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Multi-modal Pulmonary Imaging: Using Complementary Information from CT and Hyperpolarized 129Xe MRI to Evaluate Lung Structure-Function

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Patterns of Emphysema Heterogeneity.

Arschang Valipour¹, Pallav L Shah, Wolfgang Gesierich

¹Department of Respiratory and Critical Care Medicine, Ludwig Boltzmann Institute for COPD, Otto Wagner Hospital, Vienna, Austria.

Respiration; International Review of Thoracic Diseases

|October 3, 2015

Summary

This summary is machine-generated.

Emphysema heterogeneity is common within lobes, not just between them. A segmental approach to lung volume reduction (LVR) may be more effective for treating chronic obstructive pulmonary disease (COPD) by targeting diseased segments.

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Area of Science:

Pulmonary Medicine
Radiology
Thoracic Surgery

Background:

Lobar patterns of emphysema heterogeneity guide lung volume reduction (LVR) strategies.
Segmental or sublobar emphysema heterogeneity is frequently underestimated.

Purpose of the Study:

To investigate lobar and segmental emphysema heterogeneity patterns.
To identify precise target sites for LVR procedures.

Main Methods:

Analysis of high-resolution computed tomography (HRCT) scans in 150 severe chronic obstructive pulmonary disease (COPD) patients (GOLD stage III/IV).
Quantification of interlobar and intralobar emphysema heterogeneity using specialized software.
Segmental characterization of tissue destruction to define heterogeneity patterns.

Main Results:

Interlobar heterogeneity observed in 57% of the left lung and 52% of the right lung.
Intralobar heterogeneity was present in all patients across at least one lobe.
No patient exhibited complete homogeneity at the segmental level.

Conclusions:

Most emphysema patients have both interlobar and intralobar heterogeneity.
Current LVR technologies often focus on interlobar heterogeneity, treating entire lobes.
A segmental approach to LVR is recommended to target diseased segments and preserve healthy lung tissue.