Yonsei Med J.  2016 Jul;57(4):963-967. 10.3349/ymj.2016.57.4.963.

Comparison of Predicted Total Lung Capacity and Total Lung Capacity by Computed Tomography in Lung Transplantation Candidates

• Hwang SH
• Lee JG
• Kim TH
• Paik HC
• Park CH
• Haam S

• KMID: 2374130
• DOI: http://doi.org/10.3349/ymj.2016.57.4.963

Abstract

PURPOSE
Lung size mismatch is a major cause of poor lung function and worse survival after lung transplantation (LTx). We compared predicted total lung capacity (pTLC) and TLC measured by chest computed tomography (TLC(CT)) in LTx candidates.
MATERIALS AND METHODS
We reviewed the medical records of patients on waiting lists for LTx. According to the results of pulmonary function tests, patients were divided into an obstructive disease group and restrictive disease group. The differences between pTLC calculated using the equation of the European Respiratory Society and TLC(CT) were analyzed in each group.
RESULTS
Ninety two patients met the criteria. Thirty five patients were included in the obstructive disease group, and 57 patients were included in the restrictive disease group. pTLC in the obstructive disease group (5.50±1.07 L) and restrictive disease group (5.57±1.03 L) had no statistical significance (p=0.747), while TLC(CT) in the restrictive disease group (3.17±1.15 L) was smaller than that I the obstructive disease group (4.21±1.38 L) (p<0.0001). TLC(CT)/pTLC was 0.770 in the obstructive disease group and 0.571 in the restrictive disease group.
CONCLUSION
Regardless of pulmonary disease pattern, TLC(CT) was smaller than pTLC, and it was more apparent in restrictive lung disease. Therefore, we should consider the difference between TLC(CT) and pTLC, as well as lung disease patterns of candidates, in lung size matching for LTx.

Keyword

Lung transplantation; pulmonary function test; donor selection

MeSH Terms

Adolescent
Adult
Aged
Female
Humans
Lung/*diagnostic imaging/pathology/*physiopathology
Lung Diseases/diagnostic imaging/pathology/physiopathology/therapy
*Lung Transplantation
Male
Middle Aged
Organ Size
*Patient Selection
Retrospective Studies
*Tomography, X-Ray Computed
*Total Lung Capacity
Young Adult

Figure

• 

  Fig. 1 Flow chart for interpretation of pulmonary function tests. On the basis of FEV1, FVC, and FEV1/FVC ratio measured by spirometry, the lung disease patterns were classified into obstructive and restrictive patterns. FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity.

• 

  Fig. 2 Three-dimensional (3D) CT volume rendered image to measure TLC segmented by pixel attenuation thresholds. The lung parenchyma was semi-automatically extracted from CT data sets using commercial analysis software. Total volume of low-attenuating pixels (between -400 to -1024 HU) within the extracted lung parenchyma was considered as the TLC. The figure above comprises a 3D CT image representing the TLC in a 60-year-old man with restrictive lung disease pattern according to spirometry results. CT, computed tomography; HU, Hounsfield unit; TLC, total lung capacity.

• 

  Fig. 3 Disease distribution according to pulmonary disease pattern. (A) Obstructive disease pattern. (B) Restrictive disease pattern. ARDS, acute respiratory distress syndrome; COPD, chronic obstructive pulmonary disease; IPF, idiopathic pulmonary fibrosis; LAM, lymphangioleiomyomatosis.

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