Abstract
Background: Fissure integrity (FI) as a global measure of lobar collateral ventilation has shown to correlate to response of valve-based lung volume reduction (LVR) therapy (M Schuhmann et al, AJRCCM, in press).
Objective: To determine if regional FI can further influence outcome by providing a more localized predictor
Method: Automated regional FI analysis of 253 subjects treated with valves was analyzed in Apollo (VIDA Diagnostics, IA). Individual fissures separating the treated lobe from its ipsilateral lobe were spatially matched to the corresponding ones in a reference patient, allowing voxel-based comparisons of fissure properties between responders (n=141) and non-responders (n=112). Regional FIs were derived based on sub-lobar contact areas or further divided smaller sub-segmental regions on fissure surface. Predictions of LVR outcome by lobar FI, sub-lobar FI and sub-segmental FI were obtained using a Naïve Bayes Classifier with 10-fold cross-validation to avoid over-optimistic results.
Result: Lobar distribution of LVR treatment for responders/non-responders is: RUL(36/21), RLL(19/14), LUL/LLL(101/62). The sensitivity and specificity values are listed. Both methods of local FIs yield better classification results than the global FI.
Conclusion: The results suggest local FI biomarkers may expand patient selection for valves and lead to more targeted, personalized treatments for emphysema including other LVR techniques.
Sensitivity % | Specificity % | ||
Lobar FI | 96 | 12 | |
LUL/LLL | Sub-lobar FI | 98 | 21 |
Sub-seg FI | 97 | 26 | |
Lobar FI | 90 | 9 | |
RUL | Sub-lobar FI | 95 | 92 |
Sub-seg FI | 95 | 78 | |
Lobar FI | 58 | 57 | |
RLL | Sub-lobar FI | 95 | 50 |
Sub-seg FI | 100 | 79 |
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