Computed tomography assessment of lung volume changes after bronchial valve treatment

Coxson, Harvey O.; Fauerbach, Paola V. Nasute; Storness-Bliss, Claudine; Müller, Néstor L.; Cogswell, S; Dillard, David H.; Finger, CL; Springmeyer, Steven C.

doi:10.1183/09031936.00056008

Cited by 99 publications

(100 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…7,8 These measures are commonly reported in clinical investigation and have been shown to correlate with spirometric and clinical measures of disease. [9][10][11][12] Little attention has been paid, however, to using chest CT scans to determine the normal range of lobe volumes at full infl ation and relaxed exhalation. Once such models have been developed, investigators could then determine the absolute amount of lobe-specifi c hyperinfl ation present on the inspiratory scan (ie, how much lobe volume exceeds predicted at full infl ation) and the lobe-specifi c volume of gas trapped on an expiratory CT image.…”

Section: Discussionmentioning

confidence: 99%

Characterizing Functional Lung Heterogeneity in COPD Using Reference Equations for CT Scan-Measured Lobar Volumes

Come

Díaz

Curran‐Everett

et al. 2013

Chest

View full text Add to dashboard Cite

OPD is characterized by emphysematous destruction of the lung parenchyma and remodeling of the distal small airways. [1][2][3] Emphysema is associated with hyperinfl ation, and the combination of emphysema and airway disease leads to gas trapping on exhalation. The degree to which these abnormalities exist for the whole lung can be easily assessed by either plethysmographic-or helium dilution-based measures of lung volume and regression models for predicted values derived from populations of healthy nonsmokers. 4 However, given that the abnormalities associated with COPD pathology are not homogeneous, measures capable of assessing regional lung volumes and dysfunction rather than providing "averages" over the entire lung may provide useful information for developing and monitoring targeted therapy.CT scanning is increasingly used for clinical, epidemiologic, and genetic investigations of COPD. 5,6 Using readily available tools, investigators can now report regional and lobe-specifi c measures of emphysema Background: CT scanning is increasingly used to characterize COPD. Although it is possible to obtain CT scan-measured lung lobe volumes, normal ranges remain unknown. Using COPDGene data, we developed reference equations for lobar volumes at maximal infl ation (total lung capacity [TLC]) and relaxed exhalation (approximating functional residual capacity [FRC]). Methods: Linear regression was used to develop race-specifi c (non-Hispanic white [NHW], African American) reference equations for lobar volumes. Covariates included height and sex. Models were developed in a derivation cohort of 469 subjects with normal pulmonary function and validated in 546 similar subjects. These cohorts were combined to produce fi nal prediction equations, which were applied to 2,191 subjects with old GOLD (Global Initiative for Chronic Obstructive Lung Disease) stage II to IV COPD. Results: In the derivation cohort, women had smaller lobar volumes than men. Height positively correlated with lobar volumes. Adjusting for height, NHWs had larger total lung and lobar volumes at TLC than African Americans; at FRC, NHWs only had larger lower lobes. Age and weight had no effect on lobar volumes at TLC but had small effects at FRC. In subjects with COPD at TLC, upper lobes exceeded 100% of predicted values in GOLD II disease; lower lobes were only infl ated to this degree in subjects with GOLD IV disease. At FRC, gas trapping was severe irrespective of disease severity and appeared uniform across the lobes. Conclusions: Reference equations for lobar volumes may be useful in assessing regional lung dysfunction and how it changes in response to pharmacologic therapies and surgical or endoscopic lung volume reduction.CHEST 2013; 143(6):1607-1617Abbreviations: AA 5 African American; FRC 5 functional residual capacity; GOLD 5 Global Initiative for Chronic Obstructive Lung Disease; HU 5 Hounsfi eld Units; LLL 5 left lower lobe; LUL 5 left upper lobe; NHW 5 non-Hispanic white; %LAA-856 5 % of total lung volume falling below an attenuation thresho...

show abstract

Section: Discussionmentioning

confidence: 99%

Characterizing Functional Lung Heterogeneity in COPD Using Reference Equations for CT Scan-Measured Lobar Volumes

Come

Díaz

Curran‐Everett

et al. 2013

Chest

View full text Add to dashboard Cite

show abstract

“…In 57 subjects treated with the Spiration valve, CT measurements of atelectasis and volume reduction before and after treatment were correlated with symptomatic response. However, this was not correlated with improvements in pulmonary function tests [145].…”

