and maximal mid-expiratory flow throughout follow-up, but there was no difference in the change in pulmonary function from the time of lung biopsy. The BO diagnosis was not associated with poorer overall survival. Fifty-two percent of patients with biopsy-verified BO and 24% of patients with other noninfectious pulmonary pathology fulfilled the BOS criteria. Pathological BO diagnosis was not superior to BOS criteria in predicting decrease in pulmonary function beyond the time of biopsy. A lung biopsy may provide a characterization of pathological patterns that can extend our knowledge on the pathophysiology of HSCT-related lung diseases.
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Abstract
RATIONALE Bronchiolitis obliterans syndrome (BOS) is a late, non-infectious pulmonary complication following hematopoietic stem cell transplantation (HSCT). There is minimal data published on quantitative radiologic characterization of airway remodeling in these subjects. OBJECTIVES To examine quantitative measurements of airway morphology and their correlation with lung function in a cohort of patients who underwent HSCT and developed BOS. METHODS All adult patients who underwent allogeneic HSCT at the Dana-Farber Cancer Institute/Brigham and Women's Hospital (n = 1854) between January 1st 2000 and June 30th 2010 were screened for the development of BOS. Clinically acquired high resolution CT (HRCT) scans of the chest were collected. For each subjects discrete measures of airway wall area were performed and the square root of wall area of a 10-mm luminal perimeter (Pi10) was calculated. MEASUREMENTS AND MAIN RESULTS We identified 88 cases of BOS, and 37 of these patients had available HRCT. On CT scans obtained after BOS diagnosis, the Pi10 decreased (consistent with airway dilation) as compared with pre-BOS values (p < 0.001). After HSCT the Pi10 correlated with FEV(1)% predicted (r = 0.636, p < 0.0001), and RV/TLC% predicted (r = -0.736, p < 0.0001), even after adjusting for age, sex and total lung capacity (p < 0.0001 for both). CONCLUSIONS On HRCT scan BOS is characterized by central airway dilation, the degree of which is correlated to decrements in lung function. This is opposite of what has been previously demonstrated in COPD and asthma that quantitative measure of proximal airway wall thickening directly correlate with pulmonary function. Our data suggests that the pathologic process affecting the central airways is different from the pathology observed in the distal airways. Further work is needed to determine if such change can be used as a sensitive and specific tool for the future diagnosis and staging of BOS.
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10
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Godet C, Elsendoorn A, Roblot F. Benefit of CT scanning for assessing pulmonary disease in the immunodepressed patient. Diagn Interv Imaging 2012; 93:425-30. [PMID: 22634153 DOI: 10.1016/j.diii.2012.04.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Management of pulmonary disease in immunodepressed patients requires a clear diagnostic and therapeutic strategy and multidisciplinary cooperation. DISCUSSION The diagnostic approach should take into account the type of immunodepression, the clinical picture, the radiological signs and symptoms, and the microbiological, cytological and even histological examination of the pulmonary or extrapulmonary specimens. The high-resolution CT scan plays a central role and makes it possible to prioritize the diagnostic possibilities. CONCLUSION The analysis of the literature shows three important points: the chest X-ray has low diagnostic value; the CT scan of the chest can reveal lesions that cannot be detected on a standard chest X-ray; the CT scan is helpful for early detection and monitoring of invasive pulmonary aspergillosis.
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Affiliation(s)
- C Godet
- Service de maladies infectieuses et médecine interne, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers cedex, France.
