Abstract Rationale Endobronchial valve (EBV) therapy is an established treatment for severe emphysema. Optimal target lobe selection remains challenging, particularly in patients with homogeneous emphysema. Quantitative CT and fissure integrity are conventionally used but may not fully reflect functional impairment. This study evaluated whether selecting the target lobe based on the lowest ventilation-perfusion discrepancy index (VQDI) derived from V/Q SPECT/CT improved outcomes after EBV treatment. Methods Twenty-four patients with severe emphysema underwent preoperative V/Q SPECT/CT imaging. The lobe with the lowest VQDI was selected for EBV placement. Outcomes, including pulmonary function, exercise capacity, quality of life, and regional V/Q redistribution, were assessed at 6 months. Results Significant reductions in ventilation (-80.27%), perfusion (-76.09%), and volume (-32.72%) were observed in the target lobe (all p 0.01), with compensatory increases in the ipsilateral nontarget zones. Patients showed improvements in FEV1 (+0.19 L), 6-minute walk distance (6MWD) (+71.8 m), and SGRQ score (-18.7 points) (all p 0.01). Lower baseline VQDI predicted greater improvements in DLCO and mMRC scores (p 0.05). ΔVQDI correlated with improvements in DLCO (r = 0.643), FEV1 (r = 0.573), and 6MWD (r = 0.582) (all p 0.01). The agreement between the VQDI and qCT for lobe selection was high (κ = 0.819). Conclusion VQDI-guided EBV therapy improved lobar selection precision and volume reduction, correlating with clinical improvements across emphysema phenotypes. VQDI shows promise for personalizing endoscopic lung volume reduction. This abstract is funded by: None
G Hou (2026) studied this question.