Quantifizierung des Lungenemphysems in der Mehrschicht-CT mittels verschiedener Softwareverfahren

Heußel, CP; Achenbach, Tobias; Buschsieweke, C; Kuhnigk, Jan-Martin; Weinheimer, Oliver; Hammer, Gregory B.; Düber, C.; Kauczor, HU

doi:10.1055/s-2006-926823

Cited by 19 publications

(9 citation statements)

References 25 publications

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“…This was confirmed by perfusion scintigraphy [16]. At baseline, the emphysema distribution was visualized and the total lung volume and emphysema index were estimated with YACTA analysis of the CT data [17]. In more detail, YACTA automatically detects the lung tissue (<−500 Hounsﬁeld units, HU) based on threshold values and an anatomical knowledge-based algorithm and it excludes the tracheobronchial tree.…”

Section: Methodsmentioning

confidence: 99%

“…In more detail, YACTA automatically detects the lung tissue (<−500 Hounsﬁeld units, HU) based on threshold values and an anatomical knowledge-based algorithm and it excludes the tracheobronchial tree. For emphysema detection, a threshold of −950 HU is used, with a noise correction for voxels with a density of between −910 and −949 HU surrounded by at least 4 voxels with a density of ≤−950 HU [17,18]. From the CT analysis, the volume of the segmented lung (lung volume), the volume of the segmented emphysema (emphysema volume), their ratio (pixel index, emphysema index), the volume of the excluded tracheobronchial tree and the 15th percentile are calculated automatically.…”

Section: Methodsmentioning

confidence: 99%

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Effectiveness of Endobronchial Coil Treatment for Lung Volume Reduction in Patients with Severe Heterogeneous Emphysema and Bilateral Incomplete Fissures: A Six-Month Follow-Up

Kontogianni¹,

Gerovasili²,

Gompelmann³

et al. 2014

Respiration

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Background: Treatment with lung volume reduction coils (LVRC) may be effective in patients with severe heterogeneous emphysema and incomplete fissures. Objective: We hypothesized that LVRC placement improves pulmonary function, exercise tolerance and quality of life in these patients. Methods: Twenty-six patients with chronic obstructive pulmonary disease (COPD), 13 males and 13 females, aged 66 ± 8 years with heterogeneous emphysema and incomplete fissures were included in this retrospective analysis. The coils were implanted unilaterally in the upper or lower lobe. Patients were followed up at 30, 90 and 180 days after treatment and changes in pulmonary function test and 6-minute-walk-test (6MWT) values as well as scores for the modified Medical Research Council (mMRC) dyspnea scale and the St. George's Respiratory Questionnaire (SGRQ) were recorded. Results: FEV₁ improved significantly at 90 days and tended to decrease at the 180-day follow-up (0.67 ± 0.17 vs. 0.78 ± 0.25 vs. 0.73 ± 0.21 liters, respectively, p < 0.001). The 6MWT score had improved significantly at 90 days and had tended to decrease at the 180-day follow-up (216 ± 107 vs. 262 ± 97 vs. 262 ± 112 m, respectively, p = 0.001). SGRQ was significantly improved at 90 days. Multivariate analysis showed that worse 6MWT performance at baseline was independently associated with a greater improvement in 6MWT at the 90-day follow-up. The total complication rate was 54% (n = 14) and included light hemorrhage in 6 patients, COPD exacerbation in 6, pneumothorax in 1 and both COPD exacerbation and pneumothorax in 1 patient. Conclusions: This is the first study to show that LVRC in patients with heterogeneous emphysema and incomplete fissures improves exercise capacity, quality of life and lung function up to 90 days after the intervention. Further studies are needed to assess the long-term effects of LVRC in these patients.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Effectiveness of Endobronchial Coil Treatment for Lung Volume Reduction in Patients with Severe Heterogeneous Emphysema and Bilateral Incomplete Fissures: A Six-Month Follow-Up

Kontogianni¹,

Gerovasili²,

Gompelmann³

et al. 2014

Respiration

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“…ELVR with placement of EBV was indicated because of severe emphysema [forced expiratory volume in 1 s (FEV 1 ) <45%, residual volume (RV) >150%, total lung capacity >100%] with progressively deteriorating dyspnea and the presence of at least one complete interlobar fissure upon baseline assessment on thin-section multislice computed tomography (MSCT) [17,23]. The heterogeneity and distribution of the emphysema were visually determined by nonenhanced MSCT and the images were postprocessed with the help of an automated software analysis (YACTA®), enhancing the emphysema distribution, and confirmed by the use of perfusion scintigraphy [24,25]. …”

