High-Resolution Computed Tomography-approximated Perfusion Is Comparable to Nuclear Perfusion Imaging in Severe Chronic Obstructive Pulmonary Disease

Koster, T. David; Charbonnier, Jean-Paul; Pruim, Jan; Gietema, Hester A.; Posthuma, Rein; Vanfleteren, Lowie E.G.W.; Dijk, Marlies van; Klooster, Karin; Slebos, Dirk‐Jan

doi:10.1164/rccm.202303-0463le

Cited by 2 publications

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References 8 publications

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“…At baseline and after 2–6 months follow-up a chest computed tomography (CT) scan was performed on which a quantitative analysis (QCT) was performed using LungQ software (Thirona, Nijmegen, the Netherlands). The QCT measured variables were lobar volumes (at full inspiration), lobar emphysematous destruction (expressed as the percentage of low attenuation areas (%LAA) <−950 HU at full inspiration), lobar air trapping (%LAA <−856 HU at full expiration), QCT-derived lobar perfusion [ 18 ] and standardised airway wall thickness.…”

Section: Methodsmentioning

confidence: 99%

Response to endobronchial valve treatment: it's all about the target lobe

et al. 2023

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BackgroundBronchoscopic lung volume reduction using endobronchial valves (EBV) has shown to be beneficial for severe emphysema patients. The most important predictor of treatment response is absence of collateral ventilation between the treatment target and ipsilateral lobe. However, there are still a substantial number of non-responders and it would be useful to improve the pre-treatment identification of responders. Presumably, predictors of response will be multifactorial and therefore our aim was to explore whether we can identify response groups using a clusteranalysis.MethodsAt baseline and 1 year follow-up, pulmonary function, exercise capacity and quality of life were measured. A quantitative chest CT scan analysis was performed at baseline and 2 to 6 months follow-up. The cluster analysis was performed using a hierarchical agglomerative method.ResultsIn total 428 patients (69%female, age 61±8 years, FEV127±8%pred, RV 254±50%pred) were included in our analysis. Three clusters were generated: 1 non-responder and 2 responder clusters. Despite solid technical procedures, the non-responder cluster had significantly less clinical response after treatment compared to the other clusters. The non-responder cluster was characterised by significantly less emphysematous destruction, less air trapping and a higher perfusion of the target lobe, and a more homogeneous distribution of emphysema and perfusion between the target and ipsilateral lobe.ConclusionsWe found that target lobe characteristics are the discriminators between responders and non-responders which underlines the importance of visual and quantitative assessment of the potential treatment target lobe when selecting patients for EBV treatment.

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Section: Methodsmentioning

confidence: 99%

Response to endobronchial valve treatment: it's all about the target lobe

et al. 2023

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Recent advances in bronchoscopic lung volume reduction for severe COPD patients

Posthuma,

Vaes,

Spruit

et al. 2023

Current Opinion in Supportive &Amp; Palliative Care

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Purpose of review Bronchoscopic lung volume reduction (BLVR) is a novel and effective treatment for a specific phenotype of chronic obstructive pulmonary disease (COPD) characterized by advanced emphysema with static lung hyperinflation and severe breathlessness. This review aims to provide an overview of the recent advances made in BLVR. Recent findings For achieving optimal outcomes with BLVR, patient selection and target lobe identification is crucial. BLVR has recently also been established to improve pulmonary function, exercise capacity and quality of life in COPD patients falling outside the standard treatment criteria, including patients with moderate hyperinflation, chronic hypercapnic failure or with very low diffusion capacity. In a cluster analysis, target lobe characteristics like emphysema destruction, air trapping and perfusion were found to be important discriminators between responders and non-responders. A potential survival benefit has been demonstrated in BLVR-treated patients when compared to non-treated patients. Long-term outcomes showed sustained outcomes of BLVR; however, effects decline over time, probably due to disease progression. Summary BLVR using one-way endobronchial valves has become a guideline treatment offered in specialized intervention centres for a specific subgroup of COPD patients. Recent studies further characterize responders, describe extrapulmonary effects of BLVR and show positive long-term outcomes and a potential survival benefit.

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High-Resolution Computed Tomography-approximated Perfusion Is Comparable to Nuclear Perfusion Imaging in Severe Chronic Obstructive Pulmonary Disease

Cited by 2 publications

References 8 publications

Response to endobronchial valve treatment: it's all about the target lobe

Response to endobronchial valve treatment: it's all about the target lobe

Recent advances in bronchoscopic lung volume reduction for severe COPD patients

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