Automated CT Image Processing for the Diagnosis, Prediction, and Differentiation of Phenotypes in Chronic Lung Allograft Dysfunction After Lung Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-03-26 DOI:10.1111/ctr.70137

Stefan Kuhnert, Nermin Halim, Janine Sommerlad, Henning Gall, Athiththan Yogeswaran, Fritz C. Roller, Gabriele Krombach, Martin Reichert, Ingolf Askevold, Andreas Hecker, Christian Koch, Werner Seeger, Konstantin Mayer, Oliver Weinheimer, Matthias Hecker

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引用次数: 0

Abstract

Background

Chronic lung allograft dysfunction (CLAD) after lung transplantation is a common complication with a poor prognosis. We assessed the utility of quantitative computed tomography (CT) for the diagnosis, prediction, and discrimination of CLAD phenotypes.

Methods

We retrospectively analyzed routine inspiratory and expiratory CT scans from 78 patients at different time points after lung transplantation. Mean lung density (MLD), parametric response mapping (PRM), percentage of air trapping, and airway wall morphology parameters were calculated using the image processing software YACTA. Diagnostic and predictive utility was determined by receiver operating characteristic analysis and Pearson correlation.

Results

Markers of air trapping showed promise for the diagnosis and prediction of bronchiolitis obliterans syndrome (BOS); for example, expiratory MLD showed areas under the curve (AUCs) of 0.905 for diagnosis and 0.729 for 1-year prediction. For diagnosis of CLAD with mixed phenotype, peripheral measurements (e.g., PRM of peripheral functional small airway disease: AUC 0.893) were most suitable. Markers of airway thickening (e.g., expiratory wall thickness at an inner perimeter of 10 mm: AUC 0.767) gave good diagnostic values for the undefined phenotype. CT biomarkers differed significantly among CLAD phenotypes.

Conclusions

Different CT biomarkers are suitable for the diagnosis of CLAD phenotypes, prediction of BOS, and differentiation of CLAD phenotypes.

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背景肺移植后慢性肺移植功能障碍（CLAD）是一种常见的并发症，预后较差。我们评估了定量计算机断层扫描（CT）在诊断、预测和鉴别 CLAD 表型方面的效用。方法我们回顾性分析了 78 名患者在肺移植术后不同时间点的常规吸气和呼气 CT 扫描结果。使用图像处理软件 YACTA 计算了平均肺密度 (MLD)、参数响应图 (PRM)、空气捕获百分比和气道壁形态参数。通过接收器操作特征分析和皮尔逊相关性确定诊断和预测效用。结果空气潴留标志物显示出诊断和预测阻塞性支气管炎综合征（BOS）的前景；例如，呼气性 MLD 的曲线下面积（AUC）为 0.905（诊断）和 0.729（1 年预测）。对于混合表型的 CLAD 诊断，外周测量（如外周功能性小气道疾病的 PRM：AUC 0.893）最为合适。气道增厚的标记物（如内周长为 10 毫米的呼气壁厚度：AUC 0.767）对未定义表型具有良好的诊断价值。不同 CLAD 表型的 CT 生物标记物差异显著。结论不同的 CT 生物标志物适用于诊断 CLAD 表型、预测 BOS 和区分 CLAD 表型。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.