Imaging of Emphysema and the Impact of Lung Volume Reduction Surgery

Abstract

A large body of literature has evaluated the sensitivity and specificity of radiological imaging, particularly chest radiography and computed tomography (CT), for the detection of emphysema. Practically, however, chest radiographs are used to support or confirm a diagnosis of emphysema that has been suggested by clinical history, physical examination, and pulmonary function testing. This has relegated chest radiography and CT largely to the evaluation of patients with exacerbations of their chronic obstructive lung disease, cancer staging, and possibly to screening for lung cancer, given the history of cigarette smoking in the great majority of these patients. New surgical techniques for the treatment of emphysema have created a new opportunity to revisit the radiological tools available for imaging emphysema, including quantitative analysis and more recently helical CT, because the distribution and severity of emphysema in the lungs appears to be of importance in selecting patients for lung volume reduction surgery. After revisiting the pathophysiology, histopathology, and conventional imaging of emphysema, lung volume reduction surgery and the role of imaging in evaluating patients for this procedure will be discussed.

Key Words:

Pulmonary emphysema - chronic obstructive pulmonary disease - computed tomography - chest radiography - lung volume reduction surgery