Home
|
Inbox
|
Search
|
View Abstract
Lung Fissure Interruption on Computer Tomography Imaging as a Diagnostic Tool for Interlobar Fusion
Description
.abstract img { width:300px !important; height:auto; display:block; text-align:center; margin-top:10px } .abstract { overflow-x:scroll } .abstract table { width:100%; display:block; border:hidden; border-collapse: collapse; margin-top:10px } .abstract td, th { border-top: 1px solid #ddd; padding: 4px 8px; } .abstract tbody tr:nth-child(even) td { background-color: #efefef; } .abstract a { overflow-wrap: break-word; word-wrap: break-word; }
A1736 - Lung Fissure Interruption on Computer Tomography Imaging as a Diagnostic Tool for Interlobar Fusion
Author Block: T. Vandemoortele1, D. St-Pierre1, G. Rakovich2; 1Pulmonology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada, 2Thoracic Surgery, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.
Rationale
Chronic obstructive pulmonary disease is a highly prevalent and morbid condition and a significant proportion of these patients have persistent symptoms despite optimal medical therapy. Bronchoscopic lung volume reduction techniques, such as one-way endobronchial valve (EBV) placement, are now becoming an interesting avenue for this population. Increasing evidence indicate that patients with significant inter-alveolar communication, or collateral ventilation, do not answer appropriately to EBV placement. Although some auspicious new tools are now being developed to endoscopically assess these air leaks, insufficient widespread validation and limited availability of these methods forces clinicians and researchers to use thoracic computer tomography to select patients for lung volume reduction. Interlobar fissure interruption (FI) on imaging has been widely accepted as a surrogate for collateral ventilation and has been used as an exclusion criteria for most of the largest randomized controlled trials evaluating the benefits of EBV placement. However, it has never been prospectively validated as an effective single selection modality and whether or not FI represents anatomical interlobar fusion, and thus collateral ventilation, is under debate. We will examine here the diagnostic value of FI.
Methods
Sixty four patients undergoing elective pulmonary surgery were prospectively recruited. Integrity of the interlobar fissures were rated on a scale of 1 to 5 intraoperatively by a thoracic surgeon and retrospectively by three independent radiologists reviewing preoperative imaging.
Results
Ninety four fissures were evaluated. Using a threshold of 0 to 33% of lung FI as representing significant interlobar separation (complete fissure), the agreement between the three radiologists was moderate, with a Fleiss’ kappa of 0.661. However, correlation with intraoperative interlobar separation was minimal (Cohen’s kappa=0.368). When both imaging and anatomical level of fissure integrity were taken as ordinal variables, correlation was also minimal (Cohen’s weighted kappa=0.320). Subgroup analyses for individual imaging modalities or specific fissures did not improve diagnostic value.
Conclusions
Although independent radiologists agree on the imaging interpretation, the level of fissure interruption evaluated on thoracic computer tomography does not seem to correlate with interlobar fusion. Further data should be gathered in an attempt to find better noninvasive pre-procedural tools predicting collateral ventilation and to clarify what is the anatomical correlate of an interrupted fissure on imaging.
Author Block: T. Vandemoortele1, D. St-Pierre1, G. Rakovich2; 1Pulmonology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada, 2Thoracic Surgery, Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada.
Rationale
Chronic obstructive pulmonary disease is a highly prevalent and morbid condition and a significant proportion of these patients have persistent symptoms despite optimal medical therapy. Bronchoscopic lung volume reduction techniques, such as one-way endobronchial valve (EBV) placement, are now becoming an interesting avenue for this population. Increasing evidence indicate that patients with significant inter-alveolar communication, or collateral ventilation, do not answer appropriately to EBV placement. Although some auspicious new tools are now being developed to endoscopically assess these air leaks, insufficient widespread validation and limited availability of these methods forces clinicians and researchers to use thoracic computer tomography to select patients for lung volume reduction. Interlobar fissure interruption (FI) on imaging has been widely accepted as a surrogate for collateral ventilation and has been used as an exclusion criteria for most of the largest randomized controlled trials evaluating the benefits of EBV placement. However, it has never been prospectively validated as an effective single selection modality and whether or not FI represents anatomical interlobar fusion, and thus collateral ventilation, is under debate. We will examine here the diagnostic value of FI.
Methods
Sixty four patients undergoing elective pulmonary surgery were prospectively recruited. Integrity of the interlobar fissures were rated on a scale of 1 to 5 intraoperatively by a thoracic surgeon and retrospectively by three independent radiologists reviewing preoperative imaging.
Results
Ninety four fissures were evaluated. Using a threshold of 0 to 33% of lung FI as representing significant interlobar separation (complete fissure), the agreement between the three radiologists was moderate, with a Fleiss’ kappa of 0.661. However, correlation with intraoperative interlobar separation was minimal (Cohen’s kappa=0.368). When both imaging and anatomical level of fissure integrity were taken as ordinal variables, correlation was also minimal (Cohen’s weighted kappa=0.320). Subgroup analyses for individual imaging modalities or specific fissures did not improve diagnostic value.
Conclusions
Although independent radiologists agree on the imaging interpretation, the level of fissure interruption evaluated on thoracic computer tomography does not seem to correlate with interlobar fusion. Further data should be gathered in an attempt to find better noninvasive pre-procedural tools predicting collateral ventilation and to clarify what is the anatomical correlate of an interrupted fissure on imaging.
|
Home
|
Inbox
|
Search
|