Links to Exploration step
Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Reduced ventilation–perfusion (V/Q) mismatch following endobronchial valve insertion demonstrated by Gallium‐68 V/Q photon emission tomography/computed tomography</title><author><name sortKey="Leong, Paul" sort="Leong, Paul" uniqKey="Leong P" first="Paul" last="Leong">Paul Leong</name><affiliation><nlm:aff id="rcr2253-aff-0001"></nlm:aff></affiliation></author><author><name sortKey="Le Roux, Pierre Ves" sort="Le Roux, Pierre Ves" uniqKey="Le Roux P" first="Pierre-Yves" last="Le Roux">Pierre-Yves Le Roux</name><affiliation><nlm:aff id="rcr2253-aff-0002"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Callahan, Jason" sort="Callahan, Jason" uniqKey="Callahan J" first="Jason" last="Callahan">Jason Callahan</name><affiliation><nlm:aff id="rcr2253-aff-0002"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0004"></nlm:aff></affiliation></author><author><name sortKey="Siva, Shankar" sort="Siva, Shankar" uniqKey="Siva S" first="Shankar" last="Siva">Shankar Siva</name><affiliation><nlm:aff id="rcr2253-aff-0002"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0004"></nlm:aff></affiliation></author><author><name sortKey="Hofman, Michael S" sort="Hofman, Michael S" uniqKey="Hofman M" first="Michael S" last="Hofman">Michael S. Hofman</name><affiliation><nlm:aff id="rcr2253-aff-0003"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0004"></nlm:aff></affiliation></author><author><name sortKey="Steinfort, Daniel P" sort="Steinfort, Daniel P" uniqKey="Steinfort D" first="Daniel P" last="Steinfort">Daniel P. Steinfort</name><affiliation><nlm:aff id="rcr2253-aff-0001"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0004"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">28808575</idno><idno type="pmc">5550810</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5550810</idno><idno type="RBID">PMC:5550810</idno><idno type="doi">10.1002/rcr2.253</idno><date when="2017">2017</date><idno type="wicri:Area/Pmc/Corpus">001258</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001258</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Reduced ventilation–perfusion (V/Q) mismatch following endobronchial valve insertion demonstrated by Gallium‐68 V/Q photon emission tomography/computed tomography</title><author><name sortKey="Leong, Paul" sort="Leong, Paul" uniqKey="Leong P" first="Paul" last="Leong">Paul Leong</name><affiliation><nlm:aff id="rcr2253-aff-0001"></nlm:aff></affiliation></author><author><name sortKey="Le Roux, Pierre Ves" sort="Le Roux, Pierre Ves" uniqKey="Le Roux P" first="Pierre-Yves" last="Le Roux">Pierre-Yves Le Roux</name><affiliation><nlm:aff id="rcr2253-aff-0002"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Callahan, Jason" sort="Callahan, Jason" uniqKey="Callahan J" first="Jason" last="Callahan">Jason Callahan</name><affiliation><nlm:aff id="rcr2253-aff-0002"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0004"></nlm:aff></affiliation></author><author><name sortKey="Siva, Shankar" sort="Siva, Shankar" uniqKey="Siva S" first="Shankar" last="Siva">Shankar Siva</name><affiliation><nlm:aff id="rcr2253-aff-0002"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0004"></nlm:aff></affiliation></author><author><name sortKey="Hofman, Michael S" sort="Hofman, Michael S" uniqKey="Hofman M" first="Michael S" last="Hofman">Michael S. Hofman</name><affiliation><nlm:aff id="rcr2253-aff-0003"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0004"></nlm:aff></affiliation></author><author><name sortKey="Steinfort, Daniel P" sort="Steinfort, Daniel P" uniqKey="Steinfort D" first="Daniel P" last="Steinfort">Daniel P. Steinfort</name><affiliation><nlm:aff id="rcr2253-aff-0001"></nlm:aff></affiliation><affiliation><nlm:aff id="rcr2253-aff-0004"></nlm:aff></affiliation></author></analytic><series><title level="j">Respirology Case Reports</title><idno type="eISSN">2051-3380</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p id="rcr2253-para-0001">Endobronchial