CT Assessment of Lung Fissures: Anatomy and Correlated Function

 描述（由申请人提供）：肺气肿是美国和全世界残疾和死亡的主要原因。数以百万计的人患有这种疾病，这种疾病往往多年未被诊断，并不可逆转地破坏肺实质。目前尚不清楚该疾病如何进展，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，支气管镜肺减容疗法作为用于肺气肿的治疗以减少过度充气、改善肺功能和缓解症状（例如，呼吸短促），因为其微创特性。然而，很难确定哪些患者实际上可以从这种支气管镜治疗中受益。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叶间侧支通气（CV）。一些研究者和我们的初步研究表明，CT图像上描绘的肺裂完整性（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。我们建议推进我们以前的工作，全面调查肺裂形态，肺气肿分布模式，和他们的三维空间整合。我们的最终目标是建立一个评估功能下降、COPD进展和支气管内瓣膜（EBV）治疗反应的风险分层模型。我们的假设是，叶间CV受多种因素的影响，如肺气肿周围的不完全裂的存在，而不仅仅是裂的完整性。因此，目前通过CT图像上的裂隙完整性来评估叶间CV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进展和可能制定最佳的患者管理实践，而且还可以显着简化识别EBV治疗患者的术前检查。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严重程度和分布，（3）评估特征形态、肺气肿分布模式和整合肺模型的功能意义，以及（4）开发和验证功能下降的风险分层模型，COPD进展和对EBV治疗的反应。

 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.