Chest

European Radiology

, Volume 22, Issue 7, pp 1547-1555

First online:

Emphysema lung lobe volume reduction: effects on the ipsilateral and contralateral lobes

  • Matthew S. BrownAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA Email author 
  • , Hyun J. KimAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
  • , Fereidoun G. AbtinAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
  • , Charlie StrangeAffiliated withDepartment of Pulmonary and Critical Care Medicine, Medical University of South Carolina
  • , Maya Galperin-AizenbergAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
  • , Richard PaisAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
  • , Irene G. Da CostaAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
  • , Arash OrdookhaniAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
  • , Daniel ChongAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
    • , Chiayi NiAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
    • , Michael F. McNitt-GrayAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA
    • , Donald P. TashkinAffiliated withDivision of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA
    • , Jonathan G. GoldinAffiliated withCenter for Computer Vision and Imaging Biomarkers, Department of Radiological Sciences, David Geffen School of Medicine at UCLA

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Abstract

Objectives

To investigate volumetric and density changes in the ipsilateral and contralateral lobes following volume reduction of an emphysematous target lobe.

Methods

The study included 289 subjects with heterogeneous emphysema, who underwent bronchoscopic volume reduction of the most diseased lobe with endobronchial valves and 132 untreated controls. Lobar volume and low-attenuation relative area (RA) changes post-procedure were measured from computed tomography images. Regression analysis (Spearman’s rho) was performed to test the association between change in the target lobe volume and changes in volume and density variables in the other lobes.

Results

The target lobe volume at full inspiration in the treatment group had a mean reduction of −0.45 L (SE = 0.034, P < 0.0001), and was associated with volume increases in the ipsilateral lobe (rho = −0.68, P < 0.0001) and contralateral lung (rho = −0.16, P = 0.006), and overall reductions in expiratory RA (rho = 0.31, P < 0.0001) and residual volume (RV)/total lung capacity (TLC) (rho = 0.13, P = 0.03).

Conclusions

When the volume of an emphysematous target lobe is reduced, the volume is redistributed primarily to the ipsilateral lobe, with an overall reduction. Image-based changes in lobar volumes and densities indicate that target lobe volume reduction is associated with statistically significant overall reductions in air trapping, consistent with expansion of the healthier lung.

Key Points

Computed tomography allows assessment of the treatment of emphysema with endobronchial valves.

Endobronchial valves can reduce the volume of an emphysematous lung lobe.

Compensatory expansion is greater in ipsilateral lobes than in the contralateral lung.

• Reduced air trapping is measurable by RV/TLC and smaller low attenuation area.

Keywords

Chronic obstructive pulmonary disease Computed tomography Computer-assisted image processing Lung Lung volume reduction