Supplementary Material for: Fissure Integrity and Volume Reduction in Emphysema: A Retrospective Study

Background: One-way endobronchial valves (EBVs) relieve symptoms of emphysema, particularly in patients without collateral ventilation between the target and adjacent lobes. Pretreatment knowledge of fissure integrity could serve as an aid in indicating EBV interventions. Objective: This study aimed to investigate the relationship between software-measured lung fissure integrity and clinically relevant lung volume reduction (≥350 ml) in emphysema patients treated with one-way EBVs using a lobar exclusion strategy. Methods: Of 108 patients treated between March 2008 and July 2014, 38 had both baseline and follow-up computed tomography (CT) scans acquired following a specific protocol for quantitative CT analysis and were included in the study (total of 39 treatments, two lungs treated in 1 patient). Outcome measures were fissure integrity measured on baseline CT scans, difference between pre- and postoperative lung volume (considering the lowest measured postoperative volume), and correlation between fissure integrity and volume change. Results: Fissure integrity ≥75% correlated with volume reduction ≥350 ml (Spearman coefficient: -0.65; p 90%. Conclusions: A target lobe volume reduction using EBVs is possible with lung fissure integrity ≥75%. For patients with fissure integrity between 75 and 90%, a further evaluation of interlobar ventilation should be performed. A clinically relevant volume reduction following treatment with EBVs is likely with any level of fissure integrity >90%.

背景：单向支气管内瓣膜（One-way endobronchial valves, EBVs）可缓解肺气肿患者的临床症状，尤其适用于靶肺叶与相邻肺叶之间不存在侧支通气的患者。治疗前明确肺裂完整性信息，可辅助临床判断是否适宜施行EBV治疗。
目的：本研究旨在探讨采用肺叶排除策略接受单向EBV治疗的肺气肿患者中，经软件量化的肺裂完整性与临床相关肺容积减少量（≥350ml）之间的关联。
方法：2008年3月至2014年7月期间共有108例患者接受治疗，其中38例同时具备符合定量CT分析专用方案的基线与随访计算机断层扫描（computed tomography, CT）影像，最终被纳入本研究（共计39例次治疗，其中1例患者接受了双侧肺叶治疗）。本研究的结局指标包括基线CT扫描测得的肺裂完整性、术前与术后肺容积差值（考虑术后测得的最低肺容积），以及肺裂完整性与肺容积变化之间的相关性。
结果：肺裂完整性≥75%与肺容积缩减≥350ml存在相关性（斯皮尔曼相关系数：-0.65；p值对应90%）。
结论：当肺裂完整性≥75%时，采用EBV治疗可实现靶叶肺容积缩减。对于肺裂完整性处于75%至90%之间的患者，应进一步评估叶间通气情况。当肺裂完整性>90%时，无论具体数值如何，接受EBV治疗后均大概率可获得具有临床意义的肺容积缩减。