European Radiology

, Volume 25, Issue 10, pp 2931–2936 | Cite as

Quantitative computed tomography assessment of graft-versus-host disease-related bronchiolitis obliterans in children: A pilot feasibility study

  • Hyun Gi Kim
  • Hyun Joo Shin
  • Yoon Hee Kim
  • Myung Hyun Sohn
  • Chuhl Joo Lyu
  • Myung-Joon Kim
  • Kyung Won Kim
  • Mi-Jung LeeEmail author
Computed Tomography



To suggest a simple method that can quantify air trapping from chest CT in children with graft-versus-host disease (GVHD)-related bronchiolitis obliterans (BO).


This institutional review board-approved retrospective study included eight GVHD-related BO patients (age, 6 - 17 years) who underwent both 31 CTs of variable settings and pulmonary function tests (PFT). The attenuation values of lung parenchyma in normal (An) and air trapping (Aa) areas were obtained. Individualized threshold [(An + Aa)/2] and fixed threshold of -950 HU were set for air trapping quantification. Spearman correlation analysis and generalized linear mixed models were used for statistical analysis.


The mean value of individualized threshold was -830.2 ± 48.3 HU. The mean air trapping lung volume percentage with individualized threshold and -950 HU were 45.4 ± 18.9 % and 1.4 ± 1.9 %, respectively. The air trapping lung volume percentage with individualized threshold showed a significant negative correlation with the PFT of FEV1/FVC% in all data (γ = -0.795, P < .001) and in the correction of repetition (γ = -0.837, P = .010).


We suggest a simple and individualized threshold attenuation setting method for air trapping quantification insusceptible to CT imaging protocols or respiratory phase control in children with GVHD-related BO.

Key Points

• Simple and individualized threshold attenuation setting for air trapping quantification is possible.

• Individualized threshold attenuation setting is insusceptible to CT imaging protocols or respiratory phase control.

• CT air trapping quantification correlates with PFT of pulmonary obstruction.


Lung Quantitative computed tomography Pulmonary emphysema Airway obstruction Graft-versus-host disease 



Graft-versus-host disease


Bronchiolitis obliterans


Pulmonary function test


Forced vital capacity


Forced expiratory volume in 1 s


Attenuation values of normal lung parenchyma


Attenuation values of air trapping area


The average between An and Aa


The percentage of lung volume with attenuation lower than Alow



The scientific guarantor of this publication is Mi-Jung Lee. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Jiin Choi kindly provided statistical advice for this manuscript. Dong Su Jang helped designing the figures in this article. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective / performed at one institution.


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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Hyun Gi Kim
    • 1
    • 4
  • Hyun Joo Shin
    • 1
  • Yoon Hee Kim
    • 2
  • Myung Hyun Sohn
    • 2
  • Chuhl Joo Lyu
    • 3
  • Myung-Joon Kim
    • 1
  • Kyung Won Kim
    • 2
  • Mi-Jung Lee
    • 1
    Email author
  1. 1.Department of Radiology and Research Institute of Radiological Science, Severance Children’s HospitalYonsei University College of MedicineSeoulKorea
  2. 2.Department of Pediatrics and Institute of Allergy, Severance Children’s HospitalYonsei University College of MedicineSeoulKorea
  3. 3.Department of Pediatric Hematology and Oncology, Severance Children’s HospitalYonsei University College of MedicineSeoulKorea
  4. 4.Department of Radiology, Ajou University School of MedicineAjou University Medical CenterSuwonKorea

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