Section: Methodsmentioning

confidence: 99%

Endoscopic Lung Volume Reduction with Endobronchial Valves in Patients with Severe Emphysema and Established Pulmonary Hypertension

Eberhardt¹,

Gerovasili²,

Kontogianni³

et al. 2014

Respiration

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Background: One of the most common forms of pulmonary hypertension (PH) is that associated with chronic obstructive pulmonary disease (COPD). So far, patients with severe emphysema and established PH have been excluded from endoscopic lung volume reduction (ELVR) therapy due to the risk of right heart decompensation. Objective: The aim of this pilot study was to evaluate the feasibility and efficacy of ELVR using one-way endobronchial valves (EBV) in this specific group of patients. Methods: We prospectively included 6 patients with COPD, severe heterogeneous emphysema, and established PH who underwent right heart catheterization and clinical assessments before and 90 days after ELVR with unilateral EBV placement. Results: This study was not powered to measure any statistical differences in endpoints. Ninety days after ELVR, the symptoms, lung function, and hemodynamics improved in 5 out of 6 patients (1 patient normalized and 1 slightly worsened). The mean hemodynamics improved from baseline to 90 days after ELVR as follows: mean pulmonary artery pressure, -2.5 ± 3.5 mm Hg; pulmonary arterial wedge pressure, -4.3 ± 8.3 mm Hg; cardiac index, +0.3 ± 0.6 l/min/m², and 6-min walk distance, +59 ± 99 m. ELVR was performed without PH-related complications in all patients. Conclusion: To our knowledge, this is the first prospective, single-center pilot study to evaluate the feasibility and efficacy of ELVR in patients with established PH. ELVR was feasible and resulted in an improvement of clinical and hemodynamic parameters in 5 out of 6 patients. These results have to be further confirmed in larger-scale controlled studies.

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“…However, there are major differences in the different types of software, among which are the evaluation and presentation of data. While the results were still disappointing in 2006, e. g. the considerable amount of time required and the poor correlation between human eyes and the machine [45], by 2014 it was more than clear that qMDCT (CT densitometry using multidetector-row computed tomography) represents a diagnostic gain [46]. However, it remains unclear how strongly patient-related factors (age, inspiration depth) influence the measured values.…”

Section: Quantification Of the Emphysemamentioning

confidence: 99%

Emphysema: Imaging for Endoscopic Lung Volume Reduction

Storbeck

Schröder

Oldigs

et al. 2015

Fortschr Röntgenstr

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!Chronic obstructive pulmonary disease (COPD) is characterized by two entities, the more airway-predominant type ("bronchitis") on the one hand, and emphysema-predominant type on the other. Imaging via high-resolution computed tomography plays an important role in phenotyping COPD. For patients with advanced lung emphysema, new endoscopic lung volume reduction therapies (ELVR) have been developed. Proper selection of suitable patients requires thinsection reconstruction of volumetric CT image data sets also in coronal and sagittal orientation are required. In the current manuscript we will describe emphysema subtypes (centrilobular, paraseptal, panlobular), options for quantifying emphysema and this importance of regional distribution (homogeneous or heterogeneous, target area) as this is crucial for patient selection. Analysis of the interlobular fissures is obligatory despite the lack of standardization, as incomplete fissures indicate collateral ventilation (CV) via parenchymal bridges, which is an important criterion in choosing endoscopic methods of LVR. Every radiologist should be familiar with modern LVR therapies such as valves and coils, and furthermore should know what a lung doctor expects from radiologic evaluation (before and after ELVR). Finally we present a checklist as a quick reference for all steps concerning imaging for ELVR.

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Quantifizierung des Lungenemphysems in der Mehrschicht-CT mittels verschiedener Softwareverfahren

Cited by 19 publications

References 25 publications

Effectiveness of Endobronchial Coil Treatment for Lung Volume Reduction in Patients with Severe Heterogeneous Emphysema and Bilateral Incomplete Fissures: A Six-Month Follow-Up

Effectiveness of Endobronchial Coil Treatment for Lung Volume Reduction in Patients with Severe Heterogeneous Emphysema and Bilateral Incomplete Fissures: A Six-Month Follow-Up

Endoscopic Lung Volume Reduction with Endobronchial Valves in Patients with Severe Emphysema and Established Pulmonary Hypertension

Emphysema: Imaging for Endoscopic Lung Volume Reduction

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