Parametric Response Mapping as an Imaging Biomarker in Lung Transplant Recipients
Parametric Response Mapping as an Imaging Biomarker in Lung Transplant Recipients
复制标题
参数反应图作为肺移植受者的成像生物标志物
DOI：
10.1164/rccm.201604-0732oc
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发表时间：
2017-04-01
影响因子：
24.7
通讯作者：
Lama, Vibha N.
中科院分区：
文献类型：
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作者：
Belloli, Elizabeth A.;Degtiar, Irina;Lama, Vibha N.
原理：慢性肺移植失败的主要原因是闭塞性细支气管炎引起的小气道阻塞。然而，临床方法评估存在和程度的小气道disease.Objectives：以确定是否参数反应映射（PRM），一种新的计算机断层扫描体素明智的方法，可以提供洞察慢性移植失败的表型，并提供预后信息后肺功能下降。定量功能性小气道疾病（PRMfSAD）和实质性疾病（PRMPD）的基于PRM的计算机断层扫描指标在移植后时间匹配的双侧肺移植受者和对照受试者（n = 22）之间进行比较。在一项队列研究中，通过多变量限制性平均值模型（n = 52）将肺功能下降时的PRMfSAD评估为死亡率的预后标志物。（FEV 1第一）的PRMfsAD显著高于对照受试者（28% vs. 15%; P = 0.005），而FEV 1和FVC同时下降的患者的PRMPD显著高于对照受试者（39% vs. 20%; P = 0.02）。在8.3年的随访中，肺功能下降时PRMfSAD大于或等于30%的FEV 1 First患者的平均寿命比PRMfSAD小于30%的患者短2.6年（P = 0.004）。在该组中，PRMfSAD大于或等于30%是多变量模型（包括闭塞性细支气管炎综合征分级和基线FEV1%预测值（P = 0.04））中生存率的最强预测因子（P = 0.04）。结论：PRM是肺移植受者肺功能下降的一种新型成像工具。通过PRMfsAD量化潜在的小气道阻塞有助于进一步分层具有不同肺功能下降模式的患者的死亡风险。
Rationale: The predominant cause of chronic lung allograft failure is small airway obstruction arising from bronchiolitis obliterans. However, clinical methodologies for evaluating presence and degree of small airway disease are lacking.Objectives: To determine if parametric response mapping (PRM), a novel computed tomography voxel-wise methodology, can offer insight into chronic allograft failure phenotypes and provide prognostic information following spirometric decline.Methods: PRM-based computed tomography metrics quantifying functional small airways disease (PRMfSAD) and parenchymal disease (PRMPD) were compared between bilateral lung transplant recipients with irreversible spirometric decline and control subjects matched by time post-transplant (n = 22). PRMfSAD at spirometric decline was evaluated as a prognostic marker for mortality in a cohort study via multivariable restricted mean models (n = 52).Measurements and Main Results: Patients presenting with an isolated decline in FEV1 (FEV1 First) had significantly higher PRMfsAD than control subjects (28% vs. 15%; P = 0.005), whereas patients with concurrent decline in FEV1 and FVC had significantly higher PRMPD than control subjects (39% vs. 20%; P = 0.02). Over 8.3 years of follow-up, FEV1 First patients with PRMfSAD greater than or equal to 30% at spirometric decline lived on average 2.6 years less than those with PRMfSAD less than 30% (P = 0.004). In this group, PRMfSAD greater than or equal to 30% was the strongest predictor of survival in a multivariable model including bronchiolitis obliterans syndrome grade and baseline FEV1% predicted (P = 0.04).Conclusions: PRM is a novel imaging tool for lung transplant recipients presenting with spirometric decline. Quantifying underlying small airway obstruction via PRMfsAD helps further stratify the risk of death in patients with diverse spirometric decline patterns.