Fiorelli Alfonso, Poggi Camilla, Anile Marco, Cascone Roberto, Carlucci Annalisa, Cassiano Francesco, Andreetti Claudio, Tiracorrendo Matteo, Diso Daniele, Serra Nicola, Venuta Federico, Rendina Erino Angelo, Santini Mario, D'Andrilli Antonio
Thoracic Surgery Unit, Università della Campania "Luigi Vanvitelli", Naples, Italy.
Thoracic Surgery Unit, Università La Sapienza, Policlinico Hospital, Rome, Italy.
Interact Cardiovasc Thorac Surg. 2019 May 1;28(5):751-759. doi: 10.1093/icvts/ivy340.
The aim of this study is to compare the accuracy of the standard visual scoring of computed tomography (CT) scans with a cloud-based quantitative CT analysis that uses the StratX software, to measure collateral ventilation and, thus, predict lobar atelectasis after valve treatment.
This is a retrospective, multicentre study of patients who had previously undergone valve treatment for severe heterogeneous emphysema and whose required fissure integrity ≥90% had been qualitatively scored by visual assessment of CT scans. For this study, all preprocedural CT scans were retrospectively analysed using the StratX software to provide quantitative scores of fissure integrity. The diagnostic accuracies of the visual and quantitative scores for predicting a target lobe volume reduction (TLVR) of ≥350 ml were calculated and statistically compared, as this level of volume reduction can be achieved only with sound fissure integrity. The clinical outcome of TLVR was also evaluated according to the minimal clinically important difference criteria.
Eighty-three patients were included in the analysis. Of them, 65 of 83 (78%) patients presented with TLVR ≥350 ml. Visual scoring correctly identified the absence of collateral ventilation in 65 of 83 (78%) cases but failed in 18 of 83 (22%) cases. Of these 18 patients, quantitative analysis showed that 16 of 18 (89%) patients did not present completeness of the fissure. The diagnostic accuracy of the quantitative analysis was better than that of the visual analysis (96.4% vs 78.3%; P = 0.0003). Only patients having TLVR ≥350 ml met or exceeded the minimal clinically important difference criteria.
The quantitative analysis using the StratX software contributed a more objective and efficient evaluation of collateral ventilation that would have improved the selection of emphysematous patients for endobronchial valve treatment in the study population.
本研究旨在比较计算机断层扫描（CT）标准视觉评分与使用StratX软件的基于云的定量CT分析的准确性，以测量侧支通气，从而预测瓣膜治疗后的肺叶肺不张。
这是一项回顾性多中心研究，研究对象为先前因严重异质性肺气肿接受瓣膜治疗且其所需肺裂完整性≥90%已通过CT扫描视觉评估进行定性评分的患者。在本研究中，所有术前CT扫描均使用StratX软件进行回顾性分析，以提供肺裂完整性的定量评分。计算并统计比较视觉评分和定量评分预测目标肺叶体积缩小（TLVR）≥350 ml的诊断准确性，因为只有在肺裂完整性良好的情况下才能实现这一体积缩小水平。还根据最小临床重要差异标准评估TLVR的临床结果。
83例患者纳入分析。其中，83例患者中有65例（78%）出现TLVR≥350 ml。视觉评分在83例中的65例（78%）中正确识别出无侧支通气，但在83例中的18例（22%）中出现错误。在这18例患者中，定量分析显示18例中的16例（89%）患者肺裂不完整。定量分析的诊断准确性优于视觉分析（96.4%对78.3%；P = 0.0003）。只有TLVR≥350 ml的患者达到或超过最小临床重要差异标准。
使用StratX软件进行的定量分析有助于更客观、高效地评估侧支通气，这将改善研究人群中肺气肿患者支气管内瓣膜治疗的选择。