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Incidence, risk factors and outcomes of bronchiolitis obliterans after allogeneic stem cell transplantation. Int J Hematol 2011; 93:375-382. [PMID: 21424350 DOI: 10.1007/s12185-011-0809-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2010] [Revised: 11/15/2010] [Accepted: 12/15/2010] [Indexed: 11/12/2022]
Abstract
Bronchiolitis obliterans (BO) after allogeneic stem cell transplantation (allo-SCT) is a late-onset, life-threatening respiratory complication that significantly reduces a patient's quality of life. We retrospectively analysed the incidence of and risk factors for BO in allo-SCT recipients. In 2087 patients who underwent allo-SCT between January 1994 and June 2005 and survived >90 days after transplantation, 57 patients developed BO with a 5-year cumulative incidence of 2.8%. The median time interval from transplantation to BO diagnosis was 335 days (range 83-907 days). The 5-year cumulative incidence of BO was 1.62% in bone marrow transplantation (BMT) from related donors, 3.83% in peripheral blood stem cell transplantation (PBSCT) from related donors (R-PBSCT), 2.91% in BMT from unrelated donors and 2.65% in unrelated cord blood transplantation. The incidence of BO after R-PBSCT was significantly higher than that after any other type of allo-SCT (p = 0.02). R-PBSCT (p = 0.019) and preceding chronic graft-versus-host disease (GVHD) (p < 0.001) were BO-associated risk factors. Overall 5-year survival of patients with BO from the time of diagnosis was 45.4%, significantly less than those without (77.5% from day 335, p < 0.001). R-PBSCT recipients with existent chronic GVHD have a high risk of developing BO, and need extensive care and repeated pulmonary function tests.
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12
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Yamashiro T, Matsuoka S, Estépar RSJ, Bartholmai BJ, Diaz A, Ross JC, Murayama S, Silverman EK, Hatabu H, Washko GR. Kurtosis and Skewness of Density Histograms on Inspiratory and Expiratory CT Scans in Smokers. COPD 2011; 8:13-20. [DOI: 10.3109/15412555.2010.541537] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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13
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Abstract
This article comprehensively reviews and illustrates the imaging features of small airway diseases. The authors discuss the imaging findings of small airway diseases in general and how to differentiate them from other findings that can be confused with small airway diseases. The authors also discuss the features that aid in diagnosing specific diseases that affect the small airways.
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Affiliation(s)
- Sudhakar N J Pipavath
- Department of Radiology, University of Washington Medical Center, 1959 NE Pacific Street, # 357115, Seattle, WA, USA
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14
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High-resolution CT findings of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation. J Thorac Imaging 2009; 23:244-50. [PMID: 19204468 DOI: 10.1097/rti.0b013e3181809df0] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the high-resolution computed tomography (CT) findings occurring in bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation (HSCT) and to determine the relationship between pulmonary function tests (PFTs) and air trapping detected on expiratory CT. MATERIALS AND METHODS The high-resolution CT scans of 33 patients who underwent HSCT and subsequently developed BOS were evaluated by 2 observers blinded to PFT results. Scans were ranked for degree of air trapping and scored for findings of bronchial wall thickening, bronchiectasis, and centrilobular opacities. Air-trapping rank was correlated with the degree of airflow obstruction as determined by PFTs. RESULTS The ranking of air trapping correlated significantly with 1-second forced expiratory volume (P=0.001), 1-second forced expiratory volume/forced vital capacity (P<0.001), residual volume (P<0.001), carbon monoxide diffusion capacity (P=0.023), but not forced vital capacity (P=0.14) or total lung capacity (P=0.07). Bronchial wall thickening occurred in 73.0%, predominantly in lower lobes (P=0.007), but was mild. Bronchiectasis occurred in 42.4% and centrilobular opacities in 39.4%. CONCLUSIONS In BOS developing after HSCT, air trapping is the principal finding on CT, and its severity correlates with PFTs. Bronchial wall thickening is common, but almost always mild; bronchiectasis and centrilobular opacities occur in less than half of cases and are also mild.
