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1.  Spatiotemporal activity estimation for multivoxel pattern analysis with rapid event-related designs 
NeuroImage  2012;62(3):1429-1438.
Despite growing interest in multi-voxel pattern analysis (MVPA) methods for fMRI, a major problem remains—that of generating estimates in rapid event-related (ER) designs, where the BOLD responses of temporally adjacent events will overlap. While this problem has been investigated for methods that reduce each event to a single parameter per voxel (Mumford et al., 2012), most of these methods make strong parametric assumptions about the shape of the hemodynamic response, and require exact knowledge of the temporal profile of the underlying neural activity. A second class of methods uses multiple parameters per event (per voxel) to capture temporal information more faithfully. In addition to enabling a more accurate estimate of ER responses, this allows for the extension of the standard classification paradigm into the temporal domain (e.g., Mourão-Miranda et al., 2007). However, existing methods in this class were developed for use with block and slow ER data, and there has not yet been an exploration of how to adapt such methods to data collected using rapid ER designs. Here, we demonstrate that the use of multiple parameters preserves or improves classification accuracy, while additionally providing information on the evolution of class discrimination. Additionally, we explore an alternative to the method of Mourão-Miranda et al. tailored to use in rapid ER designs that yields equivalent classification accuracies, but is better at unmixing responses to temporally adjacent events. The current work paves the way for wider adoption of spatiotemporal classification analyses, and greater use of MVPA with rapid ER designs.
doi:10.1016/j.neuroimage.2012.05.057
PMCID: PMC3408801  PMID: 22659443
Functional magnetic resonance imaging; Classification analysis; MVPA; Rapid event-related design
2.  A power calculation guide for fMRI studies 
In the past, power analyses were not that common for fMRI studies, but recent advances in power calculation techniques and software development are making power analyses much more accessible. As a result, power analyses are more commonly expected in grant applications proposing fMRI studies. Even though the software is somewhat automated, there are important decisions to be made when setting up and carrying out a power analysis. This guide provides tips on carrying out power analyses, including obtaining pilot data, defining a region of interest and other choices to help create reliable power calculations.
doi:10.1093/scan/nss059
PMCID: PMC3427872  PMID: 22641837
functional magnetic resonance imaging; classification analysis; MVPA; beta series estimation; rapid event-related design
3.  Detecting network modules in fMRI time series: A weighted network analysis approach 
NeuroImage  2010;52(4):1465-1476.
Many network analyses of fMRI data begin by defining a set of regions, extracting the mean signal from each region and then analyzing the correlations between regions. One essential question that has not been addressed in the literature is how to best define the network neighborhoods over which a signal is combined for network analyses. Here we present a novel unsupervised method for the identification of tightly interconnected voxels, or modules, from fMRI data. This approach, weighted voxel coactivation network analysis (WVCNA) is based on a method that was originally developed to find modules of genes in gene networks. This approach differs from many of the standard network approaches in fMRI in that connections between voxels are described by a continuous measure, whereas typically voxels are considered to be either connected or not connected depending on whether the correlation between the two voxels survives a hard threshold value. Additionally, instead of simply using pairwise correlations to describe the connection between two voxels, WVCNA relies on a measure of topological overlap, which not only compares how correlated two voxels are, but also the degree to which the pair of voxels is highly correlated with the same other voxels. We demonstrate the use of WVCNA to parcellate the brain into a set of modules that are reliably detected across data within the same subject and across subjects. In addition we compare WVCNA to ICA and show that the WVCNA modules have some of the same structure as the ICA components, but tend to be more spatially focused. We also demonstrate the use of some of the WVCNA network metrics for assessing a voxel’s membership to a module and also how that voxel relates to other modules. Last, we illustrate how WVCNA modules can be used in a network analysis to find connections between regions of the brain and show that it produces reasonable results.
doi:10.1016/j.neuroimage.2010.05.047
PMCID: PMC3632300  PMID: 20553896
Functional Magnetic Resonance Imaging; Functional Connectivity; Graph Theory; Small World Networks
4.  Deconvolving BOLD activation in event-related designs for multivoxel pattern classification analyses 
Neuroimage  2011;59(3):2636-2643.
