Abstract
Background: High resolution computed tomography (HRCT) may be used to assess the extent of lobar volume reduction associated with bronchoscopic lung volume reduction (LVR).
Objectives: Analysis of HRCT profiles of patients before and after BTVA in the treatment of heterogeneous emphysema during a clinical trial.
Methods: HRCT scanning was used as a key inclusion criterion for a single-arm trial of BTVA in patients with heterogeneous emphysema. Patients were included if they had a CT determined heterogeneity index (HI) >1.2 (HI = tissue to air ratio (TAR) lower lobe/upper lobe), FEV1 15%-45% predicted, age 40-75 years, RV>150%, TLC>100%, 6 minute walk distance (6MWD)>140 m, DLCO>20%, previous pulmonary rehabilitation.
Results: 44 patients (mean age 62yrs, FEV1 31% predicted, residual volume 237%, DLCO 35%) received unilateral upper lobe BTVA. HRCT assessed lobar volume reduction post BTVA was 48% after 3 months and 46% after 6 months. HRCT findings at baseline, 3 and 6 months according to the treated upper lobe were as follows:
At 6 months, HI decreased from 1.67 to 0.99 (right lung) and 1.76 to 1.04 (left lung) (p<0.05).
Conclusion: HRCT analysis demonstrates significant lung volume reductions following BTVA. Reductions of tissue mass at 6 months are consistent with lung remodeling.
- © 2011 ERS