Morphologic grading of emphysema is useful in the selection of candidates for unilateral or bilateral reduction pneumoplasty

Objective: Radiologic morphology of emphysema proves useful in the selection of candidates for bilateral reduction pneumoplasty. We developed a simple morphologic grading system capable of identifying subsets of patients who had maximal functional improvement after unilateral or bilateral operation. Methods: Fifty-two patients who underwent unilateral (n=34) or bilateral (n=18) reduction pneumoplasty were evaluated. Emphysema morphology was visually scored by digital roentgenograms and high-resolution computed tomography. In each lung, severity of emphysema (ES), heterogeneity (DHT) and hyperinflation (DHF) degrees, were assessed. Asymmetric ratio of emphysema (ARE) between the lungs was expressed as: higher ES/lower ES scores. Morphometric data were correlated with absolute preoperative–postoperative FEV1 change (ΔFEV1). Results: No difference was found between the unilateral and the bilateral group for ES and DHT. DHF was greater in the bilateral group (3.1 vs. 2.7, P=0.02) whereas ARE was greater in the unilateral group (1.29 vs. 1.05, P=0.0001). Stepwise logistic regression extracted as best predictors of maximal ΔFEV1, ARE (odds ratio=238, Wald test P=0.04) in the unilateral group, and DHT (odds ratio=24, P=0.03) in the bilateral group. Unilateral group ΔFEV1 was greater in patients with ARE≥1.3 (0.44 vs. 0.24 l, P=0.02). Bilateral group ΔFEV1 was greater in patients with DHT>1 (0.50 vs. 0.31 l, P=0.03). No difference was found when comparing ΔFEV1 resulting from unilateral RP and ARE≥1.3, and bilateral RP (0.44 vs. 0.41 l, not significant). Conclusions: This morphologic grading system identified subsets of patients who had maximal functional benefit from unilateral or bilateral reduction pneumoplasty and might be useful in the preoperative screening of candidates for either approach.