Use of multivoxel pattern analysis (MVPA) to predict the cognitive state of a subject during task performance has become a popular focus of fMRI studies. The input to these analyses consists of activation patterns corresponding to different tasks or stimulus types. These activation patterns are fairly straightforward to calculate for blocked trials or slow event-related designs, but for rapid event-related designs the evoked BOLD signal for adjacent trials will overlap in time, complicating the identification of signal unique to specific trials. Rapid event-related designs are often preferred because they allow for more stimuli to be presented and subjects tend to be more focused on the task, and thus it would be beneficial to be able to use these types of designs in MVPA analyses. The present work compares 8 different models for estimating trial-by-trial activation patterns for a range of rapid event-related designs varying by interstimulus interval and signal-to-noise ratio. The most effective approach obtains each trial’s estimate through a general linear model including a regressor for that trial as well as another regressor for all other trials. Through the analysis of both simulated and real data we have found that this model shows some improvement over the standard approaches for obtaining activation patterns. The resulting trial-by-trial estimates are more representative of the true activation magnitudes, leading to a boost in classification accuracy in fast event-related designs with higher signal-to-noise. This provides the potential for fMRI studies that allow simultaneous optimization of both univariate and MVPA approaches.
doi:10.1016/j.neuroimage.2011.08.076
PMCID: PMC3251697  PMID: 21924359
Functional Magnetic Resonance Imaging; Classification Analysis; MVPA; Beta Series Estimation; Rapid Event-Related Design
5.  Differences in neural activation as a function of risk-taking task parameters 
Despite evidence supporting a relationship between impulsivity and naturalistic risk-taking, the relationship of impulsivity with laboratory-based measures of risky decision-making remains unclear. One factor contributing to this gap in our understanding is the degree to which different risky decision-making tasks vary in their details. We conducted an fMRI investigation of the Angling Risk Task (ART), which is an improved behavioral measure of risky decision-making. In order to examine whether the observed pattern of neural activation was specific to the ART or generalizable, we also examined correlates of the Balloon Analog Risk Taking (BART) task in the same sample of 23 healthy adults. Exploratory analyses were conducted to examine the relationship between neural activation, performance, impulsivity and self-reported risk-taking. While activation in a valuation network was associated with reward tracking during the ART but not the BART, increased fronto-cingulate activation was seen during risky choice trials in the BART as compared to the ART. Thus, neural activation during risky decision-making trials differed between the two tasks, and this observation was likely driven by differences in task parameters, namely the absence vs. presence of ambiguity and/or stationary vs. increasing probability of loss on the ART and BART, respectively. Exploratory association analyses suggest that sensitivity of neural response to the magnitude of potential reward during the ART was associated with a suboptimal performance strategy, higher scores on a scale of dysfunctional impulsivity (DI) and a greater likelihood of engaging in risky behaviors, while this pattern was not seen for the BART. Our results suggest that the ART is decomposable and associated with distinct patterns of neural activation; this represents a preliminary step toward characterizing a behavioral measure of risky decision-making that may support a better understanding of naturalistic risk-taking.
doi:10.3389/fnins.2013.00173
PMCID: PMC3786224  PMID: 24137106
functional impulsivity; dysfunctional impulsivity; risky decision-making; naturalistic risk-taking; ART; BART
6.  Discovering Relations Between Mind, Brain, and Mental Disorders Using Topic Mapping 
PLoS Computational Biology  2012;8(10):e1002707.
Neuroimaging research has largely focused on the identification of associations between brain activation and specific mental functions. Here we show that data mining techniques applied to a large database of neuroimaging results can be used to identify the conceptual structure of mental functions and their mapping to brain systems. This analysis confirms many current ideas regarding the neural organization of cognition, but also provides some new insights into the roles of particular brain systems in mental function. We further show that the same methods can be used to identify the relations between mental disorders. Finally, we show that these two approaches can be combined to empirically identify novel relations between mental disorders and mental functions via their common involvement of particular brain networks. This approach has the potential to discover novel endophenotypes for neuropsychiatric disorders and to better characterize the structure of these disorders and the relations between them.
Author Summary
One of the major challenges of neuroscience research is to integrate the results of the large number of published research studies in order to better understand how psychological functions are mapped onto brain systems. In this research, we take advantage of a large database of neuroimaging studies, along with text mining methods, to extract information about the topics that are found in the brain imaging literature and their mapping onto reported brain activation data. We also show that this method can be used to identify new relations between psychological functions and mental disorders, through their shared brain activity patterns. This work provides a new way to discover the underlying structure that relates brain function and mental processes.
doi:10.1371/journal.pcbi.1002707
PMCID: PMC3469446  PMID: 23071428
7.  Functional Imaging of Sleep Vertex Sharp Transients 
Objective
The vertex sharp transient (VST) is an electroencephalographic (EEG) discharge that is an early marker of non-REM sleep. It has been recognized since the beginning of sleep physiology research, but its source and function remain mostly unexplained. We investigated VST generation using functional MRI (fMRI).
