Am. J. Respir. Crit. Care Med., Volume 164, Number 12, December 2001, 2195-2199

Core to Rind Distribution of Severe Emphysema Predicts Outcome of Lung Volume Reduction Surgery

YASUTAKA NAKANO, HARVEY O. COXSON, SOREL BOSAN, ROBERT M. ROGERS, FRANK C. SCIURBA, ROBERT J. KEENAN, KEITH R. WALLEY, PETER D. PARÉ, and JAMES C. HOGG

University of British Columbia McDonald Research Laboratories, iCAPTURE Centre, St. Paul's Hospital, and Department of Radiology, Vancouver Hospital and Health Sciences Centre, Vancouver, British Columbia, Canada; and Departments of Medicine and Surgery, University of Pittsburgh Medical Center and School of Medicine, Pittsburgh, Pennsylvania

Computed tomography (CT) has shown that emphysema is more extensive in the inner (core) region than in the outer (rind) region of the lung. It has been suggested that the concentration of emphysematous lesions in the outer rind leads to a better outcome following lung volume reduction surgery (LVRS) because these regions tend to be more surgically accessible. The present study used a recently described, computer-based CT scan analysis to quantify severe emphysema (lung inflation > 10.2 ml gas/g tissue), mild/moderate emphysema (lung inflation = 10.2 to 6.0 ml gas/g tissue), and normal lung tissue (lung inflation < 6.0 ml gas/g tissue) present in the core and rind of the lung in 21 LVRS patients. The results show that the quantification of severe emphysema independently predicts change in maximal exercise response and FEV₁. We conclude that a greater extent of severe emphysema in the rind of the upper lung predicts greater benefit from LVRS because it identifies the lesions most accessible to removal by LVRS.

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