OBJECTIVE: Th e aim of this work was to investigate if regional diff erences of specifi c gas volume (SVg ) in the diff erent regions (lobes and bronchopulmonary segments) in healthy volunteers and patients with severe emphysema can be used as a tool for planning lung volume reduction (LVR) in emphysema.METHODS: CT scans of 10 healthy subjects and 10 subjects with severe COPD were obtained at end-inspiration (total lung capacity [TLC]) and end-expiration (residual volume [RV]). For each subject, D SVg ( D SVg 5 SVg,TLC 2 SVg,RV, where SVg,TLC and SVg,RV are specifi c gas volume at TLC and RV, respectively) vs D V ( D V 5 V,TLC 2 V,RV, where V,TLC and V,RV are lung volume at TLC and RV, respectively) was plotted for the entire lung, each lobe, and all bronchopulmonary segments. For each subject, a heterogeneity index (HI) was defi ned to quantify the range of variability of D SVg/ D V in all bronchopulmonary regions .
RESULTS:In patients with COPD, SVg,TLC and SVg,RV were signifi cantly higher and D SVg variations lower than in healthy subjects ( P , .001). In COPD, D SVg/ D V slopes were lower in upper lobes than in lower lobes. In healthy subjects, the entire lung, lobes, and bronchopulmonary segments all showed similar D SVg/ D V slopes, whereas in COPD a high variance was found. As a consequence, HI was signifi cantly higher in subjects with COPD than in healthy subjects (0.80 Ϯ 0.34 vs 0.15 Ϯ 0.10, respectively; P , .001).CONCLUSIONS: SVg variations within the lung are highly homogeneous in healthy subjects. Regions with low D SVg/ D V (ie, more pronounced gas trapping) should be considered as target areas for LVR. Regions with negative values of D SVg/ D V identify where collateral ventilation is present. HI is helpful to assess the patient in the diff erent stages of disease and the eff ect of diff erent LVR treatments. LAA 5 low attenuation area; LAA-856 5 lung pixels with an attenuation of Յ 2 856 HU on expiratory CT scan; LAA-950 5 lung pixels with an attenuation of Յ 2 950 HU on inspiratory CT scan; LLL 5 left lower lobe; LUL 5 left upper lobe; LVRS 5 lung volume reduction surgery; ROI 5 region of interest; RLL 5 right lower lobe; RUL 5 right upper lobe; RV 5 residual volume; SVg 5 specific gas volume; SVg,r 5 regional specifi c gas volume; TLC 5 total lung capacity AFFILIATIONS: From the TBMLab