University of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, the Netherlands.
Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Department of Pneumology, Berlin, Germany.
Int J Chron Obstruct Pulmon Dis. 2020 Jun 9;15:1325-1334. doi: 10.2147/COPD.S242210. eCollection 2020.
Lung volume reduction using one-way endobronchial valves is a bronchoscopic treatment for patients with severe emphysema without collateral ventilation between the treatment target lobe and the ipsilateral lobe(s). CT-scan fissure analysis is often used as a surrogate to predict the absence of collateral ventilation. We aimed to evaluate the predictive value of the fissure completeness score (FCS) compared to the functional Chartis measurement of collateral ventilation and to provide cut-off values of the FCS in patient selection.
Multicenter study in patients eligible for treatment with one-way valves. The FCS was calculated by quantitative CT analysis (Thirona, the Netherlands) and compared to status of interlobar collateral ventilation measured with Chartis system (PulmonX, USA). Thresholds were calculated for the predictive values of the presence of collateral ventilation.
An FCS >95% of the left major fissure had a positive predictive value (PPV) of 91%, with 1 in 11 fissures demonstrating collateral ventilation with Chartis measurement, whereas an FCS of ≤80% had a negative predictive value (NPV) of 100% for the presence of collateral ventilation. For the right major fissure, the NPV was 100% for an FCS ≤90%, but 69.7% for the right upper lobe fissure.
Quantitative CT analysis is recommended in all patients evaluated for endobronchial valves. Patients with incomplete fissures (left major fissure: FCS <80%; right major fissure: <90%) can be excluded from Chartis measurement and endobronchial valve treatment. In patients with more complete fissures, the FCS is not specific enough for endobronchial valve treatment decisions. In this case, additional Chartis measurements are always recommended in the right lung. For the left lung, Chartis assessments may be omitted if the FCS is >95%.
使用单向支气管内瓣膜进行肺减容术是一种治疗无治疗靶叶与同侧肺叶之间侧支通气的严重肺气肿患者的支气管镜治疗方法。CT 扫描裂分析常用于预测侧支通气的缺失。我们旨在评估裂完整性评分（FCS）与功能 Chartis 测量侧支通气的预测价值，并为患者选择提供 FCS 的截止值。
多中心研究纳入有资格接受单向瓣膜治疗的患者。通过定量 CT 分析（荷兰 Thirona）计算 FCS，并与 Chartis 系统（美国 PulmonX）测量的肺叶间侧支通气状态进行比较。计算了预测侧支通气存在的阈值。
左主裂 FCS>95%的患者，侧支通气的阳性预测值（PPV）为 91%，11 例中有 1 例通过 Chartis 测量显示侧支通气，而 FCS≤80%的患者侧支通气的阴性预测值（NPV）为 100%。对于右主裂，FCS≤90%的 NPV 为 100%，但右肺上叶裂的 NPV 为 69.7%。
所有接受支气管内瓣膜评估的患者均建议进行定量 CT 分析。对于裂不完整的患者（左主裂：FCS<80%；右主裂：<90%），可以排除 Chartis 测量和支气管内瓣膜治疗。对于裂更完整的患者，FCS 不足以作为支气管内瓣膜治疗决策的依据。在这种情况下，建议在右肺中进行额外的 Chartis 测量。对于左肺，如果 FCS>95%，则可以省略 Chartis 评估。