Methods
Simultaneous EEG and fMRI were recorded from 7 individuals in drowsiness and light sleep. VST occurrences on EEG were modeled with fMRI using an impulse function convolved with a hemodynamic response function to identify cerebral regions correlating to the VSTs. A resulting statistical image was thresholded at Z>2.3.
Results
Two hundred VSTs were identified. Significantly increased signal was present bilaterally in medial central, lateral precentral, posterior superior temporal, and medial occipital cortex. No regions of decreased signal were present.
Conclusion
The regions are consistent with electrophysiologic evidence from animal models and functional imaging of human sleep, but the results are specific to VSTs. The regions principally encompass the primary sensorimotor cortical regions for vision, hearing, and touch.
Significance
The results depict a network comprising the presumed VST generator and its associated regions. The associated regions functional similarity for primary sensation suggests a role for VSTs in sensory experience during sleep.
doi:10.1016/j.clinph.2010.12.049
PMCID: PMC3105179  PMID: 21310653
electroencephalography (EEG); functional MRI (fMRI); sleep; vertex sharp transients
8.  Measurement and Reliability of Response Inhibition 
Response inhibition plays a critical role in adaptive functioning and can be assessed with the Stop-signal task, which requires participants to suppress prepotent motor responses. Evidence suggests that this ability to inhibit a prepotent motor response (reflected as Stop-signal reaction time (SSRT)) is a quantitative and heritable measure of interindividual variation in brain function. Although attention has been given to the optimal method of SSRT estimation, and initial evidence exists in support of its reliability, there is still variability in how Stop-signal task data are treated across samples. In order to examine this issue, we pooled data across three separate studies and examined the influence of multiple SSRT calculation methods and outlier calling on reliability (using Intra-class correlation). Our results suggest that an approach which uses the average of all available sessions, all trials of each session, and excludes outliers based on predetermined lenient criteria yields reliable SSRT estimates, while not excluding too many participants. Our findings further support the reliability of SSRT, which is commonly used as an index of inhibitory control, and provide support for its continued use as a neurocognitive phenotype.
doi:10.3389/fpsyg.2012.00037
PMCID: PMC3283117  PMID: 22363308
response inhibition; stop-signal reaction time; reliability
9.  Decreasing Ventromedial Prefrontal Cortex Activity During Sequential Risk-Taking: An fMRI Investigation of the Balloon Analog Risk Task 
Functional imaging studies examining the neural correlates of risk have mainly relied on paradigms involving exposure to simple chance gambles and an economic definition of risk as variance in the probability distribution over possible outcomes. However, there is little evidence that choices made during gambling tasks predict naturalistic risk-taking behaviors such as drug use, extreme sports, or even equity investing. To better understand the neural basis of naturalistic risk-taking, we scanned participants using fMRI while they completed the Balloon Analog Risk Task, an experimental measure that includes an active decision/choice component and that has been found to correlate with a number of naturalistic risk-taking behaviors. In the task, as in many naturalistic settings, escalating risk-taking occurs under uncertainty and might be experienced either as the accumulation of greater potential rewards, or as exposure to increasing possible losses (and decreasing expected value). We found that areas previously linked to risk and risk-taking (bilateral anterior insula, anterior cingulate cortex, and right dorsolateral prefrontal cortex) were activated as participants continued to inflate balloons. Interestingly, we found that ventromedial prefrontal cortex (vmPFC) activity decreased as participants further expanded balloons. In light of previous findings implicating the vmPFC in value calculation, this result suggests that escalating risk-taking in the task might be perceived as exposure to increasing possible losses (and decreasing expected value) rather than the increasing potential total reward relative to the starting point of the trial. A better understanding of how neural activity changes with risk-taking behavior in the task offers insight into the potential neural mechanisms driving naturalistic risk-taking.
doi:10.3389/fnins.2012.00080
PMCID: PMC3366349  PMID: 22675289
risk; risk-taking; BART; ventromedial prefrontal cortex; decision-making; fMRI
10.  Altered Functional Connectivity in Frontal Lobe Circuits Is Associated with Variation in the Autism Risk Gene CNTNAP2 
Science translational medicine  2010;2(56):56ra80.