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Correlation of lung abnormalities on high-resolution CT with clinical graft-versus-host disease after allogeneic versus autologous bone marrow transplantation in children. Pediatr Radiol 2008; 38:1201-9. [PMID: 18769910 DOI: 10.1007/s00247-008-0984-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 11/10/2007] [Accepted: 06/01/2008] [Indexed: 01/15/2023]
Abstract
BACKGROUND Late-onset noninfectious pulmonary complications (LONIPCs) are life-threatening complications of bone marrow transplantation (BMT). Several pathological patterns are described in the literature with different prognoses, and with different relationships to graft-versus-host disease (GVHD). The role of high-resolution CT (HRCT) is not yet well established. OBJECTIVE To illustrate different patterns of LONIPCs on HRCT in allogeneic versus autologous BMT in order to investigate the correlation with chronic GVHD (cGVHD). MATERIALS AND METHODS A total of 67 HRCT scans were performed in 24 patients with noninfectious pulmonary disease at least 3 months after BMT (16 allogeneic, 8 autologous). Abnormality patterns and extension on HRCT images were correlated with the clinical outcome and with the severity of cGVHD. RESULTS Of 24 patients, 9 showed LONIPCs (1 autologous, 8 allogeneic). There was a significant association between abnormalities on HRCT and severe cGVHD (P = 0.038), with no specific pattern. Prognosis seemed to be related to the severity of cGVHD and not to the extent of abnormalities on HRCT. CONCLUSION The significant association between abnormalities on HRCT and severe GVHD suggests that LONIPCs can be a pulmonary manifestation of the disease. HRCT is a useful tool when combined with clinical data.
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Cransberg K, Pijnenburg M, Lunstroot M, Lilien M, Cornelissen E, Davin JC, VanHoeck K, Merkus P, Nauta J. Pulmonary complaints and lung function after pediatric kidney transplantation. Pediatr Transplant 2008; 12:201-6. [PMID: 18307669 DOI: 10.1111/j.1399-3046.2007.00810.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Recently four of 38 children with a kidney transplant were diagnosed with bronchiectasis. The aim of the current study was to identify patients with increased risk for pulmonary damage. In this cross-sectional observational study, children with a functioning kidney graft in the Netherlands and Antwerp, Belgium, were screened with the use of a symptom checklist and spirometry. Maximum score for upper airway complaints was 21 (normal: <8), for lower airway complaints 28 (<10). Results of FVC, FEV(1) and MEF(25) were expressed as percentage predicted for height and sex. One hundred and thirty-five patients completed the interview (122) and/or spirometry (103); 91 did both. Lower airways symptoms were above acceptable levels in 18 (14%) patients. Forty-nine patients (48%) had an abnormal lung function test: in 12 concerning FVC%, in 11 FEV(1)%, in 24 MEF(25)% and in 36 FEV(1)/FVC. Of correlations between symptomatology or spirometry data, and clinical parameters, only that between GFR and MEF(25)% was statistically significant. Children with a kidney transplant are at increased risk for obstructive lung disease. We recommend to monitor lung function during the follow-up after renal transplantation.
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Affiliation(s)
- Karlien Cransberg
- Department of Pediatric Nephrology, Erasmus MC/Sophia Children's Hospital, Rotterdam, The Netherlands.
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Bergeron A, Feuillet S, Meignin V, Socie G, Tazi A. Les complications pulmonaires tardives non infectieuses après allogreffe de cellules souches hématopoïétiques. Rev Mal Respir 2008; 25:173-83. [DOI: 10.1016/s0761-8425(08)71515-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Armenian SH, Hoffman JA, Butturini AM, Kapoor N, Mascarenhas L. Invasive diagnostic procedures for pulmonary infiltrates in pediatric hematopoietic stem cell transplant recipients. Pediatr Transplant 2007; 11:736-42. [PMID: 17910650 DOI: 10.1111/j.1399-3046.2007.00733.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To evaluate the role of BAL, CTB, and OLB in the management of pulmonary infiltrates in pediatric HSCT recipients, we conducted a retrospective review of clinical records of pediatric HSCT recipients. Data were analyzed using Chi-square for dichotomous and anova for continuous variables. Logistic regression was used to adjust confounding variables for diagnostic yield. Forty patients underwent 44 separate procedures. Infections were the prevailing cause of infiltrates with a positive diagnostic yield (96%). CTB and OLB were performed more often in patients with focal infiltrates compared with BAL (100%, 71% vs. 22%; p < 0.01). Adverse events were not significantly different across the three procedures. OLB more often yielded information that led to change in medical management (71% vs. 0%, 34%; p < 0.05) compared with CTB and BAL. Patients who had a positive diagnostic yield had no apparent survival advantage when compared with those in whom a procedure yielded no information. Logistic regression demonstrated that focal infiltrate was the only independently predictive variable for identifying a cause of pulmonary infiltrate. In conclusion, all three invasive diagnostic procedures were safe. Having a focal infiltrate was independently and significantly associated with having a positive diagnostic yield.
