Outcomes of a Multi-Disciplinary Team (MDT) for End-Stage Emphysema Patients: Emphysema Index on Computed Tomography identifies Targets for Lung Volume Reduction

Objective: This is a retrospective review of end stage-emphysema patients considered for endobronchial or surgical management at a specialist MDT. Methods: A Lung Volume Reduction (LVR) MDT was established January 2016.Each patient9s referral Proforma included Pulmonary Function Tests, Computed Tomography (CT) including quantitative densitometry (LowATT Aquarius, TeraRecon, California, USA), perfusion scintigraphy, echocardiography +/- coronary angiogram. CT assessment included (1) semi-automated assessment presented as a colour-coded emphysema map and (2) multiplanar qualitative CT assessment. Radiologic criteria for LVR were (1) CT colour map or scintigraphic confirmation of upper lobe predominant disease (upper lobe perfusion Results: Twenty-eight patients were included between January 2016 - December 2016 (14 males, 14 females, mean age 59 (range 27-80) years). Eight patients (29%) were listed for LVR surgery, 2 (8%) for endobronchial valve and 1 (3%) for endobronchial vapour therapy. Eight patients were listed for lung transplant assessment (29%). Nine patients were not considered suitable for any intervention, instead they continued on medical support with enrolment into pulmonary rehabilitation. Eight patients underwent targeted LVR pulmonary resection. There were no deaths. Conclusion: CT densitometry is a useful adjunct tool that identifies suitable targets for lung volume reduction.