Imaging of the Lungs in Organ Donors and its Clinical Relevance A Retrospective Analysis Gracijela Bozovic, MD,* Catharina Adlercreutz, MD,* Peter Ho ¨glund, MD, PhD,wz Isabella Bjo ¨rkman-Burtscher, MD, PhD,*y Peter Reinstrup, MD, PhD,8 Richard Ingemansson, MD, PhD,z Cornelia Schaefer-Prokop, MD, PhD,# Roger Siemund, MD, PhD,* and Mats Geijer, MD, PhD**ww Purpose: The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them. Materials and Methods: Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and car- diovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation. Results: Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differ- ences were found in 71 (52%) examinations (P < 0.0001). In 31 of 42 (74%) complete or incomplete CT examinations, 50 of 74 findings with relevance for lung donation were not primarily reported (P < 0.0001). Conclusions: The majority of donor patients undergo only chest radiography. A targeted imaging review of abnormalities affecting the decision to use donor lungs may be useful in the preoperative stage. With a targeted list, substantial changes were made from initial clinical interpretations. CT can provide valuable information on donor lung pathology, even if the lungs are only partially imaged. Key Words: heart-lung transplantation, radiography, tomography, x-ray computed, image interpretation, living donor (J Thorac Imaging 2017;32:107–114) L ung transplantation is currently the only treatment option for terminally ill lung patients with <2 years’ life expectancy. It is an established practice with proven benefit but limited by organ shortage. Only about 20% of lungs from brain-dead organ donors are used for transplantation because of factors such as edema, aspiration, or poor oxygenation. 1 The utilization varied between 9% and 57% in different countries in 2014. 2 The evaluation of donor lungs follows the international lung transplant donor acceptability criteria, 1 which proposes a review of several parameters—for example, donor comorbid conditions such as history of smoking and cancer, age, sputum gram-stain findings, blood gas analysis, radiographic changes, and organ size. With the introduction of ex vivo perfusion and its transplant rehabilitation potential of marginal donors 3 as well as acceptance of patients up to 70 years of age and previous smokers 4 the donor criteria have been expanded. 5,6 Subsequently, the donor pool has increased to now include 51% of extended donors. 7 The increased age and previous smoking history of extended donors coincide with the increased incidence of lung cancer, 8 chronic obstructive pulmonary disease, 9 and idiopathic pulmonary fibrosis, 10 raising the risk for preexisting lung disease in donors. Regarding imaging, the international lung transplant donor acceptability criteria advocate a clear conventional bedside chest radiograph. 1 The accuracy of bedside chest radiography is high for detecting tubes and devices but only moderate for visualization of opacities caused by car- diopulmonary abnormalities. 11 There is substantial under- diagnosis in this complex group of intensive care unit (ICU) patients, 12,13 including potential organ donors. Some of the findings are of importance for the patient as such but also relevant for lung donation—for example, treatable decompensation, pulmonary edema, infection, and malig- nancy. Since the establishment of lung transplantation rou- tines in the 1980s and early 1990s, diagnostic imaging capabilities have developed immensely. New advanced methods have been developed and have entered clinical practice; radiologic equipment has become fast and acces- sible, and comprehensive knowledge has been gained about illnesses such as interstitial lung disease. High-resolution From the Departments of *Radiology; 8Neurosurgery; zCardiothora- cic Surgery, Ska˚ne University Hospital; wDepartment of Labo- ratory Medicine; zDivison of Clinical Chemistry and Pharmacol- ogy; yLund University Bioimaging Centre; **Department of Clinical Sciences, Lund University, Lund; wwDepartment of Radi- ology, O ¨ rebro University, O ¨ rebro, Sweden; and #Meander Medical Centre, Amersfoort, The Netherlands. The authors declare no conflicts of interest. Correspondence to: Gracijela Bozovic, MD, Department of Radiology, Ska˚ne University Hospital and Lund University, Getingeva¨gen 4, 221 85 Lund, Sweden (e-mail: gracijela.bozovic@med.lu.se). Supplemental Digital Content is Available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Website, www.thoracicimaging.com. Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/RTI.0000000000000255 ORIGINAL ARTICLE J Thorac Imaging  Volume 32, Number 2, March 2017 www.thoracicimaging.com | 107 Copyright r 2017 Wolters Kluwer Health, Inc. All rights reserved.