Department of Pulmonary and Critical Care Medicine, and Clinical Research Center for Chronic Obstructive Airway Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Korean J Radiol. 2019 Jul;20(7):1216-1225. doi: 10.3348/kjr.2018.0724.
The absence of collateral ventilation (CV) is crucial for effective bronchoscopic lung volume reduction (BLVR) with an endobronchial valve. Here, we assessed whether CT can predict the Chartis™ results.
This study included 69 patients (mean age: 70.9 ± 6.6 years; 66 [95.7%] males) who had undergone CT to assess BLVR eligibility. The Chartis™ system (Pulmonox Inc.) was used to check CV. Experienced thoracic radiologists independently determined the completeness of fissures on volumetric CT images.
The comparison between the visual and quantitative analyses revealed that 5% defect criterion showed good agreement. The Chartis™ assessment was performed for 129 lobes; 11 (19.6%) of 56 lobes with complete fissures on CT showed positive CV, while this rate was significantly higher (40 of 49 lobes, i.e., 81.6%) for lobes with incomplete fissures. The size of the fissure defect did not affect the rate of CV. Of the patients who underwent BLVR, 22 of 24 patients (91.7%) with complete fissures and three of four patients with incomplete fissures (75%) achieved target lobe volume reduction (TLVR).
The quantitative analysis of fissure shows that incomplete fissures increased the probability of CV on Chartis™, while the defect size did not affect the overall rates. TLVR could be achieved even in some patients with relatively large fissure defect, if they showed negative CV on Chartis™.
对于使用支气管内瓣膜进行有效的支气管镜肺减容术（BLVR），不存在侧支通气（CV）至关重要。在这里，我们评估了 CT 是否可以预测 Chartis™的结果。
本研究纳入了 69 名（平均年龄：70.9±6.6 岁；66[95.7%]名男性）接受 CT 评估 BLVR 适应证的患者。使用 Chartis™系统（Pulmonox Inc.）检查 CV。经验丰富的胸部放射科医生独立地在容积 CT 图像上确定裂隙的完整性。
视觉分析和定量分析之间的比较表明，5%的缺陷标准显示出良好的一致性。对 129 个肺叶进行了 Chartis™评估；在 CT 上显示裂隙完整的 56 个肺叶中有 11 个（19.6%）存在阳性 CV，而裂隙不完整的 49 个肺叶中，这一比率显著更高（40 个，即 81.6%）。裂隙缺陷的大小并不影响 CV 的发生率。在接受 BLVR 的患者中，24 名裂隙完整的患者中有 22 名（91.7%）和 4 名裂隙不完整的患者中有 3 名（75%）达到了目标肺叶体积减少（TLVR）。
裂隙的定量分析表明，不完整的裂隙增加了 Chartis™上 CV 的可能性，而缺陷的大小并不影响总体发生率。如果 Chartis™显示为阴性 CV，则即使在一些裂隙缺陷较大的患者中，也可以实现 TLVR。
