title: Morphologic Response of the Pulmonary Vasculature to Endoscopic Lung Volume Reduction.
abstract: BACKGROUND
  Endoscopic Lung Volume Reduction has been used to reduce lung hyperinflation in selected patients with severe emphysema. Little is known about the effect of this procedure on the intraparenchymal pulmonary vasculature. In this study we used CT based vascular reconstruction to quantify the effect of the procedure on the pulmonary vasculature.
  
  
  METHODS
  Intraparenchymal vasculature was reconstructed and quantified in 12 patients with CT scans at baseline and 12 weeks following bilateral introduction of sealants in the upper lobes. The volume of each lung and each lobe was measured, and the vascular volume profile was calculated for both lower lobes. The detected vasculature was further labeled manually as arterial or venous in the right lower lobe.
  
  
  RESULTS
  There was an increase in the volume of the lower lobes (3.14L to 3.25L, p=0.0005). There was an increase in BV5, defined as the volume of blood vessels with cross sectional area of less than 5mm2, (53.2ml to 57.9ml, p=0.03). This was found to be correlated with the increase in lower lobe volumes (R=0.65, p=0.02). The changes appear to be symmetric for veins and arteries with a correlation coefficient of 0.87 and a slope of near identity.
  
  
  CONCLUSIONS
  In the subjects studied, there was an increase, from baseline, in BV5 in the lower lobes that correlated with the change in the volume of the lower lobes. The change appeared to be symmetric for both arteries and veins. The study illustrates the use of intraparenchymal pulmonary vascular reconstruction to study morphologic changes in response to interventions.
authors.affiliation: Brigham and Women's Hospital, Pulmonary and Critical Care Division of Department of Medicine, 75 Francis Street, PBB - CA 3, Boston, MA 02115.
authors.forename: Farbod N
authors.initials: FN
authors.lastname: Rahaghi
authors.affiliation: Brigham and Women's Hospital, Pulmonary and Critical Care Division of Department of Medicine, 75 Francis Street, PBB - CA 3, Boston, MA 02115.
authors.forename: Carolyn E
authors.initials: CE
authors.lastname: Come
authors.affiliation: Deparment of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, 1249 Boylston Street, 2nd Floor, Room 216.
authors.forename: James
authors.initials: J
authors.lastname: Ross
authors.affiliation: Deparment of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, 1249 Boylston Street, 2nd Floor, Room 216.
authors.forename: Rola
authors.initials: R
authors.lastname: Harmouche
authors.affiliation: Brigham and Women's Hospital, Pulmonary and Critical Care Division of Department of Medicine, 75 Francis Street, PBB - CA 3, Boston, MA 02115.
authors.forename: Alejandro A
authors.initials: AA
authors.lastname: Diaz
authors.affiliation: Deparment of Radiology, Harvard School of Medicine, Surgical Planning Laboratory, 1249 Boylston Street, 2nd Floor, Room 216, Boston MA 02215.
authors.forename: Raul San Jose
authors.initials: RS
authors.lastname: Estepar
authors.affiliation: Brigham and Women's Hospital, Pulmonary and Critical Care Division of Department of Medicine, 75 Francis Street, PBB - CA 3, Boston, MA 02115.
authors.forename: George
authors.initials: G
authors.lastname: Washko