[Radiologic assessment in lung volume reduction surgery in emphysema]

Aim of this work is to present and discuss the radiologic protocol we have developed for the preoperative assessment of patients with severe pulmonary emphysema candidate to lung volume reduction surgery (LVRS). The operation aims at improving respiratory mechanics and reducing small airway obstruction by removing variable amounts of emphysematous parenchyma. January to September, 1996, twelve patients were submitted to LVRS. Before surgery all patients were examined with standard chest radiographs during maximal inspiration and expiration, chest Computed Tomography (CT), High Resolution Computed Tomography (HRCT) and air trapping quantitation on HRCT scans. Diaphragm and chest wall excursions, patterns, site and distribution of emphysema, as well as heterogeneity (i.e., the uneven distribution of emphysematous and normal parenchyma) were investigated. Air trapping was quantitated with a dedicated software. Postoperative studies were carried out 2 months later in six patients and included: maximal inspiratory and expiratory chest radiographs and air trapping assessment on 3 standardized HRCT scans. All parameters considered improved in every patient. Radiologic studies proved to be of crucial importance for patient selection and LVRS planning. Despite our limited number of patients, the diagnostic protocol adopted in our Hospital appears a valuable tool for both pre- and post-operative assessment of the patients candidate to LVRS.