Lung volume reduction surgery: comparison of preoperative radiologic features and clinical outcome.

Slone, Richard M.; Pilgram, Thomas K.; Gierada, David S.; Sagel, Stuart S.; Glazer, Harvey; Yusen, Roger D.; Cooper, Joel D.

doi:10.1148/radiology.204.3.9280244

Cited by 83 publications

(42 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many subsequent reports confirmed good correlations of histogram-derived, quantitative CT techniques with lung function tests and pathological evidence of emphysema [36][37][38][39][40][41].…”

Section: Image Analysismentioning

confidence: 77%

Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema

Newell

Hogg²,

Snider³

2004

Eur Respir J

156

138

View full text Add to dashboard Cite

It has been reported that quantitative computed tomography (CT) scanning of the lungs showed decreased progression of emphysema in a randomised clinical trial in patients with severe a 1 -antitrypsin (a 1 -AT) deficiency receiving monthly intravenous augmentation therapy with human a 1 -AT. Comparable results were not obtained using rate of decline of forced expiratory volume in one second.Accordingly, the Alpha-1 Foundation convened a workshop to explore the feasibility of using quantitative CT data as a primary outcome variable in trials of drugs for treating a 1 -AT deficiency.This report reviews the following: the principles for the use of modern CT scanners for quantifying emphysema; the methods and data on validation by comparison with measurements of severity of emphysema in inflation-fixed specimens of lungs; and the possibility of decreasing radiation dosage from CT to make it safe and ethically possible to use CT in longitudinal studies.The workshop concluded that it is feasible, safe and ethically possible to use computed tomography in longitudinal studies of emphysema. It recommended that the primary end-point should be a significant shift in the 15th percentile of lung density. Eur Respir J 2004; 23: 769-775.

show abstract

Section: Image Analysismentioning

confidence: 77%

Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema

Newell

Hogg²,

Snider³

2004

Eur Respir J

156

138

View full text Add to dashboard Cite

show abstract

“…Identification of factors that accurately and consistently predict adverse outcome is necessary to develop evidence-based exclusion criteria. Many series of LVRS have reported a variety of demographic, radiologic, and/or physiologic characteristics that predicted higher operative risk (Table 4) (9,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39). Unfortunately, most were small, retrospective, single-institution, case-controlled series with selection bias and incomplete or inconsistent data collection.…”

Section: Mortalitymentioning

confidence: 99%

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

DeCamp¹,

McKenna²,

Deschamps³

et al. 2008

Proceedings of the American Thoracic Society

View full text Add to dashboard Cite

The objective of lung volume reduction surgery (LVRS) is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Appropriate patient selection and preoperative preparation are prerequisites for successful LVRS. An effective LVRS program requires participation by and communication between experts from pulmonary medicine, thoracic surgery, thoracic anesthesiology, critical care medicine, rehabilitation medicine, respiratory therapy, chest radiology, and nursing. The critical analysis of perioperative outcomes has influenced details of the conduct of the procedure and has established a bilateral, stapled approach as the standard of care for LVRS. The National Emphysema Treatment Trial (NETT) remains the world's largest multi-center, randomized trial comparing LVRS to maximal medical therapy. NETT purposely enrolled a broad spectrum of anatomic patterns of emphysema. This, along with the prospective, audited collection of extensive demographic, physiologic, radiographic, surgical and quality-of-life data, has positioned NETT as the most robust repository of evidence to guide the refinement of patient selection criteria for LVRS, to assist surgeons in providing optimal intraoperative and postoperative care, and to establish benchmarks for survival, complication rates, return to independent living, and durability of response. This article reviews the evolution of current LVRS practice with a particular emphasis on technical aspects of the operation, including the predictors and consequences of its most common complications.Keywords: emphysema; surgery; complications; outcomes Pneumectomy or the nonanatomic resection of emphysematous lung by thoracotomy to palliate chronic dyspnea was proposed and tested by Otto Brantigan in the 1950s (1). While the physiologic principles of the procedure appeared to benefit survivors, operative morbidity and mortality proved prohibitive and relegated the procedure to the obscure pages of the history of surgery for emphysema, where it lay alongside costochondrectomy, phrenic nerve lysis, and glomectomy (2). Joel Cooper and colleagues resurrected the concept of partial pneumectomy nearly four decades later, advocating a bilateral, nonanatomic, stapled resection through a median sternotomy. Forty years of advances in anesthesia, critical care, pulmonary rehabilitation, and surgical instrumentation, along with the expertise of the Washington University group, yielded a considerable reduction in operative morbidity and mortality, and lung volume reduction surgery (LVRS) was (re)born (3).The objective of LVRS is the safe, effective, and durable palliation of dyspnea in appropriately selected patients with moderate to severe emphysema. Before the National Emphysema Treatment Trial (NETT), there were several reported single institutional, case-controlled series of LVRS demonstrating encouraging results with regard to mean improvements in spirometry, 6-minute-walk distance, self-reported dyspnea, and supplemental oxygen use (...

show abstract

“…It was regional distribution of emphysema that proved most useful in the NETT for predicting outcome after lung volume reduction surgery (LVRS), as had been proposed in prior reports (19). Predominant upper lobe emphysema was found by NETT to be predictive of a favorable outcome of LVRS.…”

Section: Ctmentioning

confidence: 83%

Imaging Studies in Emphysema

Friedman¹

2008

Proceedings of the American Thoracic Society

View full text Add to dashboard Cite

Definitions of types of emphysema within the framework of chronic obstructive pulmonary disease are given. The classic findings on the chest radiograph are described, and the advances in sensitivity and specificity achieved with computed tomography (CT) scanning are noted. The ''density mask'' and the ''percentile point'' measurements rely on the densitometric property of X-rays, but the scan also shows the severity and distribution of low-attenuation regions that usually represent pathologic emphysema. The alteration of absolute density with changes in lung inflation, CT slice thickness, collimation, and reconstruction algorithm make comparison between CT scans and across studies more difficult. Nevertheless, quantitative CT has superseded subjective scoring of scan appearance by readers as a sensitive way to measure emphysema.

show abstract

Lung volume reduction surgery: comparison of preoperative radiologic features and clinical outcome.

Abstract: Imaging studies may help predict the degree of improvement and therefore should be considered an integral part of an objective patient selection process. Radiography alone may be adequate for initial screening.

Cited by 83 publications

References 0 publications

Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema

Report of a workshop: quantitative computed tomography scanning in longitudinal studies of emphysema

Lung Volume Reduction Surgery: Technique, Operative Mortality, and Morbidity

Imaging Studies in Emphysema

Contact Info

Product

Resources

About