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Lung hyperinflation quantitated by chest CT in children with bronchiolitis obliterans syndrome following allogeneic hematopoietic cell transplantation

  • Author Footnotes
    1 Both authors have contributed equally to the preparation of the manuscript.
    Dimitrios Moutafidis
    Footnotes
    1 Both authors have contributed equally to the preparation of the manuscript.
    Affiliations
    Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine & Aghia Sophia Children's Hospital, Athens, Greece
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  • Author Footnotes
    1 Both authors have contributed equally to the preparation of the manuscript.
    Maria Gavra
    Footnotes
    1 Both authors have contributed equally to the preparation of the manuscript.
    Affiliations
    CT, MRI & PET/CT Department, Aghia Sophia Children's Hospital, Athens, Greece
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  • Sotirios Golfinopoulos
    Affiliations
    CT, MRI & PET/CT Department, Aghia Sophia Children's Hospital, Athens, Greece
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  • Christina Oikonomopoulou
    Affiliations
    Stem Cell Transplant Unit, Aghia Sophia Children's Hospital, Athens, Greece
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  • Vasiliki Kitra
    Affiliations
    Stem Cell Transplant Unit, Aghia Sophia Children's Hospital, Athens, Greece
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  • Jason C. Woods
    Affiliations
    Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology, Cincinnati Children's Hospital Medical Center & Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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  • Athanasios G. Kaditis
    Correspondence
    Corresponding author at: First Department of Pediatrics, Aghia Sophia Children's Hospital, Thivon and Papadiamantopoulou St., Athens 11527, Greece.
    Affiliations
    Division of Pediatric Pulmonology, First Department of Pediatrics, National and Kapodistrian University of Athens School of Medicine & Aghia Sophia Children's Hospital, Athens, Greece
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  • Author Footnotes
    1 Both authors have contributed equally to the preparation of the manuscript.

      Highlights

      • Bronchiolitis obliterans syndrome may complicate bone marrow transplantation.
      • Quantitative chest CT facilitates diagnosis of BOS in children.
      • Low-attenuation lung volume is associated with severity of airway obstruction.

      Abstract

      Objectives

      Bronchiolitis obliterans syndrome (BOS) diagnosis in children following allogeneic hematopoietic stem cell transplantation (post-HSCT) is based on detection of airway obstruction on spirometry and air-trapping, small airway thickening or bronchiectasis on chest CT. We assessed the relationship between spirometry indices and low-attenuation lung volume at total lung capacity (TLC) on CT.

      Methods

      Data of children post-HSCT with and without BOS were analyzed. An age-specific, low-attenuation threshold (LAT) was defined as average of (mean-1SD) lung parenchyma attenuation of 5 control subjects without lung disease matched to each age subgroup of post-HSCT patients. % CT lung volume at TLC with attenuation values <LAT was calculated. Association between % lung volume with low attenuation and FEV1/FVC was assessed.

      Results

      Twenty-nine children post-HSCT were referred to exclude BOS and 12 of them had spirometry and an analyzable chest CT. We studied: (i) 6 children post-HSCT/BOS (median age: 8.5 years [IQR 7, 15]; median FEV1/FVC z-score: -2.60 [IQR -2.93, −2.14]); (ii) 6 children post-HSCT/no BOS (age: 13.5 years [9.8, 16.3]; FEV1/FVC z-score: 0.44 [−0.30, 2.10]); and (iii) 40 controls without lung disease (age:11 years [8.3, 15.8]). Patients post-HSCT/BOS had significantly higher % lung volume with low attenuation than patients post-HSCT/no BOS: median % volume 16.4% (7.1%, 37.2%) vs. 0.61% (0.34%, 2.79%), respectively; P = .004. An exponential model described the association between % CT lung volume below LAT and FEV1/FVC z-score (r2 = 0.76; P < .001).

      Conclusion

      In children post-HSCT with BOS, low-attenuation lung volume on chest CT is associated with airway obstruction severity as expressed by FEV1/FVC z-score.

      Keywords

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