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Use of HRCT to Characterize Significant Airway Stenosis Following Lung Transplantation
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A7487 - Use of HRCT to Characterize Significant Airway Stenosis Following Lung Transplantation
Author Block: M. Kousha1, P. Hota2, C. Dass2, F. C. Cordova1, N. Shigemura1, Y. Toyoda1, G. J. Criner1; 1Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, United States, 2Department of Radiology, Temple University Hospital, Philadelphia, PA, United States.
Rationale: Bronchial stenosis is the most common central airway complication after lung transplant causing significant morbidity. It currently has no standardized radiographic classification. We report on using chest high-resolution computed tomography (HRCT) to characterize significant post-transplant bronchial stenosis in our center.
Methods: We retrospectively reviewed lung transplant cases performed in our center between 4/2000 and 12/2016, excluding shorter than 45-day survival and combined heart-lung transplants. Bronchial stenosis was considered significant if a treatment was required, including balloon dilation, laser therapy, or stent placement. HRCT images of these cases were reviewed pre-transplant and up to 1-year post-transplant using multiplanar reconstruction. Bronchial airways in each allograft were evaluated at 3 of the following 6 anatomical segments: Right mainstem (RMS), right upper lobe (RUL), bronchus intermedius (BI), left mainstem (LMS), left upper lobe (LUL) and left lower lobe (LLL). The cross-sectional area was measured at the narrowest site of each segment, while avoiding the airway branching points.
Results: A significant airway stenosis requiring intervention developed in 42 out of 407 lung transplant patients (10.3%), including 32/229 (13.9%) double lung transplants (DLT) and 10/178 (5.6%) single lung transplants (SLT). In all stenosis cases, HRCT scans showed a post-transplant cross-sectional area less than 70% of pre-transplant measurement in at least one segments. This radiographic indication of stenosis was found in 125 segments (20 SLT and 100 DLT) of 60 allografts (10 SLT and 50 DLT); most frequently identified in BI (24%), followed by RMS (22.4%) and LMS (19.2%), while LUL was least affected (7.2%). Stenosis was either limited to 1 segment (28.3%), affected 2 segments (35%) or involved all 3 locations (36.7%). Among SLT patients, stenosis occurred in nine right allografts (11.5% of 78 right SLT) compared to one left allograft (1% of 100 left SLT), with RMS being the most affected segment (45%). Stenosis was also found more on the right side in DLT with 61/105 (58.1%) narrowed segments in 26 right allografts (mostly affecting BI) versus 44/105 (41.9%) segments in 24 left allografts (mostly affecting LMS), and was twice as likely in RUL and BI compared to LUL and LLL, respectively.
Conclusion: HRCT can characterize the distribution and patterns of significant post-transplant bronchial stenosis. Right allografts are most affected, and stenosis was most identified in the RMS in SLT and in the BI in DLT cases. LMS was the most frequently narrowed segment in left allografts. Stenosis affected 2-3 segments in most allografts.
Author Block: M. Kousha1, P. Hota2, C. Dass2, F. C. Cordova1, N. Shigemura1, Y. Toyoda1, G. J. Criner1; 1Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA, United States, 2Department of Radiology, Temple University Hospital, Philadelphia, PA, United States.
Rationale: Bronchial stenosis is the most common central airway complication after lung transplant causing significant morbidity. It currently has no standardized radiographic classification. We report on using chest high-resolution computed tomography (HRCT) to characterize significant post-transplant bronchial stenosis in our center.
Methods: We retrospectively reviewed lung transplant cases performed in our center between 4/2000 and 12/2016, excluding shorter than 45-day survival and combined heart-lung transplants. Bronchial stenosis was considered significant if a treatment was required, including balloon dilation, laser therapy, or stent placement. HRCT images of these cases were reviewed pre-transplant and up to 1-year post-transplant using multiplanar reconstruction. Bronchial airways in each allograft were evaluated at 3 of the following 6 anatomical segments: Right mainstem (RMS), right upper lobe (RUL), bronchus intermedius (BI), left mainstem (LMS), left upper lobe (LUL) and left lower lobe (LLL). The cross-sectional area was measured at the narrowest site of each segment, while avoiding the airway branching points.
Results: A significant airway stenosis requiring intervention developed in 42 out of 407 lung transplant patients (10.3%), including 32/229 (13.9%) double lung transplants (DLT) and 10/178 (5.6%) single lung transplants (SLT). In all stenosis cases, HRCT scans showed a post-transplant cross-sectional area less than 70% of pre-transplant measurement in at least one segments. This radiographic indication of stenosis was found in 125 segments (20 SLT and 100 DLT) of 60 allografts (10 SLT and 50 DLT); most frequently identified in BI (24%), followed by RMS (22.4%) and LMS (19.2%), while LUL was least affected (7.2%). Stenosis was either limited to 1 segment (28.3%), affected 2 segments (35%) or involved all 3 locations (36.7%). Among SLT patients, stenosis occurred in nine right allografts (11.5% of 78 right SLT) compared to one left allograft (1% of 100 left SLT), with RMS being the most affected segment (45%). Stenosis was also found more on the right side in DLT with 61/105 (58.1%) narrowed segments in 26 right allografts (mostly affecting BI) versus 44/105 (41.9%) segments in 24 left allografts (mostly affecting LMS), and was twice as likely in RUL and BI compared to LUL and LLL, respectively.
Conclusion: HRCT can characterize the distribution and patterns of significant post-transplant bronchial stenosis. Right allografts are most affected, and stenosis was most identified in the RMS in SLT and in the BI in DLT cases. LMS was the most frequently narrowed segment in left allografts. Stenosis affected 2-3 segments in most allografts.
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