Radiographic Graft Surveillance in Lung Transplantation Prognostic Role of Parametric Response Mapping
Radiographic Graft Surveillance in Lung Transplantation Prognostic Role of Parametric Response Mapping
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DOI：
10.1164/rccm.202012-4528oc
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发表时间：
2021-10-15
影响因子：
24.7
通讯作者：
Lama, Vibha N.
中科院分区：
文献类型：
--
作者：
Belloli, Elizabeth A.;Gu, Tian;Lama, Vibha N.
原理：慢性肺移植物功能障碍（CLAD）导致肺移植后的显著发病率。当肺功能下降至基线的80-90%时，可能发生CLAD。需要更好的非侵入性工具来预测潜在的CLAD。目标：确定参数响应映射（PRM）（一种应用于高分辨率CT扫描的计算机断层扫描（CT）体素方法）是否可以识别有进展为CLAD或死亡风险的患者。方法：功能性小气道疾病（PRMfSAD）和实质性疾病（PRMPD）的影像学特征和基于PRM的CT指标在潜在CLAD下进行研究（n = 61）。高PRMfSAD和高PRMPD定义为>= 30%。测量和主要结果：PRM指标确定了以下三个独特的签名：高PRMfSAD（11.5%），高PRMPD（41%），和两者都没有（PRMNormal; 47.5%）。与PRMfSAD和PRMPD组相比，高PRMfSAD或PRMPD组患者的无CLAD中位生存时间（0.46年和0.50年）短于主要PRMNormal组患者（2.03年; P = 0.004和P = 0.007）。在调整单肺移植与双肺移植的多变量模型中，移植时年龄、潜在CLAD时的体重指数和从移植到CT扫描的时间，PRMfSAD >= 30%或PRMPD >= 30%仍然是无CLAD生存期较短的统计学显著预测因素。放射科医师解释的空气滞留很常见（66%），在PRM组之间相似，并且不能预测无CLAD生存率。16%的病例出现放射科医生判读的磨玻璃样阴影，与CLAD无生存率降低相关（P < 0.001）。结论：PRM分析为潜在CLAD提供了有价值的预后信息，确定了最有可能发生CLAD或死亡的患者。
Rationale: Chronic lung allograft dysfunction (CLAD) results in significant morbidity after lung transplantation. Potential CLAD occurs when lung function declines to 80-90% of baseline. Better noninvasive tools to prognosticate at potential CLAD are needed.Objectives: To determine whether parametric response mapping (PRM), a computed tomography (CT) voxel-wise methodology applied to high-resolution CT scans, can identify patients at risk of progression to CLAD or death.Methods: Radiographic features and PRM-based CT metrics quantifying functional small airway disease (PRMfSAD) and parenchymal disease (PRMPD) were studied at potential CLAD (n = 61). High PRMfSAD and high PRMPD were defined as >= 30%. Restricted mean modeling was performed to compare CLAD-free survival among groups.Measurements and Main Results: PRM metrics identified the following three unique signatures: high PRMfSAD (11.5%), high PRMPD (41%), and neither (PRMNormal; 47.5%). Patients with high PRMfSAD or PRMPD had shorter CLAD-free median survival times (0.46 yr and 0.50 yr) compared with patients with predominantly PRMNormal (2.03 yr; P = 0.004 and P = 0.007 compared with PRMfSAD and PRMPD groups, respectively). In multivariate modeling adjusting for single-versus double-lung transplant, age at transplant, body mass index at potential CLAD, and time from transplant to CT scan, PRMfSAD >= 30% or PRMPD >= 30% continue to be statistically significant predictors of shorter CLAD-free survival. Air trapping by radiologist interpretation was common (66%), was similar across PRM groups, and was not predictive of CLAD-free survival. Ground-glass opacities by radiologist read occurred in 16% of cases and were associated with decreased CLAD-free survival (P < 0.001).Conclusions: PRM analysis offers valuable prognostic information at potential CLAD, identifying patients most at risk of developing CLAD or death.