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Evaluating Regional Pulmonary Deposition using Patient-Specific 3D Printed Lung Models
Published on: November 11, 2020
Patient selection for lung volume reduction surgery: An objective model based on prior clinical decisions and
D S Gierada1, R D Yusen, I A Villanueva
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA. gieradad@mir.wustl.edu
Chest
|April 18, 2000
Summary
Quantitative CT analysis (QCT) improves patient selection for lung volume reduction surgery by providing objective emphysema assessment. This method enhances prediction of postoperative outcomes, aiding consistent and confident surgical decisions.
Area of Science:
- Pulmonary Medicine
- Radiology
- Thoracic Surgery
Background:
- Lung volume reduction surgery (LVRS) is a treatment for severe emphysema.
- Patient selection for LVRS traditionally relies on subjective radiologic assessment.
- Consistency and accuracy of subjective criteria in selecting patients for LVRS remain a concern.
Purpose of the Study:
- To evaluate the consistency of subjective selection criteria for LVRS using quantitative CT analysis (QCT).
- To develop a predictive model for patient selection based on QCT and physiologic data.
- To assess the relationship between the predictive model and postoperative outcomes.
Main Methods:
- Logistic regression analysis was employed.
- Independent variables included QCT indexes of emphysema and preoperative physiologic test results.
- The dependent variable was the decision for LVRS.
Main Results:
- Patients selected for LVRS exhibited more severe emphysema overall and in the upper lungs by QCT (p < 0.01).
- A predictive model incorporating percent severe emphysema, upper/lower lung emphysema ratio, and residual volume accurately predicted selection decisions (model r(2) = 0.48; p < 0.0001).
- Higher model-derived probability of selection correlated with greater postoperative improvement in FEV1 and 6-minute walk distance.
Conclusions:
- Subjective radiologic selection criteria for LVRS are generally applied consistently.
- QCT features are significantly associated with selection decisions and influence postoperative outcomes.
- QCT can enhance the consistency and confidence in patient selection for LVRS.
