LUNG-VOLUME REDUCTION SURGERY - COMPARISON OF PREOPERATIVE RADIOLOGICFEATURES AND CLINICAL OUTCOME

PURPOSE: To examine the relationship between preoperative radiologic f indings and clinical outcome after lung volume reduction surgery. MATE RIALS AND METHODS: In 50 consecutive patients, preoperative chest radi ographs and computed tomographic (CT) scans were scored by four radiol ogists for features related to the severity and distribution of emphys ema and compared with clinical improvement in forced expiratory volume in 1 second (FEV1), arterial partial pressure of oxygen, and exercise tolerance 6 months after surgery. RESULTS: In the 47 surviving patien ts, follow-up data showed greater postoperative improvement in functio n in patients with a global pattern of predominantly upper-lobe emphys ema (P < .05) and in patients with a more heterogeneous distribution o f emphysema, compressed lung, and a larger percentage of normal and mi ldly emphysematous lung (P < .05 for improvement in FEV1). Radiographi c scores for individual features were more strongly correlated with ou tcome than CT scores. The combination of upper-lobe severity and perce ntage of normal and mildly emphysematous lung at CT were the strongest predictors of improvement in FEV1 (r(2) = .49). The three patients wh o died were older (P = .05) and had more severe, diffuse emphysema com pared with other patients. CONCLUSION: Imaging studies may help predic t the degree of improvement and therefore should be considered an inte gral part of an objective patient selection process. Radiography alone may be adequate for initial screening.