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Affiliation(s)
- Saro H Armenian
- Division of Hematology/Oncology, Childrens Hospital Los Angeles, Los Angeles, CA, USA
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Levine DS, Navarro OM, Chaudry G, Doyle JJ, Blaser SI. Imaging the complications of bone marrow transplantation in children. Radiographics 2007; 27:307-24. [PMID: 17374855 DOI: 10.1148/rg.272065088] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Bone marrow transplantation is frequently performed to restore hematologic and immunologic competence after chemotherapy and radiation therapy for a range of childhood malignancies, as well as to treat various congenital conditions in which hematologic and immunologic functions are depressed or absent. Potentially devastating complications may occur during the pre-engraftment period after bone marrow transplantation, when marrow aplasia may supervene for several weeks until engraftment occurs, as well as during the post-engraftment period (the 3 months after engraftment) and in subsequent months and years. Complications of bone marrow transplantation may be classified either according to the time interval between transplantation and the occurrence of the complication or according to the organ system affected. The range of complications that may affect the central nervous system and the rest of the body may be detected with ultrasonography, computed tomography, and magnetic resonance imaging. Neurologic, paranasal sinus, pulmonary, and abdominopelvic complications all may be seen after bone marrow transplantation. Graft-versus-host disease and lymphoproliferative disorders also may occur. The increasing use of bone marrow transplantation mandates that the radiologist be familiar with the full range of potential complications and their imaging appearances.
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Affiliation(s)
- Daniel S Levine
- Department of Diagnostic Imaging, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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21
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Bergeron A, Belle A, Chevret S, Ribaud P, Devergie A, Esperou H, Ades L, Gluckman E, Socié G, Tazi A. Combined inhaled steroids and bronchodilatators in obstructive airway disease after allogeneic stem cell transplantation. Bone Marrow Transplant 2007; 39:547-53. [PMID: 17351647 DOI: 10.1038/sj.bmt.1705637] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Bronchiolitis obliterans (BO) is a potentially life-threatening complication following allogeneic stem cell transplantation (SCT) and usually carries a poor prognosis. Immunosuppressive medications are the main treatment, but are rarely effective, especially when the disease is severe. Thus, both early detection and alternative therapeutic approaches of post SCT BO are needed. We report our experience with Budesonide/Formoterol, an inhaled steroid and long-acting bronchodilatator combination, in a group of patients with mild to moderately severe BO after SCT whose systemic immunosuppressive treatment had not been modified. Thirteen patients were treated. The diagnosis of BO was based on the presence of respiratory symptoms and air-trapping on expiratory lung high-resolution computed tomography in all patients, associated with irreversible airflow obstruction in seven cases. The median follow-up was 12.8 months (range: 5-29 months). All patients improved clinically, and both forced expiratory volume in 1 (FEV(1)) and mean expiratory flow values increased significantly during follow-up (534+/-268 ml in absolute values and 36+/-27% compared to pretreatment values for FEV(1); P<0.02). These encouraging results provide new insights in the therapeutic approach of BO after SCT and require confirmation in a larger group of patients with a longer follow-up.
