Quantitative assessment of emphysematous parenchyma using multidetector-row computed tomography in patients scheduled for endobronchial treatment with one-way valves

Fiorelli, Alfonso; Petrillo, Mario; Vicidomini, Giovanni; Crescenzo, Vincenzo Giuseppe Di; Frongillo, Elisabetta; Felice, Alberto De; Rotondò, Antonio; Santini, Mario

doi:10.1093/icvts/ivu107

Cited by 30 publications

(21 citation statements)

References 20 publications

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“…Indeed, our results confirm that this definition yields good predictive accuracy in the ROC analysis (AUC =0.72, P =0.009). Interestingly enough, however, this is not the definition that was used in most of the major trials published in the literature 1,13,32. Instead, in these studies, interlobar emphysema heterogeneity was defined as the emphysema score of the TL minus the emphysema score of the INTL, disregarding the middle lobe, that is, HI 4 in our analysis, which surprisingly enough also yielded the best predicative accuracy (AUC =0.73, P =0.008).…”

Section: Discussionmentioning

confidence: 99%

Comparison of distinctive models for calculating an interlobar emphysema heterogeneity index in patients prior to endoscopic lung volume reduction

Theilig

Doellinger

Poellinger

et al. 2017

COPD

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BackgroundThe degree of interlobar emphysema heterogeneity is thought to play an important role in the outcome of endoscopic lung volume reduction (ELVR) therapy of patients with advanced COPD. There are multiple ways one could possibly define interlobar emphysema heterogeneity, and there is no standardized definition.PurposeThe aim of this study was to derive a formula for calculating an interlobar emphysema heterogeneity index (HI) when evaluating a patient for ELVR. Furthermore, an attempt was made to identify a threshold for relevant interlobar emphysema heterogeneity with regard to ELVR.Patients and methodsWe retrospectively analyzed 50 patients who had undergone technically successful ELVR with placement of one-way valves at our institution and had received lung function tests and computed tomography scans before and after treatment. Predictive accuracy of the different methods for HI calculation was assessed with receiver-operating characteristic curve analysis, assuming a minimum difference in forced expiratory volume in 1 second of 100 mL to indicate a clinically important change.ResultsThe HI defined as emphysema score of the targeted lobe (TL) minus emphysema score of the ipsilateral nontargeted lobe disregarding the middle lobe yielded the best predicative accuracy (AUC =0.73, P=0.008). The HI defined as emphysema score of the TL minus emphysema score of the lung without the TL showed a similarly good predictive accuracy (AUC =0.72, P=0.009). Subgroup analysis suggests that the impact of interlobar emphysema heterogeneity is of greater importance in patients with upper lobe predominant emphysema than in patients with lower lobe predominant emphysema.ConclusionThis study reveals the most appropriate ways of calculating an interlobar emphysema heterogeneity with regard to ELVR.

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Section: Discussionmentioning

confidence: 99%

Comparison of distinctive models for calculating an interlobar emphysema heterogeneity index in patients prior to endoscopic lung volume reduction

Theilig

Doellinger

Poellinger

et al. 2017

COPD

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“…contrast showed a likely 3 cm area of active contrast along with compressive atelectasis of the left lower lobe and pleural effusion (Figure 2). She also underwent a fibrobronchoscopy showing no pathological signs [14,15]. Pulmonary angiography confirmed an AVM of a basilar left pulmonary artery supplying aneurysmal AVM and dilated draining vein.…”

Section: Case Reportmentioning

confidence: 99%

Pulmonary arterovenous malformation causing hemothorax in a pregnant woman without Osler- Weber-Rendu syndrome

et al. 2015

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Pulmonary arteriovenous malformations (PAVMs), although most commonly congenital, are usually detected later in life. Case report: We present a case of a 19-year-old woman with no previous history of AVM or telangiectasia, who presented dyspnea and hypoxia by massive left hemothorax in the 34th week of gestation. After emergent cesarean delivery, a chest computed tomography (CT) with i.v. contrast showed a likely 3 cm area of active contrast in left lower lung. Chest tube placement revealed about 2 liters of blood. The patient was subsequently found to have pulmonary AVM. A successful embolisation of AVM followed by lung atipic resection involving AVM and decortication for lung re-expansion were the treatments provided. Conclusions: Women with known pulmonary AVM should be maximally treated prior to becoming pregnant, and the physician should be alert to complications of pulmonary AVM during pregnancy.

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“…However, there are major differences in the different types of software, among which are the evaluation and presentation of data. While the results were still disappointing in 2006, e. g. the considerable amount of time required and the poor correlation between human eyes and the machine [45], by 2014 it was more than clear that qMDCT (CT densitometry using multidetector-row computed tomography) represents a diagnostic gain [46]. However, it remains unclear how strongly patient-related factors (age, inspiration depth) influence the measured values.…”

Section: Quantification Of the Emphysemamentioning

confidence: 99%

Emphysema: Imaging for Endoscopic Lung Volume Reduction

Storbeck

Schröder

Oldigs

et al. 2015

Fortschr Röntgenstr

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!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.

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Quantitative assessment of emphysematous parenchyma using multidetector-row computed tomography in patients scheduled for endobronchial treatment with one-way valves

Abstract: Our study showed that the volumetric quantification adds further informations to the routine evaluation for optimizing the selection of patients scheduled for endobronchial valve treatment.

Cited by 30 publications

References 20 publications

Comparison of distinctive models for calculating an interlobar emphysema heterogeneity index in patients prior to endoscopic lung volume reduction

Comparison of distinctive models for calculating an interlobar emphysema heterogeneity index in patients prior to endoscopic lung volume reduction

Pulmonary arterovenous malformation causing hemothorax in a pregnant woman without Osler- Weber-Rendu syndrome

Emphysema: Imaging for Endoscopic Lung Volume Reduction

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