BACKGROUND: Although lobar patterns of emphysema heterogeneity are indicative of optimal target sites for lung volume reduction (LVR) strategies, the presence of segmental, or sublobar, heterogeneity is often underappreciated. OBJECTIVE: The aim of this study was to understand lobar and segmental patterns of emphysema heterogeneity, which may more precisely indicate optimal target sites for LVR procedures. METHODS: Patterns of emphysema heterogeneity were evaluated in a representative cohort of 150 severe (GOLD stage III/IV) chronic obstructive pulmonary disease (COPD) patients from the COPDGene study. High-resolution computerized tomography analysis software was used to measure tissue destruction throughout the lungs to compute heterogeneity (≥15% difference in tissue destruction) between (inter-) and within (intra-) lobes for each patient. Emphysema tissue destruction was characterized segmentally to define patterns of heterogeneity. RESULTS: Segmental tissue destruction revealed interlobar heterogeneity in the left lung (57%) and right lung (52%). Intralobar heterogeneity was observed in at least one lobe of all patients. No patient presented true homogeneity at a segmental level. There was true homogeneity across both lungs in 3% of the cohort when defining heterogeneity as ≥30% difference in tissue destruction. CONCLUSION: Many LVR technologies for treatment of emphysema have focused on interlobar heterogeneity and target an entire lobe per procedure. Our observations suggest that a high proportion of patients with emphysema are affected by interlobar as well as intralobar heterogeneity. These findings prompt the need for a segmental approach to LVR in the majority of patients to treat only the most diseased segments and preserve healthier ones.
BACKGROUND: Although lobar patterns of emphysema heterogeneity are indicative of optimal target sites for lung volume reduction (LVR) strategies, the presence of segmental, or sublobar, heterogeneity is often underappreciated. OBJECTIVE: The aim of this study was to understand lobar and segmental patterns of emphysema heterogeneity, which may more precisely indicate optimal target sites for LVR procedures. METHODS: Patterns of emphysema heterogeneity were evaluated in a representative cohort of 150 severe (GOLD stage III/IV) chronic obstructive pulmonary disease (COPD) patients from the COPDGene study. High-resolution computerized tomography analysis software was used to measure tissue destruction throughout the lungs to compute heterogeneity (≥15% difference in tissue destruction) between (inter-) and within (intra-) lobes for each patient. Emphysema tissue destruction was characterized segmentally to define patterns of heterogeneity. RESULTS: Segmental tissue destruction revealed interlobar heterogeneity in the left lung (57%) and right lung (52%). Intralobar heterogeneity was observed in at least one lobe of all patients. No patient presented true homogeneity at a segmental level. There was true homogeneity across both lungs in 3% of the cohort when defining heterogeneity as ≥30% difference in tissue destruction. CONCLUSION: Many LVR technologies for treatment of emphysema have focused on interlobar heterogeneity and target an entire lobe per procedure. Our observations suggest that a high proportion of patients with emphysema are affected by interlobar as well as intralobar heterogeneity. These findings prompt the need for a segmental approach to LVR in the majority of patients to treat only the most diseased segments and preserve healthier ones.
Authors: A Dirksen; J H Dijkman; F Madsen; B Stoel; D C Hutchison; C S Ulrik; L T Skovgaard; A Kok-Jensen; A Rudolphus; N Seersholm; H A Vrooman; J H Reiber; N C Hansen; T Heckscher; K Viskum; J Stolk Journal: Am J Respir Crit Care Med Date: 1999-11 Impact factor: 21.405
Authors: Maren Schuhmann; Philippe Raffy; Youbing Yin; Daniela Gompelmann; Ipek Oguz; Ralf Eberhardt; Derek Hornberg; Claus Peter Heussel; Susan Wood; Felix J F Herth Journal: Am J Respir Crit Care Med Date: 2015-04-01 Impact factor: 21.405
Authors: Sourish Bandyopadhyay; Erik Henne; Avina Gupta; Robert Barry; Greg Snell; Charlie Strange; Felix J F Herth Journal: Respiration Date: 2014-12-06 Impact factor: 3.580
Authors: Alfred Fishman; Fernando Martinez; Keith Naunheim; Steven Piantadosi; Robert Wise; Andrew Ries; Gail Weinmann; Douglas E Wood Journal: N Engl J Med Date: 2003-05-20 Impact factor: 91.245
Authors: Christian Thomsen; Dorothea Theilig; Dominik Herzog; Alexander Poellinger; Felix Doellinger; Nils Schreiter; Vera Schreiter; Dirk Schürmann; Bettina Temmesfeld-Wollbrueck; Stefan Hippenstiel; Norbert Suttorp; Ralf-Harto Hubner Journal: Int J Chron Obstruct Pulmon Dis Date: 2016-06-09
Authors: Dorothea Theilig; Felix Doellinger; Alexander Poellinger; Vera Schreiter; Konrad Neumann; Ralf-Harto Hubner Journal: Int J Chron Obstruct Pulmon Dis Date: 2017-06-01
Authors: Pavlina Lenga; Christoph Ruwwe-Glösenkamp; Christian Grah; Joachim Pfannschmidt; Jens Rückert; Stephan Eggeling; Sven Gläser; Bernd Schmidt; Paul Schneider; Sylke Kurz; Gunda Leschber; Andreas Gebhardt; Birgit Becke; Olaf Schega; Jakob Borchardt; Ralf-Harto Hübner Journal: ERJ Open Res Date: 2021-01-25