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Affiliation(s)
- A Bergeron
- Service de Pneumologie, Hôpital Saint-Louis, Université Paris 7, UFR Denis Diderot, Assistance Publique-Hôpitaux de Paris, Paris, France
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22
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Endo M, Furukawa H, Aramaki T, Morimoto N, Uematsu T, Yukisawa S, Yuen S, Yamamoto N, Ohde Y, Kondo H, Amano K. Unusual Late Pulmonary Complication in a Child After Umbilical Cord Blood Transplantation. J Thorac Imaging 2005; 20:103-6. [PMID: 15818209 DOI: 10.1097/01.rti.0000141352.31750.d9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We encountered a late pulmonary complication after umbilical cord blood transplantation (UCBT) that has not been previously reported. High-resolution CT (HRCT) findings of this disease were compared with the pathology. HRCT obtained on inspiration showed dilated thick-walled bronchioli, and innumerable centrilobular linear and branching structures in the bilateral middle and lower lobes. Neither mosaic perfusion nor air-trapping was seen in HRCT on inspiration and expiration. These HRCT findings were atypical compared with those of former bronchiolitis obliterans (BO) after bone marrow transplant (BMT). Pathologic specimens obtained by open lung biopsy showed thickening of the wall from the distal bronchioli to the alveolar ducts due to submucosal and intraepithelial infiltration of lymphocytes, histiocytes and foamy macrophages, which was not accompanied by organizing changes. These changes resemble lymphocytic bronchiolitis in lung transplant recipients, which was well correlated with HRCT findings. We think that our case was a new late pulmonary complication after UCBT.
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Affiliation(s)
- Masahiro Endo
- Division of Diagnostic Radiology, Shizuoka Cancer Center, Japan.
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23
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Abstract
Bronchiolitis obliterans (BO) in children is a relatively rare diagnosis. The increase in lung and bone marrow transplantation in children, however, has led to a heightened interest in BO, as this is one of the important complications of those procedures. This article will discuss BO as an entity that can follow any of several illnesses or toxic exposures, in addition to following allogeneic lung or bone marrow transplantation. The complex and incompletely understood pathology, pathogenesis, and molecular pathology involved in BO remain the subject of ongoing investigations. As the prognosis for BO is uncertain and treatment is often unsuccessful, the continued need for the recognition of surrogate markers for BO in patients at risk and the development of better forms of therapy are paramount. This review will describe our current understanding of BO, and will call attention to those research areas that require continuing efforts in order to prevent or treat this entity.
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Affiliation(s)
- Geoffrey Kurland
- Division of Pediatric Pulmonology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA.
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24
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Jung JI, Jung WS, Hahn ST, Min CK, Kim CC, Park SH. Bronchiolitis obliterans after allogenic bone marrow transplantation: HRCT findings. Korean J Radiol 2004; 5:107-13. [PMID: 15235235 PMCID: PMC2698138 DOI: 10.3348/kjr.2004.5.2.107] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Objective To evaluate the high resolution computed tomography (HRCT) findings of bronchiolitis obliterans (BO) after bone marrow transplantation (BMT). Materials and Methods During 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. Results Abnormal 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). Conclusion HRCT 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.
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Affiliation(s)
- Jung Im Jung
- Department of Radiology, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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25
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Dudek AZ, Mahaseth H, DeFor TE, Weisdorf DJ. Bronchiolitis obliterans in chronic graft-versus-host disease: analysis of risk factors and treatment outcomes. Biol Blood Marrow Transplant 2004; 9:657-66. [PMID: 14569562 DOI: 10.1016/s1083-8791(03)00242-8] [Citation(s) in RCA: 204] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Bronchiolitis obliterans (BrOb), a late complication of bone marrow transplantation (BMT), is associated with chronic graft-versus-host disease (GVHD) and is frequently fatal. To identify the risk factors associated with BrOb, the factors affecting survival, treatment outcomes, and causes of death of patients with BrOb, we retrospectively analyzed 2859 BMT recipients. No cases of BrOb occurred among 1070 autologous BMT recipients. Among 1789 allogeneic BMT recipients, we identified 47 patients with BrOb. In multivariate analysis, older recipients or donors and acute GVHD were significantly associated with the development of BrOb. Among patients with BrOb, 5-year survival from the time of transplantation was only 10%, versus 40% among allogeneic BMT recipients without BrOb. The clinical course of BrOb had a significant effect on survival: 79% survived 5 years from the time of BrOb diagnosis if BrOb improved versus 13% if there was no improvement after the first-line therapy. Predictors of response included older donors and recipients, a previous diagnosis of chronic GVHD, and diagnosis of BrOb 6 months after transplantation; each of these significantly increased the likelihood of a favorable response to treatment. BrOb had high mortality rate of 55%, and pulmonary failure was the leading cause of death. More effective BrOb therapy is needed, especially for patients with unfavorable presentation.
