Our overall goal is to identify CT and MR-imaging techniques that will best guide and inform the two minimally-invasive surgical therapies for COPD which are under development around the world: endobronchial stent-supported conduits from conducting airways to emphysematous parenchyma, and endobronchial one-way exit valves to effect volume reduction in severely emphysematous lung regions. Both proposed interventions show great promise at reducing dyspnea in patients with severe emphysema, for which there is no therapeutic treatment option other than lung transplantation and, for a few, lung volume reduction surgery. Despite the great promise, there is no currently identified method for identification of target regions for the intervention or for efficacy prediction. The work proposed here will be performed in human lungs removed at transplant for advanced COPD for two reasons: human emphysema is not well replicated in any animal model, and interventional placement can be at random locations, allowing a range of functional results without regard to patient outcomes and allowing testing of the underlying assumptions about regional collateral ventilation and regional lung function. Though the imaging procedures proposed here are all ex vivo, they can be and have been employed in vivo. By correlating lung functional improvements after intervention with quantitative 3He MRI and CT results (pre- and post-intervention), we will be able to demonstrate the utility of pulmonary imaging techniques to (i) guide the endoscopic installation of valves or stents in a given lung and (ii) predict the functional improvement outcomes for a given intervention. This proposal aims to make a significant step forward toward effective and predictable endoscopic treatment of emphysema, through a combined effort at two sites (Washington University and the University of Pennsylvania / University of Virginia) that are world leaders in thoracic imaging and treatment of severe COPD.
Chronic obstructive pulmonary disease (COPD) affects between 11 and 24 million Americans and is a major cause of suffering and premature death. Two minimally- invasive surgical procedures are under development to treat severe COPD and show great promise but results vary significantly among patients. We propose new imaging methods via CT and MRI to test these interventions, to eventually improve patient selection, choice of lung target areas in individuals, and reliable prediction of success of these procedures in individual patients.
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