Section: Update On Copdmentioning

confidence: 69%

Treatment of COPD: from pharmacological to instrumental therapies

Alifano¹,

Cuvelier²,

Delage³

et al. 2010

Eur Respir Rev

View full text Add to dashboard Cite

T he two main goals of the current management of chronic obstructive pulmonary disease (COPD) are: 1) to reduce the impact of the disease on daily activities; and 2) to reduce the risk of future events (exacerbations, lung function decline and death) [1]. The first measure is obviously smoking cessation; however, we will not discuss this.Treatment guidelines are mainly based on randomised clinical trials that include a small and highly selected fraction of the COPD population [2]. Therefore, it is questionable as to whether these evidence-based guidelines can be extrapolated to the overall COPD population in the everyday practice. Indeed, less than one in five or 10 patients with COPD could fit into inclusion or exclusion criteria commonly used in clinical trials evaluating efficacy of pharmacological treatments [2,3]. In addition, COPD is a heterogeneous disease and patients with similar forced expiratory volume in 1 s (FEV1) may show very different functional status, underlying lung pathology and comorbidities. For most treatments, differences in the responsiveness of COPD subgroups are not yet established and large, long clinical trials, along with high-quality meta-analyses, remain the basis of the current treatment guidelines and the evaluation of the benefit/risk ratio of the main therapeutic classes used in COPD management. However, even the large therapeutic trials may suffer from methodological limitations in the design or analysis [4].The most important outcomes in clinical trials are patientcentred outcomes. Exacerbations, health-related quality of life and mortality are logical major outcomes in COPD trials [4]. In addition, exercise performance and lung function decline are other important targets for therapeutic intervention in COPD [5]. Lung function and biological markers reliably predicting individual response to treatments would be useful. PHARMACOLOGICAL INTERVENTIONS BronchodilatorsBronchodilators are the mainstay of the current pharmacological management of COPD. Long-acting bronchodilators reduce exacerbations and improve health-related quality of life [6][7][8][9][10][11]. The inconsistencies in the definitions or statistical analyses of exacerbations hamper comparison of efficacy data on this outcome between trials performed with different long-acting bronchodilators [4,12]. A clinical trial has been designed to compare the effect of tiotropium and salmeterol on exacerbations and would require the inclusion of 6,800 patients in order to potentially detect a difference in efficacy between the two long-acting bronchodilators [13]. The reduction of lung function decline by bronchodilators is a matter of debate [11]. A post hoc analysis of the TORCH study suggested that salmeterol reduces the rate of decline in post-bronchodilator FEV1 versus placebo [8]. A post hoc analysis of two 1-yr trials with tiotropium versus placebo also showed an improvement in the rate of decline of FEV1 [14]. Except in patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage II COPD [10], t...

show abstract

“…CT examinations performed following valve implantations have shown that the desired atelectasis is frequently not achieved, can have a delayed onset or is only temporary [51]. The main reason for this would be what is referred to as collateral ventilation (CV), i. e. even if the valves are placed correctly and good occlusion is established, a retrograde reventilation of the treated lobe occurs via parenchymal bridges from the neighboring lobe [52].…”

Section: Fissure Analysis: the Interlobular Fissuresmentioning

confidence: 99%

Emphysema: Imaging for Endoscopic Lung Volume Reduction

Storbeck

Schröder

Oldigs

et al. 2015

Fortschr Röntgenstr

View full text Add to dashboard Cite

!Chronic obstructive pulmonary disease (COPD) is characterized by two entities, the more airway-predominant type ("bronchitis") on the one hand, and emphysema-predominant type on the other. Imaging via high-resolution computed tomography plays an important role in phenotyping COPD. For patients with advanced lung emphysema, new endoscopic lung volume reduction therapies (ELVR) have been developed. Proper selection of suitable patients requires thinsection reconstruction of volumetric CT image data sets also in coronal and sagittal orientation are required. In the current manuscript we will describe emphysema subtypes (centrilobular, paraseptal, panlobular), options for quantifying emphysema and this importance of regional distribution (homogeneous or heterogeneous, target area) as this is crucial for patient selection. Analysis of the interlobular fissures is obligatory despite the lack of standardization, as incomplete fissures indicate collateral ventilation (CV) via parenchymal bridges, which is an important criterion in choosing endoscopic methods of LVR. Every radiologist should be familiar with modern LVR therapies such as valves and coils, and furthermore should know what a lung doctor expects from radiologic evaluation (before and after ELVR). Finally we present a checklist as a quick reference for all steps concerning imaging for ELVR.

show abstract

Computed tomography assessment of lung volume changes after bronchial valve treatment

Cited by 99 publications

References 31 publications

Characterizing Functional Lung Heterogeneity in COPD Using Reference Equations for CT Scan-Measured Lobar Volumes

Characterizing Functional Lung Heterogeneity in COPD Using Reference Equations for CT Scan-Measured Lobar Volumes

Treatment of COPD: from pharmacological to instrumental therapies

Emphysema: Imaging for Endoscopic Lung Volume Reduction

Contact Info

Product

Resources

About