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Affiliation(s)
- Arkadiusz Z Dudek
- Bone Marrow Transplantation Program, University of Minnesota Health Sciences Center, 420 Delaware Street SE, MMC 480, Minneapolis, MN 55455, USA.
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26
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Pijnenburg MWH, Cransberg K, Wolff E, Bouquet J, Merkus PJFM. Bronchiectasis in children after renal or liver transplantation: a report of five cases. Pediatr Transplant 2004; 8:71-4. [PMID: 15009844 DOI: 10.1046/j.1397-3142.2003.00130.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
More effective immunosuppressive treatment in children following organ transplantation has significantly improved the survival of the grafts. Therefore, quality of life, long-term prognosis and adverse drug reactions have become more important. One of the main complications of immunosuppressive drugs is infections of the respiratory tract, but irreversible damage to the airways has not been described after renal or liver transplantation. Five children following transplantation of kidney or liver were referred to the Paediatric Pulmonology department because of chronic respiratory complaints. Pulmonary function tests and HRCT scan were performed as routine patient care. Four children with a renal transplant and one with a liver transplant showed chronic bronchitis and moderate to severe airways obstruction. HRCT showed bronchiectasis in all of them. We speculate that the immunosuppressive treatment (in)directly contributes to irreversible airway damage. We recommend including follow-up of lung function in the post-transplantation protocol and considering bronchiectasis in case of respiratory symptoms, to try preventing further damage to the lung.
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Affiliation(s)
- Mariëlle W H Pijnenburg
- Department of Pediatrics, Division of Respiratory Medicine, Erasmus Medical Center/Sophia Children's Hospital, PO Box 2060, 3000 CB Rotterdam, The Netherlands.
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27
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Alonso Riofrío R, Villa Asensi JR, Sequeiros González A, Díaz Pérez MA, González Vicent M, Madero López L. Enfermedad pulmonar obstructiva tras trasplante alogénico de progenitores hematopoyéticos en niños. An Pediatr (Barc) 2004; 61:124-30. [PMID: 15274876 DOI: 10.1016/s1695-4033(04)78369-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Bronchiolitis obliterans is recognized as a life-threatening pulmonary complication that can develop 3 months after bone marrow transplantation. OBJECTIVE To determine the incidence and clinical progression of obstructive lung disease (OLD) in a population of children who had undergone allogenic hematopoietic stem cell transplantation (HSCT). PATIENTS AND METHODS We examined a sequential sample of 110 patients who received allogeneic HSCT between January 1992 and June 2002. The incidence of OLD in the 77 children who survived for more than 100 days after transplantation was analyzed. The diagnosis of OLD was based on clinical findings with no evidence of infection, pulmonary function test (FEV1/FVC less than 80 % and FEV1 less than 80 % of predicted value) and computed tomography scan. RESULTS Eight patients (10.4 %) developed OLD at a median time of onset of 184 days after allogenic HSCT (range: 100-1735 days). All patients with OLD had respiratory symptoms. In six out of eight patients airflow obstruction was diagnosed within 1 year of transplantation. All patients showed chronic graft-versus-host disease (GVHD) (p < 0.01). The incidence of OLD in the 23 patients with chronic GVHD was 34.8 %. Two patients (25 %) had a complete response to intensified treatment of chronic GVHD with immunosuppressant therapy. FEV1 declined rapidly in three patients (37.5 %) who died of respiratory failure. Two patients (25 %) had partial reversal but pulmonary function continued below normal values. In one patient (12.5 %) severe obstructive disease was stable. CONCLUSIONS The time of onset and form of progression of OLD after HSCT may vary. OLD is strongly associated with chronic GVHD and its incidence depends on the number of patients with chronic GVHD.
