Diagnosis of bronchiolitis obliterans with computed tomography in children

Smith K.J.; Dishop M.K.; Fan L.L.; Moonnumakal S.P.; Smith E.O.; Bayindir P.; Guillerman R.P.

Diagnosis of bronchiolitis obliterans with computed tomography in children

Date

2010

Authors

Abstract

Histopathology has been considered the gold standard for diagnosis of bronchiolitis obliterans (BO). Although chest computed tomography (CT) has gained acceptance as an alternative tool for diagnosis, no systematic studies validating the diagnostic accuracy of chest CT have been performed in children with BO unrelated to transplantation. A study was undertaken to provide estimates of the strength of association between CT findings and the presence or absence of BO, and to determine if chest CT is predictive of lung biopsy results. In a single-center, retrospective, case-control study, 120 children who had both a chest CT and lung biopsy and no history of lung, heart-lung, or bone marrow transplant were included in this study. Chest CTs were scored for the presence or absence of 24 individual CT findings by a blinded subspecialty-trained pediatric radiologist. Lung biopsies were reviewed by a pediatric lung pathologist for the presence of airway fibrosis, which was classified as mild, moderate, or severe. Ten children had moderate-to-severe BO by lung biopsy. The presence of parenchymal hypoattenuation (P=0.003) and bronchiectasis (P=0.001) distinguished these patients from the remaining 110 patients who formed the control group. Combinations of findings improved specificity, and the combination of parenchymal hypoattenuation and vascular attenuation was highly specific (specificity 99.1%; positive likelihood ratio 22.2 and 44.4 for moderate and severe disease, respectively). However, the sensitivity of individual and combination findings was modest. In children with moderate or severe BO, a confident diagnosis can be made with a chest CT that has characteristic radiographic findings, thus avoiding the need for open lung biopsy. However, CT is not an effective screening tool for excluding BO. © 2010, Mary Ann Liebert, Inc. 2010.