Caviezel Claudio, Froehlich Tamara, Schneiter Didier, Muehlematter Urs, Frauenfelder Thomas, Guglielmetti Laura-Chiara, Opitz Isabelle, Weder Walter
Dept of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland.
Institute for Interventional and Diagnostic Radiology, University Hospital Zurich, Zurich, Switzerland.
ERJ Open Res. 2020 Sep 14;6(3). doi: 10.1183/23120541.00305-2020. eCollection 2020 Jul.
The key issues for performing lung volume reduction surgery (LVRS) is the identification of the target zones. Recently introduced three-dimensional computed tomography rendering methods are used to identify the morphological distribution and its severity of lung emphysema by densitometry. We demonstrate a new software for emphysema imaging and show the pre- and post-operative results in patients undergoing LVRS planned based on this new technology.
A real-time three-dimensional image analysis software system was used pre- and 3 months post-operatively in five patients with heterogeneous emphysema and a single patient with homogeneous morphology scheduled for LVRS. Focus was on low attenuation areas with <950 HU, distribution on both lungs and the value of the three-dimensional images for planning surgery. Functional outcome was assessed by pulmonary function tests after 3 months.
Five patients underwent bilateral LVRS and one patient had unilateral LVRS. All patients showed a median increase in forced expiratory volume in 1 s of 70% (range 30-120%), compared with baseline values. Hyperinflation (expressed as residual volume/total lung capacity ratio) was reduced by 30% (range 5-32%). In the patients with heterogeneous emphysema, the pre- and post-operative computed tomography scans and the densitometries showed a decrease in low attenuation areas by 23% (right side) and by 17% (left side), respectively.
We demonstrate three-dimensional computed tomography-rendered images for planning personalised remodelling of hyperinflated lungs using LVRS. This user-friendly software has the potential to assist surgeons and interventional pulmonologists to select patients and to visualise target areas in LVRS procedures.
进行肺减容手术（LVRS）的关键问题是确定目标区域。最近引入的三维计算机断层扫描渲染方法用于通过密度测定法确定肺气肿的形态分布及其严重程度。我们展示了一种用于肺气肿成像的新软件，并展示了基于这项新技术计划接受LVRS治疗的患者的术前和术后结果。
对5例异质性肺气肿患者和1例形态均匀的计划接受LVRS治疗的患者，在术前和术后3个月使用实时三维图像分析软件系统。重点关注低于950HU的低衰减区域、双肺分布以及用于手术规划的三维图像的值。3个月后通过肺功能测试评估功能结果。
5例患者接受了双侧LVRS，1例患者接受了单侧LVRS。与基线值相比，所有患者的1秒用力呼气量中位数增加了70%（范围为30%-120%）。肺过度充气（以残气量/肺总量比值表示）减少了30%（范围为5%-32%）。在异质性肺气肿患者中，术前和术后的计算机断层扫描及密度测定显示，低衰减区域分别减少了23%（右侧）和17%（左侧）。
我们展示了用于计划使用LVRS对过度充气的肺进行个性化重塑的三维计算机断层扫描渲染图像。这种用户友好型软件有潜力协助外科医生和介入肺科医生选择患者，并在LVRS手术中可视化目标区域。