Genetic studies are rapidly identifying variants that shape risk for disorders of human cognition, but the question of how such variants predispose to neuropsychiatric disease remains. Noninvasive human brain imaging allows assessment of the brain in vivo, and the combination of genetics and imaging phenotypes remains one of the only ways to explore functional genotype-phenotype associations in human brain. Common variants in contactin-associated protein-like 2 (CNTNAP2), a neurexin superfamily member, have been associated with several allied neurodevelopmental disorders, including autism and specific language impairment, and CNTNAP2 is highly expressed in frontal lobe circuits in the developing human brain. Using functional neuroimaging, we have demonstrated a relationship between frontal lobar connectivity and common genetic variants in CNTNAP2. These data provide a mechanistic link between specific genetic risk for neurodevelopmental disorders and empirical data implicating dysfunction of long-range connections within the frontal lobe in autism. The convergence between genetic findings and cognitive-behavioral models of autism provides evidence that genetic variation at CNTNAP2 predisposes to diseases such asautism in part through modulation of frontal lobe connectivity.
doi:10.1126/scitranslmed.3001344
PMCID: PMC3065863  PMID: 21048216
11.  Inhibitory motor control in response stopping and response switching 
While much is known about the neural regions recruited in the human brain when a dominant motor response becomes inappropriate and must be stopped, less is known about the regions that support switching to a new, appropriate, response. Using fMRI with two variants of the stop-signal paradigm that require either stopping altogether or switching to a different response, we examined the brain systems involved in these two forms of executive control. Both stopping trials and switching trials showed common recruitment of the right inferior frontal gyrus, pre-supplementary motor area, and midbrain. Contrasting switching trials with stopping trials showed activation similar to that observed on response trials (where the initial response remains appropriate and no control is invoked), whereas there were no regions that showed significantly greater activity for stopping trials compared to switching trials. These results show that response switching can be supported by the same neural systems as response inhibition, and suggest that the same mechanism of rapid, nonselective response inhibition that is thought to support speeded response stopping can also support speeded response switching when paired with execution of the new, appropriate, response.
doi:10.1523/JNEUROSCI.1096-10.2010
PMCID: PMC2905623  PMID: 20573898
12.  Greater Neural Pattern Similarity Across Repetitions Is Associated with Better Memory 
Science (New York, N.Y.)  2010;330(6000):97-101.
Repeated study improves memory, but the underlying neural mechanisms of this improvement are not well understood. Using functional magnetic resonance imaging and representational similarity analysis of brain activity, we found that, compared with forgotten items, subsequently remembered faces and words showed greater similarity in neural activation across multiple study in many brain regions, including (but not limited to) the regions whose mean activities were correlated with subsequent memory. This result addresses a longstanding debate in the study of memory by showing that successful episodic memory encoding occurs when the same neural representations are more precisely reactivated across study episodes, rather than when patterns of activation are more variable across time.
doi:10.1126/science.1193125
PMCID: PMC2952039  PMID: 20829453
13.  Simple group fMRI modeling and inference 
NeuroImage  2009;47(4):1469-1475.
While many advanced mixed-effects models have been proposed and are used in fMRI, the simplest, ordinary least squares (OLS), is still the one that is most widely used. A survey of 90 papers found that 92% of group fMRI analyses used OLS. Despite the widespread use, this simple approach has never been thoroughly justified and evaluated; for example, the typical reference for the method is a conference abstract, (Holmes and Friston, 1998), which has been referenced over 400 times.
In this work we fully derive the simplified method in a general setting and carefully identify the homogeneity assumptions it is based on. We examine the specificity (Type I error rate) of the OLS method under heterogeneity in the one-sample case and find that the OLS method is valid, with only slight conservativeness. Surprisingly, a Satterthwaite approximation for effective degrees of freedom only makes the method more conservative, instead of more accurate. While other authors have highlighted the inferior power of the OLS method relative to optimal mixed effects methods under heterogeneity, we revisit these results and find the power differences very modest.
While statistical methods that make the best use of the data are always to be preferred, software or other practical concerns may require the use of the simple OLS group modeling. In such cases, we find that group mean inferences will be valid under the null hypothesis and will have nearly optimal sensitivity under the alternative.
doi:10.1016/j.neuroimage.2009.05.034
PMCID: PMC2719771  PMID: 19463958
Functional Magnetic Resonance Imaging; ordinary least squares; general linear model; specificity; hypothesis testing; Two-Stage Summary Statistics; Study Design
14.  Independence in ROI analysis: where is the voodoo? 
We discuss the effects of non-independence on region of interest (ROI) analysis of functional magnetic resonance imaging data, which has recently been raised in a prominent article by Vul et al. We outline the problem of non-independence, and use a previously published dataset to examine the effects of non-independence. These analyses show that very strong correlations (exceeding 0.8) can occur even when the ROI is completely independent of the data being analyzed, suggesting that the claims of Vul et al. regarding the implausibility of these high correlations are incorrect. We conclude with some recommendations to help limit the potential problems caused by non-independence.
