Lung volume reduction surgery: comparison of preoperative radiologic features and clinical outcome.
OBJECTIVE
To examine the relationship between preoperative radiologic findings and clinical outcome after lung volume reduction surgery.


METHODS
In 50 consecutive patients, preoperative chest radiographs and computed tomographic (CT) scans were scored by four radiologists for features related to the severity and distribution of emphysema and compared with clinical improvement in forced expiratory volume in 1 second (FEV1), arterial partial pressure of oxygen, and exercise tolerance 6 months after surgery.


RESULTS
In the 47 surviving patients, follow-up data showed greater postoperative improvement in function in patients with a global pattern of predominantly upper-lobe emphysema (P < .05) and in patients with a more heterogeneous distribution of emphysema, compressed lung, and a larger percentage of normal and mildly emphysematous lung (P < .05 for improvement in FEV1). Radiographic scores for individual features were more strongly correlated with outcome than CT scores. The combination of upper-lobe severity and percentage of normal and mildly emphysematous lung at CT were the strongest predictors of improvement in FEV1 (r2 = .49). The three patients who died were older (P = .05) and had more severe, diffuse emphysema compared with other patients.


CONCLUSIONS
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.
Slone
R M
RM
Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, Washington University School of Medicine, St Louis, MO 63110, USA.
Pilgram
T K
TK
Gierada
D S
DS
Sagel
S S
SS
Glazer
H S
HS
Yusen
R D
RD
Cooper
J D
JD
D000328:Adult; D000368:Aged; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010100:Oxygen / Q000097:blood; D011013:Pneumonectomy; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D010100:Oxygen