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Affiliation(s)
- R Alonso Riofrío
- Seccion de Neumología Pediátrica, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.
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28
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Abstract
Haematopoietic stem cell transplantation (SCT) is used to treat a wide range of malignant and non-malignant haematological conditions, solid malignancies, and metabolic and autoimmune diseases. Although imaging has a limited role before SCT, it is important after transplantation when it may support the clinical diagnosis of a variety of complications. It may also be used to monitor the effect of therapy and to detect recurrence of the underlying disease if the transplant is unsuccessful. We present a pictorial review of the imaging of patients who have undergone SCT, based upon 15 years experience in a large unit performing both adult and paediatric transplants.
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Affiliation(s)
- A Evans
- Department of Clinical Radiology, University Hospital of Wales, Heath Park, Cardiff, UK.
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29
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Affiliation(s)
- Alison D Leiper
- Department of Haematology and Oncology, Great Ormond Street Hospital for Children NHS Trust, London, UK.
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30
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Abstract
High-resolution CT in children remains a technically challenging procedure, both to perform optimally and to interpret correctly. Although much remains to be learned about its optimal application, it is apparent that often confusing or nonspecific chest radiographs are clarified and a much clearer understanding is being gained about the diagnosis and evolution of both common and unusual pediatric lung diseases. As new therapies become available for these disorders, and CT becomes faster and easier to perform, it will become increasingly used not only for more accurate diagnosis but also for better evaluation of effects of therapy.
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Affiliation(s)
- Jerald P Kuhn
- Department of Radiology, State University of New York at Buffalo School of Medicine, USA.
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31
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Chabat F, Hu XP, Hansell DM, Yang GZ. ERS transform for the automated detection of bronchial abnormalities on CT of the lungs. IEEE TRANSACTIONS ON MEDICAL IMAGING 2001; 20:942-952. [PMID: 11585210 DOI: 10.1109/42.952731] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The identification of bronchi on Computed Tomography (CT) images of the lungs provides valuable clinical information in patients with suspected airways diseases including bronchiectasis, emphysema, or constrictive obliterative bronchiolitis. The automated recognition of the airways is, therefore, an important part of a diagnosis aid system for resolving potential ambiguities associated with intensity-based feature extractors. On CT images, near-perpendicular cross sections of bronchi normally appear as elliptical rings and this paper presents a novel technique for their recognition. The proposed method, the edge-radius-symmetry (ERS) transform, is based on the analysis of the distribution of edges in local polar coordinates. Pixels are ranked according to local edge (E) strength, radial (R), uniformity and local symmetry (S). A discrete implementation of the technique is provided which reduces the computational cost of the ERS transform by using a geometric approximation of the intensity patterns. The identification of the adjacent pulmonary vessels with template matching then allows for the automated measurement of bronchial dilatation and bronchial wall thickening. Computationally, the method compares favorably with other methods such as the Hough transform. Noise-sensitivity of the technique was evaluated on a set of synthetic images and nine patients under investigation for suspected airways disease. Agreement for the automated scoring of the presence and severity of bronchial abnormalities was demonstrated to be comparable to that of an experienced radiologist (kappa statistics kappa > 0.5 ).
