Objectives: Bronchoscopic lung volume reduction using coils (LVRC) is a well-known treatment option for severe emphysema. The purpose of this study was to identify quantitative computed tomography (QCT) and clinical parameters associated with positive treatment outcome. Patients and methods: The CT scans, pulmonary function tests (PFT), and 6-minute walk test (6-MWT) data were collected from 72 patients with advanced emphysema prior to and at 3 months after LVRC treatment. The procedure involved placing 10 coils unilaterally. Various QCT parameters were derived using Apollo imaging software (VIDA). Independent predictors of clinically relevant outcome (Delta6-MWT >/= 26 m, DeltaFEV1 >/= 12%, DeltaRV >/= 10%) were identified through stepwise linear regression analysis. Results: The response outcome for Delta6-MWT, for DeltaFEV1 and for DeltaRV was met by 55%, 32% and 42%, respectively. For Delta6-MWT >/= 26 m a lower baseline 6-MWT (p = 0.0003) and a larger standard deviation (SD) of low attenuation cluster (LAC) sizes in peripheral regions of treated lung (p = 0.0037) were significantly associated with positive outcome. For DeltaFEV1 >/= 12%, lower baseline FEV1 (p = 0.02) and larger median LAC sizes in the central regions of treated lobe (p = 0.0018) were significant predictors of good response. For DeltaRV >/= 10% a greater baseline TLC (p = 0.0014) and a larger SD of LAC sizes in peripheral regions of treated lung (p = 0.007) tended to respond better. Conclusion: Patients with lower FEV1 and 6-MWT, with higher TLC and specific QCT characteristics responded more positively to LVRC treatment, suggesting a more targeted CT-based approach to patient selection could lead to greater efficacy in treatment response.
- Kontogianni, K.
- Russell, K.
- Eberhardt, R.
- Schuhmann, M.
- Heussel, C. P.
- Wood, S.
- Herth, F. J.
- Gompelmann, D.
Keywords
- *copd
- *bronchoscopy
- *emphysema
- *endobronchial coils
- *endoscopic lung volume reduction
- *interventional pulmonology
- Lecture and travel fees from Olympus, Pulmonx and Uptake Medical/Broncus outside
- the submitted work. MS: Fees for lectures and advisory boards from the following
- companies: Olympus, Pulmonx, Astra Zeneca, Novartis, Teva, GSK, PneumRx and
- Boston Scientific outside the submitted work. CH: Stock ownership in medical
- industry, Stada, GSK
- Patents Method and Device for Representing the
- Microstructure of the Lungs. IPC8 Class: AA61B5055FI, PAN: 20080208038,
- Inventors: W Schreiber, U Wolf, AW Scholz, CP Heussel
- personal fees from
- Schering-Plough, personal fees from Pfizer, personal fees from Basilea, personal
- fees from Boehringer Ingelheim, personal fees from Novartis, personal fees from
- Roche, personal fees from Astellas, personal fees from Gilead, personal fees from
- MSD, personal fees from Lilly, personal fees from Intermune, personal fees from
- Fresenius, personal fees from Olympus, personal fees from Siemens, personal fees
- from MeVis, personal fees from Essex, personal fees from AstraZeneca, personal
- fees from Bracco, personal fees from MEDA Pharma, personal fees from Intermune,
- personal fees from Chiesi, personal fees from Covidien, personal fees from Pierre
- Fabre, personal fees from Grifols, personal fees from Bayer, other from Stada,
- other from GSK, outside the submitted work. FH: Fees for lectures and advisory
- boards from Astra, Allmirall, Berlin Chemie, Boehringer, Roche, GSK, Pulmonx,
- BTG, Olympus, PneumRx, Boston Scientific, Medupdate, Grifols, CSL Behring,
- Omniamed, Lilly, Novartis, Teva, Uptake and Vital Air, outside the submitted
- work. DG: Personal fees from Olympus, personal fees from Pulmonx, personal fees
- from Chiesi, personal fees from Berlin Chemie, personal fees from Astra Zeneca,
- personal fees from Boehringer Ingelheim, personal fees from Novartis, personal
- fees from Mundipharma, personal fees from Grifols, outside the submitted work.
