Kloth Christopher, Thaiss Wolfgang Maximilian, Fritz Jan, Nikolaou Konstantin, Beer Meinrad, Hetzel Jürgen, Ioanoviciu Sorin Dumitru, Horger Marius
Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.
Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University, Tübingen, Germany.
J Thorac Dis. 2019 Jan;11(1):93-102. doi: 10.21037/jtd.2018.12.64.
To test if the emphysema type of the targeted lobe, ipsilateral non-targeted lobe, and lobes of the contralateral lung impact outcome of endobronchial lung volume reduction (ELVR) treatment, and to document lobar volume changes in treated and non-treated lung lobes.
Thirty patients (16 men, 14 women; median age, 66±6 years; range, 48-78 years) underwent chest-computed tomography (CT) before and after endobronchial coiling for lung volume reduction (LVR) at our institution between December 2011 and March 2016. Forty-five pulmonary lobes were coiled. We classified the treated lobes into homogenous or heterogeneous emphysema phenotype based on the distribution of voxels showing tissue attenuation of less than -950 HU. Clinical response was defined as an increase or consistency in the walking distance (6MWT) 6 months after LVR-therapy. Lung volume changes were compared for treated, ipsilateral, and contralateral lobes. Additionally, pulmonary function tests (PFT), chronic obstructive pulmonary disease (COPD) assessment test (CAT), and blood gas analysis were performed.
Responder (19/30, 63.3%) showed a significant improvement of 6 MWT from 281.05 to 335.26 (P=0.001). Non-responder (11/30, 36.7%) showed a decrease in 6MWT from 308.18 to 255.45 (P=0.001). Responders showed a significant reduction in CAT test from 23.23 to 20.73 points (P=0.038) and pCO from 42.94 to 40.31 (P=0.001), whereas non-responders showed an increase in pCO (P=0.003; from 44.27 to 47.45). There were no significant changes in PFT-parameters. In responders, there was a significant volume reduction in treated lobes from 1,627.68 to 1,519.21 mL (P=0.009). In responders, treated lobes/non-treated ipsilateral lobes were homogenous (n=11/5) and heterogeneous (n=10/28). In non-responders, treated lobes/non-treated ipsilateral were homogenous (n=5/4) and heterogeneous (n=7/16). In responders and non-responders, the emphysema phenotype in treated, ipsilateral non-treated and even contralateral lobes (P=0.250) did not differ and or change significantly before and after therapy. Only the volume of treated lobes in responders changed significantly after coiling.
The emphysema-phenotype in the targeted and non-targeted ipsilateral lobe has no impact on the outcome of endobronchial coiling for LVR and also does not change significantly after treatment, whereas the volume of the treated lobe significantly decreases in responders.
旨在测试目标肺叶、同侧非目标肺叶以及对侧肺叶的肺气肿类型是否会影响支气管内肺减容术（ELVR）的治疗效果，并记录治疗和未治疗肺叶的肺叶体积变化。
2011年12月至2016年3月期间，30例患者（16例男性，14例女性；中位年龄66±6岁；范围48 - 78岁）在我院接受了支气管内线圈置入肺减容术（LVR）前后的胸部计算机断层扫描（CT）检查。共对45个肺叶进行了线圈置入。根据显示组织衰减小于-950 HU的体素分布，将治疗的肺叶分为均匀或不均匀肺气肿表型。临床反应定义为LVR治疗6个月后步行距离（6MWT）增加或保持一致。比较治疗肺叶、同侧肺叶和对侧肺叶的肺体积变化。此外，还进行了肺功能测试（PFT）、慢性阻塞性肺疾病（COPD）评估测试（CAT）和血气分析。
反应者（19/30，63.3%）的6MWT从281.05显著提高到335.26（P = 0.001）。无反应者（11/30，36.7%）的6MWT从308.18降至255.45（P = 0.001）。反应者的CAT测试从23.23分显著降至20.73分（P = 0.038），pCO从42.94降至40.31（P = 0.001），而无反应者的pCO升高（P = 0.003；从44.27升至47.45）。PFT参数无显著变化。在反应者中，治疗肺叶的体积从1,627.68显著减少至1,519.21 mL（P = 0.009）。在反应者中，治疗肺叶/未治疗同侧肺叶为均匀型（n = 11/5）和不均匀型（n = 10/28）。在无反应者中，治疗肺叶/未治疗同侧肺叶为均匀型（n = 5/4）和不均匀型（n = 7/16）。在反应者和无反应者中，治疗肺叶、同侧未治疗肺叶甚至对侧肺叶的肺气肿表型（P = 0.250）在治疗前后无差异且无显著变化。仅反应者治疗肺叶的体积在置入线圈后有显著变化。
目标肺叶和同侧非目标肺叶的肺气肿表型对支气管内线圈置入LVR的治疗效果无影响，治疗后也无显著变化，而反应者中治疗肺叶的体积显著减小。