valves (<styled-content style="fixed-case">EBVs</styled-content>) are increasingly deployed in the management of severe emphysema. Initial studies focussed on volume reduction as the mechanism, with subsequent improvement in forced expiratory volume in 1 s (<styled-content style="fixed-case">FEV<sub>1</sub></styled-content>). More recent studies have emphasized importance of perfusion on predicting outcomes, though findings have been inconsistent. Gallium‐68 ventilation–perfusion (V/Q) photon emission tomography (<styled-content style="fixed-case">PET</styled-content>)/computed tomography (<styled-content style="fixed-case">CT</styled-content>) is a novel imaging modality with advantages in spatial resolution, quantitation, and speed over conventional V/Q scintigraphy. We report a pilot case in which <styled-content style="fixed-case">V/Q‐PET</styled-content>/<styled-content style="fixed-case">CT</styled-content> demonstrated discordant findings compared with quantitative <styled-content style="fixed-case">CT</styled-content> analysis, and directed left lower lobe <styled-content style="fixed-case">EBV</styled-content> placement. The patient experienced a significant improvement in 6‐min walk distance (<styled-content style="fixed-case">6MWD</styled-content>) without change in spirometry. Post‐<styled-content style="fixed-case">EBV</styled-content> V/Q‐<styled-content style="fixed-case">PET</styled-content>/<styled-content style="fixed-case">CT</styled-content> demonstrated a marked decrease in unmatched (detrimental) V/Q areas and improvement in overall V/Q matching on post‐<styled-content style="fixed-case">EBV</styled-content> V/Q‐<styled-content style="fixed-case">PET</styled-content>/<styled-content style="fixed-case">CT</styled-content>. These preliminary novel findings suggest that <styled-content style="fixed-case">EBVs</styled-content> improve V/Q matching and may explain the observed functional improvements.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Respirol Case Rep</journal-id><journal-id journal-id-type="iso-abbrev">Respirol Case Rep</journal-id><journal-id journal-id-type="doi">10.1002/(ISSN)2051-3380</journal-id><journal-id journal-id-type="publisher-id">RCR2</journal-id><journal-title-group><journal-title>Respirology Case Reports</journal-title></journal-title-group><issn pub-type="epub">2051-3380</issn><publisher><publisher-name>John Wiley & Sons, Ltd</publisher-name><publisher-loc>Chichester, UK</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28808575</article-id><article-id pub-id-type="pmc">5550810</article-id><article-id pub-id-type="doi">10.1002/rcr2.253</article-id><article-id pub-id-type="publisher-id">RCR2253</article-id><article-categories><subj-group subj-group-type="overline"><subject>Case Report</subject></subj-group><subj-group subj-group-type="heading"><subject>Case Reports</subject></subj-group></article-categories><title-group><article-title>Reduced ventilation–perfusion (V/Q) mismatch following endobronchial valve insertion demonstrated by Gallium‐68 V/Q photon emission tomography/computed tomography</article-title><alt-title alt-title-type="right-running-head">Reduced V/Q mismatch after <styled-content style="fixed-case">EBV</styled-content></alt-title><alt-title alt-title-type="left-running-head">P. Leong <styled-content style="italic-in-any-context">et al</styled-content>.</alt-title></title-group><contrib-group><contrib id="rcr2253-cr-0001" contrib-type="author"><name><surname>Leong</surname><given-names>Paul</given-names></name><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-7409-9328</contrib-id><xref ref-type="aff" rid="rcr2253-aff-0001"><sup>1</sup></xref></contrib><contrib id="rcr2253-cr-0002" contrib-type="author"><name><surname>Le Roux</surname><given-names>Pierre‐Yves</given-names></name><xref ref-type="aff" rid="rcr2253-aff-0002"><sup>2</sup></xref><xref ref-type="aff" rid="rcr2253-aff-0003"><sup>3</sup></xref></contrib><contrib