doi:10.1093/scan/nsp011
PMCID: PMC2686233  PMID: 19470529
functional magnetic resonance imaging; region of interest analysis; bias; statistics; multiple comparisons
15.  Striatal Dopamine D2/D3 Receptor Availability is Reduced in Methamphetamine Dependence and is Linked to Impulsivity 
While methamphetamine addiction has been associated with both impulsivity and striatal dopamine D2/D3 receptor deficits, human studies have not directly linked the latter two entities. We therefore compared methamphetamine-dependent and healthy control subjects using the Barratt Impulsiveness Scale (version 11, BIS-11) and positron emission tomography with [18F]fallypride to measure striatal dopamine D2/D3 receptor availability. The methamphetamine-dependent subjects reported recent use of the drug 3.3 g per week, and a history of using methamphetamine, on average, for 12.5 years. They had higher scores than healthy control subjects on all BIS-11 impulsiveness subscales (p < 0.001). Volume-of-interest analysis found lower striatal D2/D3 receptor availability in methamphetamine-dependent than in healthy control subjects (p < 0.01) and a negative relationship between impulsiveness and striatal D2/D3 receptor availability in the caudate nucleus and nucleus accumbens that reached statistical significance in methamphetamine-dependent subjects. Combining data from both groups, voxelwise analysis indicated that impulsiveness was related to D2/D3 receptor availability in left caudate nucleus and right lateral putamen/claustrum (p < 0.05, determined by threshold-free cluster enhancement). In separate group analyses, correlations involving the head and body of the caudate and the putamen of methamphetamine-dependent subjects, and the lateral putamen/claustrum of control subjects were observed at a weaker threshold (p < 0.12 corrected). The findings suggest that low striatal D2/D3 receptor availability may mediate impulsive temperament and thereby influence addiction.
doi:10.1523/JNEUROSCI.3765-09.2009
PMCID: PMC2822639  PMID: 19940168
methamphetamine; impulsivity; addiction; dopamine; receptor; striatum
16.  Estimation efficiency and statistical power in arterial spin labeling fMRI 
NeuroImage  2006;33(1):103-114.
Arterial spin labeling (ASL) data are typically differenced, sometimes after interpolation, as part of preprocessing before statistical analysis in fMRI. While this process can reduce the number of time points by half, it simplifies the subsequent signal and noise models (i.e., smoothed box-car predictors and white noise). In this paper, we argue that ASL data are best viewed in the same data analytic framework as BOLD fMRI data, in that all scans are modeled and colored noise is accommodated. The data are not differenced, but the control/label effect is implicitly built into the model. While the models using differenced data may seem easier to implement, we show that differencing models fit with ordinary least squares either produce biased estimates of the standard errors or suffer from a loss in efficiency. The main disadvantage to our approach is that non-white noise must be modeled in order to yield accurate standard errors, however, this is a standard problem that has been solved for BOLD data, and the very same software can be used to account for such autocorrelated noise.
doi:10.1016/j.neuroimage.2006.05.040
PMCID: PMC2772871  PMID: 16860577
Arterial spin labeling; Perfusion; Blood flow; Functional MRI (fMRI); Statistical analysis; Statistical power; Functional imaging; Signal processing
17.  Engagement of Fusiform Cortex and Disengagement of Lateral Occipital Cortex in the Acquisition of Radiological Expertise 
Cerebral Cortex (New York, NY)  2009;19(11):2746-2754.
The human visual pathways that are specialized for object recognition stretch from lateral occipital cortex (LO) to the ventral surface of the temporal lobe, including the fusiform gyrus. Plasticity in these pathways supports the acquisition of visual expertise, but precisely how training affects the different regions remains unclear. We used functional magnetic resonance imaging to measure neural activity in both LO and the fusiform gyrus in radiologists as they detected abnormalities in chest radiographs. Activity in the right fusiform face area (FFA) correlated with visual expertise, measured as behavioral performance during scanning. In contrast, activity in left LO correlated negatively with expertise, and the amount of LO that responded to radiographs was smaller in experts than in novices. Activity in the FFA and LO correlated negatively in experts, whereas in novices, the 2 regions showed no stable relationship. Together, these results suggest that the FFA becomes more engaged and left LO less engaged in interpreting radiographic images over the course of training. Achieving expert visual performance may involve suppressing existing neural representations while simultaneously developing others.
