Abstract Rationale Bronchoscopic lung volume reduction (BLVR) is an effective treatment for severe emphysema, which employs endobronchial one-way valves to induce lobe collapse. Although this procedure improves pulmonary function, reduces hyperinflation and shortness of breath, collateral ventilation (CV) due to incomplete fissures can impede successful lobe collapse. This study aims to evaluate whether advanced computed tomography (CT) imaging can improve CV assessment and subsequently optimise BLVR outcomes. Method The prospective study included 30 participants, aged 40 and above, at Temple University Hospital, USA. Using Chartis assessment as the reference, paired inspiratory-expiratory CT scans generated regional ventilation outputs (CT LVAS, 4DMedical) and density/emphysema maps (LDAf, IMBIO). These images were assessed for ventilation and emphysema patterns within fissures between target and ipsilateral lobes, serving as CV predictors. A weighted factor model was applied and validated through k-fold cross-validation to ensure reliability. Results Our weighted predictive model leveraged LDAf density scoring and fissure region ventilation to predict CV with 97% accuracy, achieving an area under the curve (AUC) of 0.94, sensitivity of 0.9, and specificity of 1. Consistent findings were supported by repeated stratified k-folds cross-validation, demonstrating a mean accuracy of 94%. Conclusion This study confirms that leveraging advanced imaging techniques significantly enhances CV detection in BLVR pre-procedural planning. This innovative imaging method presents a more efficient, minimally invasive solution that promises to improve the precision of BLVR interventions and patient outcomes. Key Words: Emphysema, lung volume reduction, COPD, collateral ventilation, BLVR This abstract is funded by: This study was supported in part by 4DMedical
Eikelis et al. (Fri,) studied this question.
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