title: Computed tomography predictors of response to endobronchial valve lung reduction treatment. Comparison with Chartis.
abstract: BACKGROUND
  Chartis Pulmonary Assessment System (Pulmonx Inc., Redwood, CA) is an invasive procedure used to assess collateral ventilation and select candidates for valve-based lung volume reduction (LVR) therapy. Quantitative computed tomography (QCT) is a potential alternative to Chartis and today consists primarily of assessing fissure integrity (FI).
  
  
  OBJECTIVE
  In this retrospective analysis, we aimed to determine QCT predictors of LVR outcome and compare the QCT model with Chartis in selecting likely responders to valve-based LVR treatment.
  
  
  METHODS
  Baseline CT scans of 146 subjects with severe emphysema who underwent endobronchial valve LVR were analyzed retrospectively using dedicated lung quantitative imaging software (Apollo; VIDA Diagnostics, Coralville, IA). A lobar volume reduction greater than 350 ml at 3 months was considered to be indicative of positive response to treatment. Thirty-four CT baseline variables, including quantitative measurements of FI, density, and vessel volumetry, were used to feed a multiple logistic regression analysis to find significant predictors of LVR outcome. The primary predictors were then used in 33 datasets with Chartis results to evaluate the relative performance of QCT versus Chartis.
  
  
  RESULTS
  FI (P < 0.0001) and low attenuation clusters (P = 0.01) measured in the treated lobe and vascular volumetric percentage of patient's detected smallest vessels (P = 0.02) were identified as the primary QCT predictors of LVR outcome. Accuracy for QCT patient selection based on these primary predictors was comparable to Chartis (78.8 vs. 75.8%).
  
  
  CONCLUSIONS
  Quantitative CT led to comparable results to Chartis for classifying LVR and is a promising tool to effectively select patients for valve-based LVR procedures.
authors: 1 Department of Pulmonology and Critical Care Medicine, Thoraxklinik, and.
authors: Maren
authors: M
authors: Schuhmann
authors: Philippe
authors: P
authors: Raffy
authors: Youbing
authors: Y
authors: Yin
authors: Daniela
authors: D
authors: Gompelmann
authors: Ipek
authors: I
authors: Oguz
authors: Ralf
authors: R
authors: Eberhardt
authors: Derek
authors: D
authors: Hornberg
authors: Claus Peter
authors: CP
authors: Heussel
authors: Susan
authors: S
authors: Wood
authors: Felix J F
authors: FJ
authors: Herth
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000534:rehabilitation*; D011237:Predictive Value of Tests; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000601:surgery*; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: computed tomography lung predictors; emphysema; endobronchial lung volume reduction; fissure integrity; quantitative imaging