Emphysema lung lobe volume reduction: effects on the ipsilateral and contralateral lobes

Objectives To investigate volumetric and density changes in the ipsilateral and contralateral lobes following volume reduction of an emphysematous target lobe. Methods The study included 289 subjects with heterogeneous emphysema, who underwent bronchoscopic volume reduction of the most diseased lobe with endobronchial valves and 132 untreated controls. Lobar volume and low-attenuation relative area (RA) changes post-procedure were measured from computed tomography images. Regression analysis (Spearman’s rho) was performed to test the association between change in the target lobe volume and changes in volume and density variables in the other lobes. Results The target lobe volume at full inspiration in the treatment group had a mean reduction of −0.45 L (SE = 0.034, P < 0.0001), and was associated with volume increases in the ipsilateral lobe (rho = −0.68, P < 0.0001) and contralateral lung (rho = −0.16, P = 0.006), and overall reductions in expiratory RA (rho = 0.31, P < 0.0001) and residual volume (RV)/total lung capacity (TLC) (rho = 0.13, P = 0.03). Conclusions When the volume of an emphysematous target lobe is reduced, the volume is redistributed primarily to the ipsilateral lobe, with an overall reduction. Image-based changes in lobar volumes and densities indicate that target lobe volume reduction is associated with statistically significant overall reductions in air trapping, consistent with expansion of the healthier lung. Key Points • Computed tomography allows assessment of the treatment of emphysema with endobronchial valves . • Endobronchial valves can reduce the volume of an emphysematous lung lobe . • Compensatory expansion is greater in ipsilateral lobes than in the contralateral lung . • Reduced air trapping is measurable by RV/TLC and smaller low attenuation area .