吸呼气低剂量动态CT显示的空气滞留在预测骨髓移植术后早期阻塞性细支气管炎中的价值（英文）

Value of air trapping at inspiratory and expiratory low-dose CT in predicting early bronchiolitis obliterans syndrome after bone marrow transplantation

目的使用吸呼气低剂量动态CT扫描评价在骨髓移植术后阻塞性细支气管炎(BOS)发生前的空气滞留特点和分级,探讨能否根据空气滞留预测BOS的发生。方法对33例骨髓移植术后BOS患者(BOS组)和111例骨髓移植术后正常人群(正常对照组)进行对照性分析,BOS组的CT图像主要依据在BOS发生前的最后一次扫描结果。评价内容包括空气滞留的发生率、动态变化及诊断效能。结果 BOS组的空气滞留(尤其马赛克和广泛性空气滞留)的发生率高于正常对照组(P=0.03)。BOS组的总体空气滞留评分的平均值高于正常对照组(P=0.01)。随疾病的发展而加重的空气滞留多见于BOS组(50.0%,9/18),而空气滞留范围减少、消失或间断出现多见于正常对照组(60.0%,15/25)。当把马赛克空气滞留或广泛性空气滞留作为诊断标准时,诊断特异度较高(90.5%,96.7%),敏感度较低(29.4%,15.8%)。结论空气滞留征象可以为骨髓移植术后BOS的发生提供一定的预测信息,马赛克空气滞留和广泛性空气滞留是特异性较高但是不敏感的CT征象。

Objective To determine whether bronchiolitis obliterans syndrome （BOS） after bone marrow transplantation can be predicted in light of air trapping. Methods Thirty three cases of BOS （BOS group） and 111 normal patients （normal group） were comparatively reviewed for the CT characteristics （including frequency, dynamic change and diagnostic potency） of air trapping. The analysis was mainly based on the last CT scans before occurrence of BOS. Results The frequency of air trapping, especially mosaic air trapping or extensive air trapping, was higher in the BOS group than in the normal group （P=0.03）. The median total air trapping score was higher in the BOS group than in the normal group （P=0.01）. The increase of air trapping extent with the progress of disease was more common in the BOS group （50.0%, 9/18）, whereas a decrease of air trapping extent, disappearance or intermittent appearance of air trapping was more common in the normal group （60.0%, 15/25） during the follow up period. When mosaic air trapping or extensive air trapping was used as the diagnostic threshold, the specificity was high （90.5%, 96.7%）, but the sensitivity was low （29.4%, 15.8%）. Conclusion Occurrence of air trapping is a clue for development of BOS in patients receiving bone marrow transplantation. Mosaic air trapping and extensive air trapping are insensitive but specific CT findings.