ABSTRACT
The imaging of emphysema has received renewed attention since the resurgent interest in lung volume reduction surgery (LVRS). Prior to LVRS, the clinical imaging of emphysema extended little beyond the chest radiograph. Computed tomography (CT) had a narrow role. It was used to establish the diagnosis of emphysema in patients with dyspnea, normal chest radiographs, and isolated reduction in diffusing capacity on pulmonary function testing (1,2). More commonly, emphysema was reported as an incidental finding on CT examinations performed for other clinical indications, such as lung cancer. CT scans had not been used routinely in the evaluation of pulmonary emphysema itself. With recent evidence that the severity and distribution of emphysema within the lungs are useful predictors of patient outcome after LVRS, a new indication has arisen for the advanced imaging of emphysema with both CT and perfusion scintigraphy (3-9). Other techniques are being used investigationally, including magnetic resonance imaging (MRI) to evaluate the morphology and coordinated movements of the chest wall and diaphragm before and
after LVRS (10) and xenon-enhanced CT to map the distribution of ventilation (11,12).