id="rcr2253-cr-0003" contrib-type="author"><name><surname>Callahan</surname><given-names>Jason</given-names></name><xref ref-type="aff" rid="rcr2253-aff-0002"><sup>2</sup></xref><xref ref-type="aff" rid="rcr2253-aff-0004"><sup>4</sup></xref></contrib><contrib id="rcr2253-cr-0004" contrib-type="author"><name><surname>Siva</surname><given-names>Shankar</given-names></name><xref ref-type="aff" rid="rcr2253-aff-0002"><sup>2</sup></xref><xref ref-type="aff" rid="rcr2253-aff-0004"><sup>4</sup></xref></contrib><contrib id="rcr2253-cr-0005" contrib-type="author"><name><surname>Hofman</surname><given-names>Michael S</given-names></name><xref ref-type="aff" rid="rcr2253-aff-0003"><sup>3</sup></xref><xref ref-type="aff" rid="rcr2253-aff-0004"><sup>4</sup></xref></contrib><contrib id="rcr2253-cr-0006" contrib-type="author" corresp="yes"><name><surname>Steinfort</surname><given-names>Daniel P</given-names></name><address><email>daniel.steinfort@mh.org.au</email></address><xref ref-type="aff" rid="rcr2253-aff-0001"><sup>1</sup></xref><xref ref-type="aff" rid="rcr2253-aff-0004"><sup>4</sup></xref></contrib></contrib-group><aff id="rcr2253-aff-0001"><label><sup>1</sup></label><named-content content-type="organisation-division">Department of Respiratory Medicine</named-content><institution>Melbourne Health</institution><named-content content-type="city">Melbourne</named-content><country country="AU">Australia</country></aff><aff id="rcr2253-aff-0002"><label><sup>2</sup></label><named-content content-type="organisation-division">Division of Radiation Oncology and Cancer Imaging</named-content><institution>Peter MacCallum Cancer Centre</institution><named-content content-type="city">Melbourne</named-content><country country="AU">Australia</country></aff><aff id="rcr2253-aff-0003"><label><sup>3</sup></label><named-content content-type="organisation-division">Department of Nuclear Medicine</named-content><institution>Brest University Hospital</institution><named-content content-type="city">Brest</named-content><country country="FR">France</country></aff><aff id="rcr2253-aff-0004"><label><sup>4</sup></label><institution>Department of Medicine, University of Melbourne</institution><named-content content-type="city">Melbourne</named-content><country country="AU">Australia</country></aff><author-notes><corresp id="correspondenceTo"><label>*</label><bold>Correspondence</bold><break></break>Daniel P Steinfort, Department of Respiratory Medicine, Melbourne Health, 300 Grattan Street, Parkville, Melbourne, Vic. 3000, Australia. E‐mail: <email>daniel.steinfort@mh.org.au</email><break></break></corresp></author-notes><pub-date pub-type="epub"><day>10</day><month>8</month><year>2017</year></pub-date><pub-date pub-type="collection"><month>9</month><year>2017</year></pub-date><volume>5</volume><issue>5</issue><issue-id pub-id-type="doi">10.1002/rcr2.v5.5</issue-id><elocation-id>e00253</elocation-id><history><date date-type="received"><day>20</day><month>4</month><year>2017</year></date><date date-type="rev-recd"><day>30</day><month>5</month><year>2017</year></date><date date-type="accepted"><day>24</day><month>6</month><year>2017</year></date></history><permissions><pmc-comment> © 2017 Asian Pacific Society of Respirology </pmc-comment>
<copyright-statement content-type="article-copyright">© 2017 The Authors. <italic>Respirology Case Reports</italic> published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology</copyright-statement><license license-type="creativeCommonsBy-nc-nd"><license-p>This is an open access article under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/4.0/">Creative Commons Attribution‐NonCommercial‐NoDerivs</ext-link> License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.