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Affiliation(s)
- F Chabat
- Royal Society/Wolfson Foundation Medical Image Computing Laboratory, Imperial College of Science, Technology and Medicine, London, UK
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32
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Socié G, Mary JY, Esperou H, Robert DV, Aractingi S, Ribaud P, Devergie A, Toubert ME, Boudou P, Cathelinau B, Gluckman E, Vexiau P. Health and functional status of adult recipients 1 year after allogeneic haematopoietic stem cell transplantation. Br J Haematol 2001; 113:194-201. [PMID: 11328302 DOI: 10.1046/j.1365-2141.2001.02678.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Increasing numbers of patients are surviving after allogeneic haematopoietic stem cell transplantation (SCT). Among these patients, a number of late complications have been described but few data on the risk factors of these long-term effects of SCT are available. We report the analysis on 105 adult patients, surviving free of haematological disease at a median time of 15 months after SCT. At the time of screening, 52% had returned to work, general health status was normal in 67% and 47% were sexually active. Female patient gender odds ratio (OR) 2.9 (P = 0.01) and age > 25 years (OR = 3.2, P = 0.02) were associated with non-return to work. Decreased general status was associated with chronic graft-versus-host disease (GvHD) (OR = 3.2, P = 0.009) and irradiation (OR = 3.6, P = 0.004). Sexual inactivity was associated with younger age (OR = 7.0, P = 0.0002) and chronic GvHD (OR = 3.3, P = 0.006). Risk factors for altered pulmonary function tests included previous smoking habits, irradiation and chronic GvHD. Obstructive lung disease was associated with a previous history of asthma. Sicca syndrome and conjunctivitis were increased in patients with previous acute GvHD and cataracts were less frequent in patients with aplastic anaemia. Persistent impaired hair re-growth was less frequent in patients who received irradiation (OR = 0.18, P = 0.002) but increased in patients with previous acute GvHD (OR = 5.3, P = 0.007). Microalbuminuria was more frequent in irradiated patients (OR = 9.4, P = 0.05). Raised cholesterol was associated with age (OR = 20.8, P < 0.001), previous acute GvHD (OR = 4.7, P = 0.03), steroid use (OR = 6.3, P = 0.001) and familial hypercholesterolaemia (OR = 4.4, P = 0.04). Decreased bone density was associated with chronic GvHD (OR = 3.9, P = 0.001). Thus, using routine tests in adult patients we were able to detect significant numbers of-non-symptomatic complications enabling early treatment.
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Affiliation(s)
- G Socié
- Hematologie Greffe de Moelle, Hospital Saint Louis, Paris, France.
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33
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Boulad F, Sands S, Sklar C. Late complications after bone marrow transplantation in children and adolescents. CURRENT PROBLEMS IN PEDIATRICS 1998; 28:273-97. [PMID: 9794096 DOI: 10.1016/s0045-9380(98)80030-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- F Boulad
- Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
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34
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Affiliation(s)
- E D Evans
- Department of Radiology, Children's Hospital of Philadelphia, PA 19104, USA
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35
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Abstract
As the use of BMT increases for the treatment of a variety of malignant and nonmalignant diseases in children, awareness of the complications that can occur in these children is important. The imaging appearance of the complications that may occur in the central nervous system, paranasal sinus, lungs, abdomen, and pelvis in children following BMT have been reviewed. CT and MR imaging examination with the use of contrast material as indicated is important for defining pathology in the brain. Plain films should be supplemented with CT examination as needed to identify and characterize disease in the paranasal sinuses and lungs. Finally, the use of ultrasound and CT is crucial for defining complications that may occur in the abdomen and pelvis.
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Affiliation(s)
- E C Benya
- Department of Radiology, University of Chicago Children's Hospital, Illinois, USA
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36
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Abstract
Two patients are described with clinical and radiographic bronchiectasis which occurred after allogeneic bone marrow transplantation for haematological malignancy. Both had evidence of chronic graft versus host disease in other organs. Increased immunosuppression with corticosteroids resulted in clinical response, although both patients persisted with chronic mucopurulent sputum production and one had progressive airflow obstruction. Bronchiectasis may be an under-recognised manifestation of chronic graft versus host disease of the lung.
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Affiliation(s)
- R S Morehead
- Division of Pulmonary Medicine, Veterans Affairs Medical Center, Lexington, Kentucky, USA
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37
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Affiliation(s)
- S W Crawford
- Program in Pulmonary and Critical Care Medicine, Fred Hutchinson Cancer Research Center, University of Washington, Seattle 98104, USA
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