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Densitometry for assessment of effect of lung volume reduction surgery for emphysema

¹ Depts of Pulmonology, ² Thoracic Surgery, and, ³ Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands. ⁴ Division of Pulmonology, ⁵ Dept of Radiology, and ⁶ Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.

CORRESPONDENCE: J. Stolk, Dept of Pulmonology (C3-P), Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands. Fax: 31 715266927. E-mail: j.stolk.long{at}lumc.nl

Keywords: Computed tomography, densitometry, emphysema, lung volume reduction surgery, outcome parameter

Received: April 26, 2006
Accepted February 17, 2007

To explore if change in the extent of emphysema correlated with change in lung function, the effect of resection of emphysematous tissue was studied by computed tomography (CT) densitometry. In addition, the current authors studied how surgery-induced change in emphysema related to lung density in control subjects.

In total, 30 patients (14 females; mean±SD age 59±10 yrs) with severe emphysema before and 3 months after lung volume reduction surgery (LVRS), 48 patients with moderate emphysema and 76 control subjects were investigated. Lung density (15th percentile point) of both lungs and heterogeneity of lung density between 12 isovolumetric partitions in each lung were calculated from chest CT images.

The 15th percentile point and its heterogeneity could distinguish controls from subjects with moderate emphysema with a sensitivity and specificity of >95%. LVRS significantly increased lung density by 5.0±10.9 g·L^–1 (n = 30). Improvement in the diffusing capacity of the lung for carbon monoxide and in residual volume significantly correlated with an increase in lung density (n = 20 and 28, respectively). Change in forced expiratory volume in one second did not correlate with change in lung density.

In conclusion, lung density 15th percentile point is a valuable surrogate marker for detection of both the extent of and reduction in emphysema.

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