Imaging of Bronchoscopic Lung Volume Reduction Using Endobronchial Valves

Lung volume reduction is a treatment option for patients with severe emphysema and predominant chronic obstructive pulmonary disease that is refractory to medical treatment. These patients often experience symptoms associated with hyperinflation including dyspnea and exercise limitation. In recent years, bronchoscopic lung volume reduction using endobronchial valve (EBV) therapy has emerged as a U.S. Food and Drug Administration-approved and less invasive alternative to lung volume reduction surgery. The two approved one-way valves allow air to exit the lung but prohibit air from entering, with the intended goal of reducing hyperinflation. After patients meet clinical eligibility criteria, imaging has an integral role in preprocedural and postprocedural assessment. Findings from qualitative and quantitative preprocedural thin-section CT and perfusion scintigraphic analysis provides the characterization of emphysema, degree of collateral ventilation, and lung perfusion data necessary for target lobe selection, while aiding in detection of the presence of contraindications to the procedure, including suspicious pulmonary nodules, significant bronchiectasis, large bullae, and pleural adhesions. At procedure completion, chest radiography is required for assessment of complications, most commonly pneumothorax. Subsequent imaging may determine whether the procedure has successfully induced lobar atelectasis as well as the presence of additional complications such as infection and valve malposition or migration. Knowledge of EBV therapy and pertinent imaging findings is crucial in optimizing patient selection for the procedure, identifying complications, and evaluating treatment response. ^©RSNA, 2025.