留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肺移植术后排斥反应的影像学检查方法现状及展望

徐琳 严浩吉 王俊杰 唐宏涛 李偲涵 陈婷婷 张涵 付思怡 田东

徐琳, 严浩吉, 王俊杰, 等. 肺移植术后排斥反应的影像学检查方法现状及展望[J]. 器官移植, 2021, 12(5): 544-549. doi: 10.3969/j.issn.1674-7445.2021.05.007
引用本文: 徐琳, 严浩吉, 王俊杰, 等. 肺移植术后排斥反应的影像学检查方法现状及展望[J]. 器官移植, 2021, 12(5): 544-549. doi: 10.3969/j.issn.1674-7445.2021.05.007
Xu Lin, Yan Haoji, Wang Junjie, et al. Current status and prospect of imaging examination methods for rejection after lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(5): 544-549. doi: 10.3969/j.issn.1674-7445.2021.05.007
Citation: Xu Lin, Yan Haoji, Wang Junjie, et al. Current status and prospect of imaging examination methods for rejection after lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(5): 544-549. doi: 10.3969/j.issn.1674-7445.2021.05.007

肺移植术后排斥反应的影像学检查方法现状及展望

doi: 10.3969/j.issn.1674-7445.2021.05.007
基金项目: 

医学影像四川省重点实验室开放课题 MIKLSP202007

南充市市校合作科研专项 19SXHZ0189

川北医学院附属医院科研发展计划项目 2021ZK003

详细信息
    通讯作者:

    田东,男,博士,副主任医师,研究方向为肺移植基础与临床研究,E-mail: TianD_EATTS@nsmc.edu.cn

  • 中图分类号: R617, R445

Current status and prospect of imaging examination methods for rejection after lung transplantation

More Information
  • 摘要: 肺移植是治疗终末期肺病的唯一有效手段,其术后发生的排斥反应是影响受者预后的主要因素。影像学检查可作为无创手段,辅助其他检查监测肺移植术后排斥反应。目前已报道的影像学方式较多,明确各种影像学检查的优势与不足,有助于排斥反应的早期诊断,使得肺移植受者可以得到及时治疗,进而提高其生活质量及预后。本文对肺移植术后排斥反应各种影像学检查的利弊及进展进行综述,为寻找肺移植术后排斥反应的最佳无创检查手段提供参考,提高受者远期生存。

     

  • 表  1  肺移植术后排斥反应影像学检查方法

    Table  1.   Imaging methods of rejection after lung transplantation

    影像学方法 影像学表现 优点 缺点
    AR CLAD
    胸部X线检查 肺间质纤细的网格影、肺段实变和肺门周围实变影 早期:表现正常
    加重:肺血管纹理减少,亚段肺不张
    晚期:不规则及不透明区域增加
    操作简单、成本较低 诊断效果不佳
    CT检查 肺部磨玻璃影及小叶间隔增厚 BOS:肺体积和肺密度的纵向变化明显,伴有细支气管空气潴留支气管扩张
    RAS:肺间质毛玻璃结节、蜂窝状改变和小叶间隔增厚
    密度分辨率较高、显示人体解剖结构能力强 辐射较大、准确性仍存在争议
    MRI检查 超短回波时间MRI序列可显示AR引起的变化 肺通气动力学参数及区域异质性 高分辨率、高清晰度、可多参数成像与多方位扫描 价格昂贵
    PET/CT检查 18F-FDG摄取量增加 BOS:18F-FDG摄取量增加,纤维增生活跃、肺胸膜实质改变
    RAS:18F-FDG摄取量降低
    唯一用解剖形态方式进行功能、代谢和受体显像的技术 无法精确定位病灶
    超声检查 存在B线 BOS:胸膜下实变伴有B线
    RAS:肺间质性纤维化
    无辐射、易用性、实时性、便携性、低成本 肺部气体干扰及肋骨遮挡,超声检查受限
    注:①18F-FDG为18F-氟代脱氧葡萄糖。
    下载: 导出CSV
  • [1] ARYAL S, NATHAN SD. Lung transplantation in China: a firm foundation for a solid future[J]. Ann Transl Med, 2020, 8(6): 265. DOI: 10.21037/atm.2020.02.165.
    [2] 胡春晓, 李小杉, 卫栋, 等. 前进中的肺移植事业——我国肺移植发展现状及未来[J]. 器官移植, 2020, 11(2): 204-207. DOI: 10.3969/j.issn.1674-7445.2020.02.005.

