Endobronchial valves in severe emphysematous patients: CT evaluation of lung fissures completeness, treatment radiological response and quantitative emphysema analysis

Radiologia Brasileira

Marcel Koenigkam-santos²  Wagner Diniz De Paula¹  Daniela Gompelmann¹  Hans-ulrich Kauczor¹  Claus Peter Heussel¹  Michael Puderbach¹ 

[1] ,Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto Hospital das ClínicasRibeirão Preto SP ,Brazil

关键词: Emphysema;    Collapse therapy;    Computed tomography;    Enfisema;    Terapia de colapso pulmonar;    Tomografia computadorizada;   

DOI  :  10.1590/S0100-39842013000100008

来源: SciELO

【 摘 要 】

OBJECTIVE: To evaluate lung fissures completeness, post-treatment radiological response and quantitative CT analysis (QCTA) in a population of severe emphysematous patients submitted to endobronchial valves (EBV) implantation. MATERIALS AND METHODS: Multi-detectors CT exams of 29 patients were studied, using thin-section low dose protocol without contrast. Two radiologists retrospectively reviewed all images in consensus; fissures completeness was estimated in 5% increments and post-EBV radiological response (target lobe atelectasis/volume loss) was evaluated. QCTA was performed in pre and post-treatment scans using a fully automated software. RESULTS: CT response was present in 16/29 patients. In the negative CT response group, all 13 patients presented incomplete fissures, and mean oblique fissures completeness was 72.8%, against 88.3% in the other group. QCTA most significant results showed a reduced post-treatment total lung volume (LV) (mean 542 ml), reduced EBV-submitted LV (700 ml) and reduced emphysema volume (331.4 ml) in the positive response group, which also showed improved functional tests. CONCLUSION: EBV benefit is most likely in patients who have complete interlobar fissures and develop lobar atelectasis. In patients with no radiological response we observed a higher prevalence of incomplete fissures and a greater degree of incompleteness. The fully automated QCTA detected the post-treatment alterations, especially in the treated lung analysis.

【 授权许可】

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