本期胸小星将为大家带来超低剂量光子计数CT检测肺移植术后肺部变化的准确性；双肺移植后单肺再移植的结局，一起来看看吧！
2017·EATTS
01
Accuracy of Ultralow-Dose Photon-counting CT in the Detection of Lung Changes after Lung Transplant
Ruxandra-Iulia Milos1, Lisa Lechner1, Aida Korajac1, Daria Kifjak1, Martin Luther Watzenböck1, Dietmar Tamandl1, Andreas Strassl1, Marlene Stuempflen1, Lucian Beer1, Michael Weber1, Peter Jaksch1, Gabriella Muraközy1, Elisabeth Hielle-Wittmann1, Zsofia Kovacs1, Konrad Hoetzenecker1, Helmut Prosch1
1 Departments of Biomedical Imaging and Image-guided Therapy (R.I.M., L.L., A.K., D.K., M.L.W., D.T., A.S., M.S., L.B., M.W., H.P.) and Thoracic Surgery (P.J., G.M., E.H.W., Z.K., K.H.), Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
Background:
Data on the diagnostic accuracy of ultralow-dose (ULD) CT protocols for periodic surveillance in recipients of lung transplant are lacking.
Purpose:
To assess the potential for radiation dose reduction using ULD photon-counting CT (PCT) to detect lung abnormalities in recipients of lung transplant during repeat CT follow-up.
Materials and Methods:
Consecutive adult recipients of lung transplant undergoing same-day standard-of-care low-dose (LD) and ULD PCT from March 2023 to May 2023 were prospectively included. The ULD protocols were performed with two target effective doses comprising 20% (hereafter, ULD1) and 10% (hereafter, ULD2) of the standard LD protocol. The 1-mm reconstructions were reviewed by three readers. Subjective image quality, the visibility of certain anatomic structures (using a five-point Likert scale), and the presence of lung abnormalities were independently assessed. The χ2 or t tests were used to evaluate differences between the ULD1 and ULD2 protocols.
Results:
A total of 82 participants (median age, 64 years [IQR, 54–69 years]; 47 male) were included (41 participants for each ULD protocol). The mean effective doses per protocol were 1.41 mSv ± 0.44 (SD) for LD, 0.26 mSv ± 0.08 for ULD1, and 0.17 mSv ± 0.04 for ULD2. According to three readers, the subjective image quality of the ULD images was deemed diagnostic (Likert score ≥3) in 39–40 (ULD1) and 40–41 (ULD2) participants, and anatomic structures could be adequately visualized (Likert score ≥3) in 33–41 (ULD1) and 34–41 (ULD2) participants. The detection accuracy for individual lung anomalies exceeded 70% for both ULD protocols, except for readers 1 and 3 detecting proximal bronchiectasis and reader 3 detecting bronchial wall thickening and air trapping. No evidence of a statistically significant difference in noise (P = 0.96), signal-to-noise ratio (P = 0.77), or reader accuracy (all P ≥ 0.05) was noted between the ULD protocols.
Conclusion:
ULD PCT was feasible for detecting lung abnormalities following lung transplant, with a tenfold radiation dose reduction.
[CITATION]: Milos RI, Lechner L, Korajac A, et al. Accuracy of Ultralow-Dose Photon-counting CT in the Detection of Lung Changes after Lung Transplant. Radiology. 2024 Sep;312(3): e240271.
[DOI]: 10.1148/radiol.240271.
[IF]:12.1
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胸“星”外科学术团队成员 钟方敏 译
背景
方法
结果
结论
Table 3: Results of CT Radiation Dose and Quantitative Image Assessment.
Figure 2. Bar graphs show assessment of the subjective image quality and individual anatomic structures (bronchial wall, left and right oblique fissures, peripheral vessels) based on a five-point Likert scale according to three readers (R1, R2, R3) for each ultralow-dose (ULD) photon-counting CT protocol. Participants were divided into groups to receive either a target effective dose of 20% (ULD1) or 10% (ULD2) of the standard-of-care low-dose protocol.
2017·EATTS
02
Victoria Yin1, John C S Rodman2, Scott M Atay3, Sean C Wightman3, Graeme M Rosenberg3, Brooks V Udelsman3, Sivagini Ganesh4, Peter Chung4, Anthony W Kim3, Takashi Harano5
1.Keck School of Medicine of the University of Southern California, Los Angeles, CA.
2.Biostatistics, Epidemiology, and Research Design, Southern California Clinical and Translational Science Institute, the University of Southern California, Los Angeles, CA.
3.Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
4.Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
5.Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA.
Objective:
The aim of this study is to compare outcomes of single lung retransplantation (SLRTx) to double lung retransplantation (DLRTx) after an initial double lung transplantation.
Methods:
The Organ Procurement and Transplantation Network/United Network for Organ Sharing database between May 2005 and December 2022 was retrospectively analyzed. Multiorgan transplantation, repeated retransplantation, and lung retransplantation when the status of the initial transplantation was unknown were excluded.
Results:
891 patients were included in the analysis: 698 cases (78.3%) were DLRTx and 193 cases (21.7%) were SLRTx. Mean lung allocation score was higher among DLRTx (59.6±20.7 vs 55.1±19.3, P = 0.007). Extracorporeal membrane oxygenation (ECMO) bridge to lung transplantation use was similar between groups (P =0.125), as was waitlist time (P=0.610). Need for mechanical ventilation (54.6% vs 35.8%, P = 0.005) and ECMO (17.9% vs 9.0%, P = 0.069) at 72 hours after transplantation was more frequent in DLRTx group. However, median posttransplant hospital stay (21.5 [IQR 12-35] vs 20 days [IQR 12-35], P=0.119) and in-hospital mortality (10.9% [76/698] vs 12.4% [24/193], P=0.547) were comparable between groups. Longterm survival was significantly better among DLRTx (log-rank test P < 0.001). In the propensityscore weighted multivariable model, DLRTx had 28% lower risk of mortality at any point during follow-up compared to SLRTx (HR: 0.72, 95% confidence interval: 0.57-0.91, P=0.006).
Conclusions:
Less invasiveness of single lung transplantation in the retransplant setting has minimal short-term benefit and is associated with significantly worse long-term survival. Double lung retransplantation should remain the standard for lung retransplantation after initial double lung transplantation.
[CITATION]: Yin V, Rodman JCS, Atay SM, et al. The Outcomes of Single Lung Retransplantation After Double Lung Transplantation. J Thorac Cardiovasc Surg. 2024 Sep 30:S0022-5223(24)00892-4.
[DOI]: 10.1016/j.jtcvs.2024.09.039.
[IF]:4.9
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双肺移植后单肺再移植的结局
胸“星”外科学术团队成员 刘霖曦 译
目的
方法
结果
结论
Figure 2. Kaplan-Meier curves illustrating overall survival based on lung retransplantation type (Double lung retransplantation vs. Single lung retransplantation), with 95% confidence intervals.
Figure 3. Kaplan-Meier curves illustrating graft survival based on lung retransplantation type
(Double lung retransplantation vs. Single lung retransplantation), with 95% confidence intervals.
2017·EATTS