    HU CX, LI XS, WEI D, et al. The development of lung transplantation: current situation and future of lung transplantation in China[J]. Organ Transplant, 2020, 11(2): 204-207. DOI: 10.3969/j.issn.1674-7445. 2020.02.005.
    [3] KHUSH KK, CHERIKH WS, CHAMBERS DC, et al. The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: thirty-sixth adult heart transplantation report - 2019; focus theme: donor and recipient size match[J]. J Heart Lung Transplant, 2019, 38(10): 1056-1066. DOI: 10.1016/j.healun.2019.08.004.
    [4] TIAN D, HUANG H, WEN HY. Noninvasive methods for detection of chronic lung allograft dysfunction in lung transplantation[J]. Transplant Rev (Orlando), 2020, 34(3): 100547. DOI: 10.1016/j.trre.2020.100547.
    [5] Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specification for immunosuppressive therapy and rejection in lung transplantation in China (2019 edition)[J/CD]. Chin J Transplant (Electr Edit), 2019, 13(2): 94-98. DOI: 10.3877/cma.j.issn.1674-3903.2019.02.004.
    [6] GREER M, WERLEIN C, JONIGK D. Surveillance for acute cellular rejection after lung transplantation[J]. Ann Transl Med, 2020, 8(6): 410. DOI: 10.21037/atm.2020.02.127.
    [7] PARULEKAR AD, KAO CC. Detection, classification, and management of rejection after lung transplantation[J]. J Thorac Dis, 2019, 11(Suppl 14): S1732-S1739. DOI: 10.21037/jtd.2019.03.83.
    [8] BERGIN CJ, CASTELLINO RA, BLANK N, et al. Acute lung rejection after heart-lung transplantation: correlation of findings on chest radiographs with lung biopsy results[J]. AJR Am J Roentgenol, 1990, 155(1): 23-27. DOI: 10.2214/ajr.155.1.2112858.
    [9] KUNDU S, HERMAN SJ, LARHS A, et al. Correlation of chest radiographic findings with biopsy-proven acute lung rejection[J]. J Thorac Imaging, 1999, 14(3): 178-184. DOI: 10.1097/00005382-199907000-00004.
    [10] PARK CH, PAIK HC, HAAM SJ, et al. HRCT features of acute rejection in patients with bilateral lung transplantation: the usefulness of lesion distribution[J]. Transplant Proc, 2014, 46(5): 1511-1516. DOI: 10.1016/j.transproceed.2013.12.060.
    [11] GOTWAY MB, DAWN SK, SELLAMI D, et al. Acute rejection following lung transplantation: limitations in accuracy of thin-section CT for diagnosis[J]. Radiology, 2001, 221(1): 207-212. DOI: 10.1148/radiol.2211010380.
    [12] DI PIAZZA A, MAMONE G, CARUSO S, et al. Acute rejection after lung transplantation: association between histopathological and CT findings[J]. Radiol Med, 2019, 124(10): 1000-1005. DOI: 10.1007/s11547-019-01059-z.
    [13] HORIE M, LEVY L, HOUBOIS C, et al. Lung density analysis using quantitative chest CT for early prediction of chronic lung allograft dysfunction[J]. Transplantation, 2019, 103(12): 2645-2653. DOI: 10.1097/TP.0000000000002771.
    [14] DETTMER S, SUHLING H, KLINGENBERG I, et al. Lobe-wise assessment of lung volume and density distribution in lung transplant patients and value for early detection of bronchiolitis obliterans syndrome[J]. Eur J Radiol, 2018, 106: 137-144. DOI: 10.1016/j.ejrad.2018.07.016.
    [15] DUBBELDAM A, BARTHELS C, COOLEN J, et al. Restrictive allograft syndrome after lung transplantation: new radiological insights[J]. Eur Radiol, 2017, 27(7): 2810-2817. DOI: 10.1007/s00330-016-4643-5.
    [16] HABRE C, SOCCAL PM, TRIPONEZ F, et al. Radiological findings of complications after lung transplantation[J]. Insights Imaging, 2018, 9(5): 709-719. DOI: 10.1007/s13244-018-0647-9.
    [17] PHILIPPOT Q, DEBRAY MP, BUN R, et al. Use of CT-scan score and volume measures to early identify restrictive allograft syndrome in single lung transplant recipients[J]. J Heart Lung Transplant, 2020, 39(2): 125-133. DOI: 10.1016/j.healun.2019.11.008.
    [18] BARBOSA EJM JR, LANCLUS M, VOS W, et al. Machine learning algorithms utilizing quantitative CT features may predict eventual onset of bronchiolitis obliterans syndrome after lung transplantation[J]. Acad Radiol, 2018, 25(9): 1201-1212. DOI: 10.1016/j.acra. 2018.01.013.
    [19] GUO J, HUANG HJ, WANG X, et al. Imaging mouse lung allograft rejection with (1)H MRI[J]. Magn Reson Med, 2015, 73(5): 1970-1978. DOI: 10.1002/mrm.25313.
    [20] KANNO S, LEE PC, DODD SJ, et al. A novel approach with magnetic resonance imaging used for the detection of lung allograft rejection[J]. J Thorac Cardiovasc Surg, 2000, 120(5): 923-934. DOI: 10.1067/mtc.2000.110184.
    [21] CHUCK NC, BOSS A, WURNIG MC, et al. Ultra-short echo-time magnetic resonance imaging distinguishes ischemia/reperfusion injury from acute rejection in a mouse lung transplantation model[J]. Transpl Int, 2016, 29(1): 108-118. DOI: 10.1111/tri.12680.
    [22] EULER A, BLÜTHGEN C, WURNIG MC, et al. Can texture analysis in ultrashort echo-time MRI distinguish primary graft dysfunction from acute rejection in lung transplants? a multidimensional assessment in a mouse model[J]. J Magn Reson Imaging, 2020, 51(1): 108-116. DOI: 10.1002/jmri.26817.
    [23] MOHER ALSADY T, VOSKREBENZEV A, GREER M, et al. MRI-derived regional flow-volume loop parameters detect early-stage chronic lung allograft dysfunction[J]. J Magn Reson Imaging, 2019, 50(6): 1873-1882. DOI: 10.1002/jmri.26799.
    [24] MOUTAFIDIS D, GAVRA M, GOLFINOPOULOS S, et al. Lung hyperinflation quantitated by chest CT in children with bronchiolitis obliterans syndrome following allogeneic hematopoietic cell transplantation[J]. Clin Imaging, 2021, 75: 97-104. DOI: 10.1016/j.clinimag. 2021.01.011.
    [25] VOSKREBENZEV A, GREER M, GUTBERLET M, et al. Detection of chronic lung allograft dysfunction using ventilation-weighted Fourier decomposition MRI[J]. Am J Transplant, 2018, 18(8): 2050-2060. DOI: 10.1111/ajt.14759.
    [26] PENNATI F, SALITO C, BORZANI I, et al. Quantitative multivolume proton-magnetic resonance imaging in lung transplant recipients: comparison with computed tomography and spirometry[J]. Acad Radiol, 2020, DOI: 10.1016/j.acra.2020.05.026[Epubahead of print].
    [27] 钱根年. 分子影像设备PET/CT成像系统的技术进展[J/CD]. 功能与分子医学影像学杂志(电子版), 2019, 8(1): 1579-1582. DOI: 10.3969/j.issn.2095-2252.2019.01.001.

