Selecting Patients for Lobar Lung Volume Reduction Therapy: What Quantitative Computed Tomography Parameters Matter?

Abstract

Purpose Evaluation of emphysema distribution with quantitative computed tomography (qCT) prior to endoscopic lung volume reduction (ELVR) is recommended. The aim of this study was to determine which of the commonly assessed qCT parameters prior to endoscopic lung volume reduction (ELVR) best predicts outcome of treatment.

Materials and Methods 50 patients who underwent technically successful ELVR at our institution were retrospectively analyzed. We performed quantitative analysis of the CT scans obtained prior to ELVR and carried out Mann-Whitney U-tests and a logistic regression analysis to identify the qCT parameters that predict successful outcome of ELVR in terms of improved forced expiratory volume in 1 second (FEV1).

Results In the Mann-Whitney U-test, the interlobar emphysema heterogeneity index (p = 0.008) and the pulmonary emphysema score (p = 0.022) showed a statistically significant difference between responders and non-responders. In multiple logistic regression analysis only the interlobar emphysema heterogeneity index (p = 0.008) showed a statistically significant impact on the outcome of ELVR, while targeted lobe volume, total lung volume, targeted lobe emphysema score and total lung emphysema score did not.

Conclusion Of all commonly assessed quantitative CT parameters, only the heterogeneity index definitely allows prediction of ELVR outcome in patients with advanced chronic obstructive pulmonary disease (COPD).

Key Points 

• Quantitative CT is recommended prior to ELVR.

• The relevance of the obtained parameters from quantitative CT remains controversial.

• This study confirms that only the emphysema heterogeneity index has a definite impact.

Citation Format

• Theilig DC, Huebner R, Neumann K et al. Selecting Patients for Lobar Lung Volume Reduction Therapy: What Quantitative Computed Tomography Parameters Matter?. Fortschr Röntgenstr 2019; 191: 40 – 47

Zusammenfassung

Ziel Vor endoskopischer Lungenvolumenreduktion (ELVR) ist die Evaluation der Emphysemverteilung mittels quantitativer Computertomografie (qCT) empfohlen. Ziel dieser retrospektiven Studie war festzustellen, welche qCT-Parameter das postinterventionelle Outcome am besten vorhersagen.

Material und Methoden Die präinterventionellen Computertomografien von fünfzig in unserer Institution technisch erfolgreich mit ELVR behandelten Patienten wurden quantitativ analysiert und mit prä- und postinterventionellen Lungenfunktionsuntersuchungen verglichen. Untersucht wurde die Relevanz der standardmäßig erhobenen qCT-Parameter, d. h. Gesamtlungenvolumen, Ziellappenvolumen, Emphysemindex der gesamten Lunge und des Ziellappens sowie Heterogenitätsindex. Mann-Whitney U-Test und logistische Regressionsanalyse wurden zur Identifikation derjenigen Parameter verwendet, die am besten einen Anstieg der FEV1 hervorsagten.

Ergebnisse Im Mann-Whitney U-Test unterschieden sich lediglich interlobärer Emphysemheterogenitätsindex (p = 0,008) und pulmonaler Emphysemindex (p = 0,022) signifikant zwischen Therapieansprechern und Therapieversagern. Die logistische Regressionsanalyse zeigte lediglich für den Heterogenitätsindex signifikante Unterschiede zwischen beiden Patientengruppen (p = 0,008). Gesamtlungenvolumen, Ziellappenvolumen, sowie die Emphysemindices der gesamten Lunge und des Ziellappens wiesen dort keine signifikanten Unterschiede auf.

Schlußfolgerungen Von allen bei der präinterventionellen qCT erhobenen Parametern scheint lediglich der interlobäre Heterogenitätsindex das klinische Outcome nach ELVR verlässlich vorauszusagen.

Kernaussagen 

• Vor ELVR wird die Durchführung einer quantitativen CT empfohlen.

• Die Relevanz der qCT-Parameter ist weiterhin umstritten.

• Diese Studie bekräftigt, dass ausschließlich die Emphysemheterogenität einen relevanten Einfluss hat.

Key words

CT-quantitative - chronic obstructive pulmonary disease - lung volume reduction therapy

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