Radiographic Evaluation of the Potential Lung Volume Reduction Surgery Candidate

Washko, George R.; Hoffman, Eric A.; Reilly, John J.

doi:10.1513/pats.200802-017et

Cited by 33 publications

(24 citation statements)

References 38 publications

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“…Upper versus nonupper lung predominance was assessed on the basis of the radiologist's visual examination of the CT scan (1). For densitometric measurements, the lung was divided into upper, middle, and lower zones of equal craniocaudal height analogous to the perfusion images, and the percent emphysema was assessed separately for each zone, using a threshold value of 2950 Hounsfield units as described previously (4,16).…”

Section: Chest Ctmentioning

confidence: 99%

“…It is well established that those with advanced upper lobe-predominant emphysema derive the greatest benefit from this surgical procedure (1-3). The current standard of care for defining upper lung-predominant emphysema is visual examination of the chest computed tomogram (CT) (1,4). Perfusion scintigraphy is another commonly available test for assessing the distribution of emphysema.…”

mentioning

confidence: 99%

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Perfusion Scintigraphy and Patient Selection for Lung Volume Reduction Surgery

Chandra¹,

Lipson²,

Hoffman³

et al. 2010

Am J Respir Crit Care Med

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Rationale: It is unclear if lung perfusion can predict response to lung volume reduction surgery (LVRS). Objectives: To study the role of perfusion scintigraphy in patient selection for LVRS. Methods: We performed an intention-to-treat analysis of 1,045 of 1,218 patients enrolled in the National Emphysema Treatment Trial who were non-high risk for LVRS and had complete perfusion scintigraphy results at baseline. The median follow-up was 6.0 years. Patients were classified as having upper or non-upper lobepredominant emphysema on visual examination of the chest computed tomography and high or low exercise capacity on cardiopulmonary exercise testing at baseline. Low upper zone perfusion was defined as less than 20% of total lung perfusion distributed to the upper third of both lungs as measured on perfusion scintigraphy. Measurements and Main Results: Among 284 of 1,045 patients with upper lobe-predominant emphysema and low exercise capacity at baseline, the 202 with low upper zone perfusion had lower mortality with LVRS versus medical management (risk ratio [RR], 0.56; P 5 0.008) unlike the remaining 82 with high perfusion where mortality was unchanged (RR, 0.97; P 5 0.62). Similarly, among 404 of 1,045 patients with upper lobe-predominant emphysema and high exercise capacity, the 278 with low upper zone perfusion had lower mortality with LVRS (RR, 0.70; P 5 0.02) unlike the remaining 126 with high perfusion (RR, 1.05; P 5 1.00). Among the 357 patients with non-upper lobe-predominant emphysema (75 with low and 282 with high exercise capacity) there was no improvement in survival with LVRS and measurement of upper zone perfusion did not contribute new prognostic information. Conclusions: Compared with optimal medical management, LVRS reduces mortality in patients with upper lobe-predominant emphysema when there is low rather than high perfusion to the upper lung.

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Section: Chest Ctmentioning

confidence: 99%

mentioning

confidence: 99%

Perfusion Scintigraphy and Patient Selection for Lung Volume Reduction Surgery

Chandra¹,

Lipson²,

Hoffman³

et al. 2010

Am J Respir Crit Care Med

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“…To date, this functional information in COPD patients has been approached non-invasively by perfusion scintigraphy, single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). Lung perfusion scintigraphy has been particularly employed to evaluate patients with severe emphysema who were candidates for lung volume reduction surgery [3][4][5][6]. Although this technique can provide information on the perfusion pattern in patients with severe emphysema, it suffers from low spatial resolution.…”

Section: Introductionmentioning

confidence: 99%

Assessment of lobar perfusion in smokers according to the presence and severity of emphysema: preliminary experience with dual-energy CT angiography

et al. 2009

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The purpose of the study was to assess pulmonary perfusion on a lobar level in smokers using dual-energy computed tomography (CT). Forty-seven smokers and ten non-smokers underwent a dual-energy multi-detector CT angiogram of the chest that allowed automatic quantification of emphysema and determination of the iodine content at the level of the microcirculation (i.e. "perfusion imaging"). Emphysema was present in 37 smokers and absent in ten smokers. Smokers with an upper lobe predominance of emphysema (n = 8) had: (1) significantly lower attenuation enhancement values in the upper lobes compared with smokers without emphysema; (2) the lobes with the most severe emphysematous changes had a statistically significantly higher percentage of emphysema (p = 0.0001) and lower mean attenuation enhancement values (p = 0.0001) than the ipsilateral lobes with less severe emphysema, matching parenchymal destruction; (3) a correlation was found between the difference in percentage of emphysema between the upper and lower lobes and the difference in attenuation attenuation enhancement values in the corresponding lobes (p = 0.0355; r = -0.54). Regional alterations of lung perfusion can be depicted by dual-energy CT in smokers with predominant emphysema.

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“…With regard to lung volume reduction surgery, these technical capabilities are of utmost importance to correctly appraise the potential postinterventional success in a preoperative setting. [5][6][7] Nevertheless, the main disadvantage of chest CT is the associated radiation dose, which is higher than that of chest x-ray. However, there exist several strategies to lower the radiation dose in chest CT, such as scanning at lower tube voltages, use of automated exposure control, scanning with the high-pitch mode, or selective in-plane shielding.…”

mentioning

confidence: 99%

Influence of Sinogram-Affirmed Iterative Reconstruction on Computed Tomography–Based Lung Volumetry and Quantification of Pulmonary Emphysema

Baumueller

Hilty

Nguyen

et al. 2016

Journal of Computer Assisted Tomography

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OBJECTIVE The purpose of this study was to evaluate the influence of sinogram-affirmed iterative reconstruction (SAFIRE) on quantification of lung volume and pulmonary emphysema in lowdose chest computed tomography compared with filtered back projection (FBP). METHODS Enhanced or nonenhanced low-dose chest computed tomography was performed in 20 patients with chronic obstructive pulmonary disease (group A) and in 20 patients without lung disease (group B). Data sets were reconstructed with FBP and SAFIRE strength levels 3 to 5. Two readers semiautomatically evaluated lung volumes and automatically quantified pulmonary emphysema, and another assessed image quality. Radiation dose parameters were recorded. RESULTS Lung volume between FBP and SAFIRE 3 to 5 was not significantly different among both groups (all P > 0.05). When compared with those of FBP, total emphysema volume was significantly lower among reconstructions with SAFIRE 4 and 5 (mean difference, 0.56 and 0.79 L; all P < 0.001). There was no nondiagnostic image quality. CONCLUSIONS Sinogramaffirmed iterative reconstruction does not alter lung volume measurements, although quantification of lung emphysema is affected at higher strength levels.

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Radiographic Evaluation of the Potential Lung Volume Reduction Surgery Candidate

Cited by 33 publications

References 38 publications

Perfusion Scintigraphy and Patient Selection for Lung Volume Reduction Surgery

Perfusion Scintigraphy and Patient Selection for Lung Volume Reduction Surgery

Assessment of lobar perfusion in smokers according to the presence and severity of emphysema: preliminary experience with dual-energy CT angiography

Influence of Sinogram-Affirmed Iterative Reconstruction on Computed Tomography–Based Lung Volumetry and Quantification of Pulmonary Emphysema

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