    QIAN GN. Technical progress of molecular imaging equipment PET/CT imaging system[J/CD]. Funct Mol Med Imaging (Electr Edit), 2019, 8(1): 1579-1582. DOI: 10.3969/j.issn.2095-2252.2019.01.001.
    [28] ERTAY T, SENCAN EREN M, KARAMAN M, et al. 18F-FDG-PET/CT in initiation and progression of inflammation and infection[J]. Mol Imaging Radionucl Ther, 2017, 26(2): 47-52. DOI: 10.4274/mirt.18291.
    [29] CHEN DL, CHERIYAN J, CHILVERS ER, et al. Quantification of lung PET images: challenges and opportunities[J]. J Nucl Med, 2017, 58(2): 201-207. DOI: 10.2967/jnumed.116.184796.
    [30] CHEN DL, WANG X, YAMAMOTO S, et al. Increased T cell glucose uptake reflects acute rejection in lung grafts[J]. Am J Transplant, 2013, 13(10): 2540-2549. DOI: 10.1111/ajt.12389.
    [31] VERLEDEN SE, GHEYSENS O, GOFFIN KE, et al. Role of 18F-FDG PET/CT in restrictive allograft syndrome after lung transplantation[J]. Transplantation, 2019, 103(4): 823-831. DOI: 10.1097/TP.0000000000002393.
    [32] ZHENG B, MAEHARA A, MINTZ GS, et al. Increased coronary lipid accumulation in heart transplant recipients with prior high-grade cellular rejection: novel insights from near-infrared spectroscopy[J]. Int J Cardiovasc Imaging, 2016, 32(2): 225-234. DOI: 10.1007/s10554-015-0777-9.
    [33] BENSTED K, MCKENZIE J, HAVRYK A, et al. Lung ultrasound after transbronchial biopsy for pneumothorax screening in post-lung transplant patients[J]. J Bronchol Interv Pulmonol, 2018, 25(1): 42-47. DOI: 10.1097/LBR.0000000000000446.
    [34] DIANA P, ZAMPIERI D, FURLANI E, et al. Lung ultrasound as a monitoring tool in lung transplantation in rodents: a feasibility study[J]. J Thorac Dis, 2018, 10(7): 4274-4282. DOI: 10.21037/jtd.2018.06.52.
    [35] NARULA T, BANGA A, SAHOO D, et al. Lung ultrasound to detect allograft dysfunction in lung transplant recipients[J]. Am J Respir Crit Care Med, 2019, 199: A2886.
    [36] DAVIDSEN JR, LAURSEN CB, BENDSTRUP E, et al. Lung ultrasound - a novel diagnostic tool to phenotype chronic lung allograft dysfunction?[J]. Ultrasound Int Open, 2017, 3(3): E117-E119. DOI: 10.1055/s-0043-116489.
  • 加载中
图(1) / 表(1)
计量
  • 文章访问数:  200
  • HTML全文浏览量:  84
  • PDF下载量:  58
  • 被引次数: 0
出版历程
  • 收稿日期:  2021-06-30
  • 网络出版日期:  2021-09-15
  • 刊出日期:  2021-09-15

目录

    /

    返回文章
    返回