doi:10.1093/cercor/bhp051
PMCID: PMC2758686  PMID: 19321653
diagnosis; expert; FFA; radiology; vision
18.  Power Calculation for Group fMRI Studies Accounting for Arbitrary Design and Temporal Autocorrelation 
NeuroImage  2007;39(1):261-268.
doi:10.1016/j.neuroimage.2007.07.061
PMCID: PMC2423281  PMID: 17919925
19.  Sex Differences in Severe Pulmonary Emphysema 
Rationale: Limited data on sex differences in advanced COPD are available.
Objectives: To compare male and female emphysema patients with severe disease.
Methods: One thousand fifty-three patients (38.8% female) evaluated for lung volume reduction surgery as part of the National Emphysema Treatment Trial were analyzed.
Measurements and Main Results: Detailed clinical, physiological, and radiological assessment, including quantitation of emphysema severity and distribution from helical chest computed tomography, was completed. In a subgroup (n = 101), airway size and thickness was determined by histological analyses of resected tissue. Women were younger and exhibited a lower body mass index (BMI), shorter smoking history, less severe airflow obstruction, lower Dlco and arterial Po2, higher arterial Pco2, shorter six-minute walk distance, and lower maximal wattage during oxygen-supplemented cycle ergometry. For a given FEV1% predicted, age, number of pack-years, and proportion of emphysema, women experienced greater dyspnea, higher modified BODE, more depression, lower SF-36 mental component score, and lower quality of well-being. Overall emphysema was less severe in women, with the difference from men most evident in the outer peel of the lung. Females had thicker small airway walls relative to luminal perimeters.
Conclusions: In patients with severe COPD, women, relative to men, exhibit anatomically smaller airway lumens with disproportionately thicker airway walls, and emphysema that is less extensive and characterized by smaller hole size and less peripheral involvement.
doi:10.1164/rccm.200606-828OC
PMCID: PMC1994221  PMID: 17431226
chronic obstructive pulmonary disease; emphysema; computed tomography; pulmonary function; gender
20.  Modeling group fMRI data 
The analysis of group fMRI data requires a statistical model known as the mixed effects model. This article motivates the need for a mixed effects model and outlines the different stages of the mixed model used to analyze group fMRI data. Different modeling options and their impact on analysis results are also described.
doi:10.1093/scan/nsm019
PMCID: PMC2569805  PMID: 18985145
functional magnetic resonance imaging; mixed effects model; summary statistics; group studies
21.  Prognostic Value of Bronchiolitis Obliterans Syndrome Stage 0-p in Single-Lung Transplant Recipients 
Rationale: Early diagnosis of bronchiolitis obliterans syndrome (BOS) is critical in understanding pathogenesis and devising therapeutic trials. Although potential-BOS stage (BOS 0-p), encompassing early changes in FEV1 and forced expiratory flow, midexpiratory phase (FEF25–75%), has been proposed, there is a paucity of data validating its utility in single-lung transplantation. Objective: The aim of this study was to define the predictive ability of BOS 0-p in single-lung transplantation. Methods: We retrospectively analyzed spirometric data for 197 single-lung recipients. Sensitivity, specificity, and positive predictive value of BOS 0-p were examined over time using Kaplan-Meier methodology. Results: BOS 0-p FEV1 was associated with higher sensitivity, specificity, and positive predictive value than the FEF25–75% criterion over different time periods investigated. The probability of testing positive for BOS 0-p FEV1 in patients with BOS (sensitivity) was 71% at 2 years before the onset of BOS. The probability of being free from development of BOS 0-p FEV1 in patients free of BOS at follow-up (specificity) was 93% within the last year. Of patients who met the BOS 0-p FEV1 criterion, 81% developed BOS or died within 3 years. The specificity and positive predictive value curves for the BOS 0-p FEV1 were significantly different between patients with underlying restrictive versus obstructive physiology (p = 0.05 and 0.01, respectively). Conclusion: The FEV1 criterion for BOS 0-p provides useful predictive information regarding the risk of development of BOS or death in single-lung recipients. The predictive value of this criterion is higher in patients with underlying restriction and is superior to the FEF25–75% criterion.
doi:10.1164/rccm.200501-097OC
PMCID: PMC2718475  PMID: 15894603
bronchiolitis obliterans syndrome; diagnosis; lung transplantation; staging

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