20 July 2018
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.
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 (Δ6-MWT ≥ 26 m, ΔFEV 1 ≥ 12%, ΔRV ≥ 10%) were identified through stepwise linear regression analysis.
The response outcome for Δ6-MWT, for ΔFEV 1 and for ΔRV was met by 55%, 32% and 42%, respectively. For Δ6-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 ΔFEV 1 ≥ 12%, lower baseline FEV 1 ( 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 ΔRV ≥ 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.