CT Assessment of Lung Fissures: Anatomy and Correlated Function

 描述(由申请人提供)：肺气肿是美国和世界范围内导致残疾和死亡的主要原因。数以百万计的人患有这种疾病，这种疾病往往多年来没有得到诊断，并不可逆转地破坏肺实质。目前尚不清楚肺气肿是如何发展的，但有新的研究表明，肺气肿的发展和程度可能遵循某些致病途径。近年来，支气管镜肺减容治疗作为一种治疗肺气肿的方法，由于其微创的特点，在减轻过度充气、改善肺功能、缓解症状(如呼吸急促)方面受到了极大的关注。然而，很难确定哪些患者可以从这种支气管镜治疗中真正受益。主要的挑战是缺乏一种准确、定量和非侵入性的方法来评估个体的肺叶间侧支通气量(CV)。一些研究人员和我们的初步研究表明，CT图像上显示的肺裂完整性(完整性)可能在叶间CV中起关键作用，但对叶间CV的确切贡献尚不清楚。我们建议推进我们之前的工作，全面研究肺裂形态、肺气肿分布模式及其三维空间整合。我们的最终目标是开发一种风险分层模型，用于评估功能下降、COPD进展和对支气管内瓣膜(EBV)治疗的反应。我们的假设是，叶间CV受多种因素的影响，如存在被肺气肿包围的不完全裂隙，而不是简单的裂隙完整性。因此，目前通过CT图像上的裂隙完整性来评估叶间循环的方法可能是不够的。如果成功，开发的计算机工具不仅可以帮助评估COPD的进展和可能开发最佳的患者管理实践，而且还可以显著简化识别EBV治疗患者的术前工作。我们有以下具体目标：(1)继续填充我们的胸部CT检查数据库，(2)进一步开发我们的3D裂隙和肺模型，以整合裂隙形态和肺气肿的严重程度和分布，(3)评估特征形态、肺气肿分布模式和综合肺模型的功能含义，以及(4)建立和验证关于功能下降、COPD进展和EBV治疗反应的风险分层模型。

 DESCRIPTION (provided by applicant): Emphysema is a leading cause of disability and death in the United States and worldwide. Millions of people suffer from this disease, which often goes undiagnosed for many years and irreversibly destroys lung parenchyma. It is unclear how the disease progresses, but there are emerging investigations indicating that the development and extent of emphysema may follow certain pathogenic pathways. In recent years, bronchoscopic lung volume reduction therapy has been gaining significant attention as a treatment for emphysema to reduce hyperinflation, improve lung function, and relieve symptoms (e.g., short of breath) because of its minimally invasive characteristic. However, it is difficult to determine which patients could actually benefit from this bronchoscopic therapy. The primary challenge is the lack of an accurate, quantitative, and non-invasive way to assess an individual's inter-lobar collateral ventilation (CV). Preliminarily studies by some investigators and us revealed that pulmonary fissure integrity (completeness) depicted on CT images may play a crucial role in interlobar CV, but the exact contribution to the interlobar CV remains unclear. We propose to advance our previous work to comprehensively investigate pulmonary fissure morphology, emphysema distribution patterns, and their 3D spatial integration. Our ultimate goal is to develop a risk stratification model for assessing function decline, COPD progression, and responses to endobronchial valve (EBV) therapy. Our assumption is that the interlobar CV is affected by multiple factors, such as the existence of incomplete fissures surrounded by emphysema, and not simply fissure integrity. Therefore the current approaches to assess interlobar CV by fissure integrity on CT images may be insufficient. If successful, the developed computer tool may not only aid in assessing COPD progression and possible developing optimal patient management practices, but also significantly simplify pre-operative work-up in identifying patients for EBV therapy. We have the following specific aims: (1) continue to populate our chest CT examination database, (2) further develop our 3D fissure and lung models to integrates fissure morphology and emphysema severity and distribution, (3) evaluate the functional implications of features morphology, emphysema distribution patterns, and integrative lung model, and (4) develop and validate a risk stratification model for function decline, COPD progression, and responses to EBV therapy.