1 Department of Pulmonology and Critical Care Medicine, Thoraxklinik, and.
Am J Respir Crit Care Med. 2015 Apr 1;191(7):767-74. doi: 10.1164/rccm.201407-1205OC.
Chartis Pulmonary Assessment System (Pulmonx Inc., Redwood, CA) is an invasive procedure used to assess collateral ventilation and select candidates for valve-based lung volume reduction (LVR) therapy. Quantitative computed tomography (QCT) is a potential alternative to Chartis and today consists primarily of assessing fissure integrity (FI).
In this retrospective analysis, we aimed to determine QCT predictors of LVR outcome and compare the QCT model with Chartis in selecting likely responders to valve-based LVR treatment.
Baseline CT scans of 146 subjects with severe emphysema who underwent endobronchial valve LVR were analyzed retrospectively using dedicated lung quantitative imaging software (Apollo; VIDA Diagnostics, Coralville, IA). A lobar volume reduction greater than 350 ml at 3 months was considered to be indicative of positive response to treatment. Thirty-four CT baseline variables, including quantitative measurements of FI, density, and vessel volumetry, were used to feed a multiple logistic regression analysis to find significant predictors of LVR outcome. The primary predictors were then used in 33 datasets with Chartis results to evaluate the relative performance of QCT versus Chartis.
FI (P < 0.0001) and low attenuation clusters (P = 0.01) measured in the treated lobe and vascular volumetric percentage of patient's detected smallest vessels (P = 0.02) were identified as the primary QCT predictors of LVR outcome. Accuracy for QCT patient selection based on these primary predictors was comparable to Chartis (78.8 vs. 75.8%).
Quantitative CT led to comparable results to Chartis for classifying LVR and is a promising tool to effectively select patients for valve-based LVR procedures.
Chartis 肺评估系统（Pulmonx Inc.，加利福尼亚州雷德伍德）是一种用于评估侧支通气并选择基于瓣膜的肺容积减少（LVR）治疗候选者的侵入性程序。定量计算机断层扫描（QCT）是 Chartis 的潜在替代方法，目前主要用于评估裂隙完整性（FI）。
在这项回顾性分析中，我们旨在确定 QCT 对 LVR 结果的预测因素，并比较 QCT 模型与 Chartis 在选择可能对基于瓣膜的 LVR 治疗有反应的患者方面的表现。
对 146 例接受支气管内瓣膜 LVR 的严重肺气肿患者的基线 CT 扫描进行回顾性分析，使用专用肺定量成像软件（Apollo；VIDA Diagnostics，爱荷华州科勒维尔）。3 个月时肺叶容积减少大于 350ml 被认为是对治疗有积极反应的指标。34 个 CT 基线变量，包括 FI、密度和血管容积定量测量，被用于多因素逻辑回归分析，以找到 LVR 结果的显著预测因素。然后，将主要预测因素应用于 33 个具有 Chartis 结果的数据集，以评估 QCT 与 Chartis 的相对性能。
在治疗的肺叶中测量的 FI（P < 0.0001）和低衰减簇（P = 0.01）以及患者最小检测血管的血管容积百分比（P = 0.02）被确定为 LVR 结果的主要 QCT 预测因素。基于这些主要预测因素，QCT 对患者的选择准确率与 Chartis 相当（78.8%对 75.8%）。
定量 CT 与 Chartis 对 LVR 分类的结果相当，是一种有前途的工具，可以有效地选择患者进行基于瓣膜的 LVR 手术。
