MRI OF DIAPHRAGM ROLE IN CANDIDATE SCREENING FOR LUNG VOLUME REDUCTION SURGERY

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The purpose of this project is to investigate whether MRI of the diaphragm is useful in the selection of emphysema patients for lung volume reduction surgery (LVRS). The hypothesis is that patients who retain diaphragmatic function benefit less from LVRS than patients who have lost this function. By testing this hypothesis we hope to improve overall surgical outcomes by learning to exclude patients whose diaphragm mechanics indicates that they are unlikely to benefit. To date, we have developed an MR protocol for imaging the diaphragm both dynamically and during suspended respiration. We have performed diaphragmatic MRI studies on 7 control subjects and 4 emphysema patients. Using these preliminary data as a basis, we have developed software analysis tools to quantify diaphragm functional morphometry: area, shape, and movement. We have made some inferences concerning the adaptation which the diaphragm makes to chronic hyperinflation. One emphysema patient whom we studied preoperatively has since gone on to LVRS. We plan to restudy that patient, the first in our series of patients imaged before and after surgery. In the coming year, we plan to extend the series of control and emphysema subjects studied. As soon as a subset of patients we have studied has gone to LVRS and postoperative rehabilitation, we can begin the search for preoperative MR parameters which predict surgical outcome. In addition, the study of LVRS patients postoperatively will permit testing of our hypothesis that, in patients who have improved functional status following LVRS, there is a concomitant normalization of diaphragmatic biomechanics.