The accuracy of computed tomography to predict completeness of pulmonary fissures. A prospective study.
BACKGROUND
Endobronchial valves are a potential alternative to lung volume reduction surgery for advanced emphysema. The greatest improvements in pulmonary function are seen in patients with complete pulmonary fissures, as determined by computed tomography (CT). However, the accuracy of CT to predict completeness of pulmonary fissures has not been compared with the reference standard of direct observation during thoracic surgery.


OBJECTIVE
To determine the accuracy of CT scans to predict completeness of pulmonary fissures.


METHODS
We conducted a double-blind, prospective trial in which completeness of pulmonary fissures was evaluated by direct observation during thoracic surgery. Preoperative CT scans were independently reviewed by two dedicated thoracic radiologists and completeness of the fissures was recorded and compared with intraoperative findings.


RESULTS
The fissures of 46 patients were evaluated. The positive predictive value of CT scan to detect a complete fissure was 100% for the right major fissure and 75% for the left fissure, but only 33% for the right minor fissure. CT scans had a negative predictive value of 29% in evaluation of the right major fissure.


CONCLUSIONS
CT scans overestimate completeness of the right minor fissure and underestimate completeness of the right major fissure. These findings may have implications for the use of CT scans to select patients for endobronchial valve insertion.
1 Division of Thoracic Surgery and.
Michael S
MS
Kent
Carole
C
Ridge
David
D
O'Dell
Peter
P
Lo
Richard
R
Whyte
Sidhu P
SP
Gangadharan
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult
computed tomography; emphysema; endobronchial valves