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Clinical Investigations: SURGERY |

Classification of Emphysema in Candidates for Lung Volume Reduction Surgery*: A New Objective and Surgically Oriented Model for Describing CT Severity and Heterogeneity

Kerstin Cederlund, MD, PhD; Ulf Tylén, MD, PhD; Lennart Jorfeldt, MD, PhD; Peter Aspelin, MD, PhD
Author and Funding Information

*From the Department of Physiology and Thoracic Radiology (Drs. Cederlund and Jorfeldt), Karolinska Hospital, Stockholm; the Department of Radiology (Dr. Tylén), Göteborg University, Sahlgrenska University Hospital, Göteborg; and the Department of Radiology (Dr. Aspelin), Huddinge University Hospital, Huddinge, Sweden.

Correspondence to: Kerstin Cederlund, MD, PhD, Department of Physiology and Thoracic Radiology, Karolinska Hospital, SE 171 76 Stockholm, Sweden; e-mail: kerstin.cederlund@ks.SE



Chest. 2002;122(2):590-596. doi:10.1378/chest.122.2.590
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Objective: To elaborate a surgically oriented and objective model for classification of emphysema heterogeneity.

Patients and interventions: CT examinations of 66 candidates for lung volume reduction surgery.

Design: Emphysema severity was calculated by computer as the emphysema index (EI), a commonly used computer-based quantification that accurately assesses the extent of emphysema of a CT image. The distribution of the EI in different parts of each lung was illustrated in a diagram with the position in the lung (from cranial to caudal) on the x-axis and the EI on the y-axis. The slope of the fitted line was calculated. As a measure of the variation of the EI within each lung, the EI difference was calculated.

Results: A diagram was constructed with the absolute value of slope, k, on the x-axis and EI difference on the y-axis. This resulted in a diagram differentiating markedly heterogeneous, intermediately heterogeneous, and homogeneous emphysema. Nineteen patients fulfilled the criteria of bilateral markedly heterogeneous emphysema, 3 patients filled the criteria of bilateral intermediately heterogeneous emphysema, and 18 patients filled the criteria of bilateral homogeneous emphysema. Twenty-six patients had different types of emphysema in the right and left lung.

Conclusion: We present a method for classification of emphysema heterogeneity that is (1) objective, (2) surgically oriented, and (3) classifies both lungs separately.

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