</license-p></license></permissions><self-uri content-type="pdf" xlink:type="simple" xlink:href="file:RCR2-5-na.pdf"></self-uri><abstract id="rcr2253-abs-0001"><p id="rcr2253-para-0001">Endobronchial valves (<styled-content style="fixed-case">EBVs</styled-content>) are increasingly deployed in the management of severe emphysema. Initial studies focussed on volume reduction as the mechanism, with subsequent improvement in forced expiratory volume in 1 s (<styled-content style="fixed-case">FEV<sub>1</sub></styled-content>). More recent studies have emphasized importance of perfusion on predicting outcomes, though findings have been inconsistent. Gallium‐68 ventilation–perfusion (V/Q) photon emission tomography (<styled-content style="fixed-case">PET</styled-content>)/computed tomography (<styled-content style="fixed-case">CT</styled-content>) is a novel imaging modality with advantages in spatial resolution, quantitation, and speed over conventional V/Q scintigraphy. We report a pilot case in which <styled-content style="fixed-case">V/Q‐PET</styled-content>/<styled-content style="fixed-case">CT</styled-content> demonstrated discordant findings compared with quantitative <styled-content style="fixed-case">CT</styled-content> analysis, and directed left lower lobe <styled-content style="fixed-case">EBV</styled-content> placement. The patient experienced a significant improvement in 6‐min walk distance (<styled-content style="fixed-case">6MWD</styled-content>) without change in spirometry. Post‐<styled-content style="fixed-case">EBV</styled-content> V/Q‐<styled-content style="fixed-case">PET</styled-content>/<styled-content style="fixed-case">CT</styled-content> demonstrated a marked decrease in unmatched (detrimental) V/Q areas and improvement in overall V/Q matching on post‐<styled-content style="fixed-case">EBV</styled-content> V/Q‐<styled-content style="fixed-case">PET</styled-content>/<styled-content style="fixed-case">CT</styled-content>. These preliminary novel findings suggest that <styled-content style="fixed-case">EBVs</styled-content> improve V/Q matching and may explain the observed functional improvements.</p></abstract><kwd-group kwd-group-type="author-generated"><kwd id="rcr2253-kwd-0001">Bronchial valve implants</kwd><kwd id="rcr2253-kwd-0002">bronchoscopy</kwd><kwd id="rcr2253-kwd-0003">positron emission tomography</kwd><kwd id="rcr2253-kwd-0004">ventilation</kwd></kwd-group><counts><fig-count count="2"></fig-count><table-count count="2"></table-count><page-count count="4"></page-count><word-count count="1648"></word-count></counts><custom-meta-group><custom-meta><meta-name>source-schema-version-number</meta-name><meta-value>2.0</meta-value></custom-meta><custom-meta><meta-name>component-id</meta-name><meta-value>rcr2253</meta-value></custom-meta><custom-meta><meta-name>header-id</meta-name><meta-value>rcr2253-hdr-0001</meta-value></custom-meta><custom-meta><meta-name>cover-date</meta-name><meta-value>September 2017</meta-value></custom-meta><custom-meta><meta-name>details-of-publishers-convertor</meta-name><meta-value>Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.6 mode:remove_FC converted:10.08.2017</meta-value></custom-meta></custom-meta-group></article-meta><notes><p content-type="self-citation"><mixed-citation publication-type="journal" id="rcr2253-cit-0000"><string-name><surname>Leong</surname>, <given-names>P.</given-names></string-name>, <string-name><surname>Le Roux</surname>, <given-names>P.‐Y.</given-names></string-name>, <string-name><surname>Callahan</surname>, <given-names>J.</given-names></string-name>, <string-name><surname>Siva</surname>, <given-names>S.</given-names></string-name>, <string-name><surname>Hofman</surname>, <given-names>M.S.</given-names></string-name> and <string-name><surname>Steinfort</surname>, <given-names>D.P.</given-names></string-name> (<year>2017</year>) <article-title>Reduced ventilation–perfusion (V/Q) mismatch following endobronchial valve insertion demonstrated by Gallium‐68 V/Q photon emission tomography/computed tomography</article-title>. <source>Respirology Case Reports</source>, <volume>5</volume> (<issue>5</issue>), e00253. doi: <ext-link ext-link-type="doi" xlink:href="10.1002/rcr2.253">10.1002/rcr2.253</ext-link>.</mixed-citation></p></notes><notes><fn-group id="rcr2253-ntgp-0001"><fn id="rcr2253-note-0001"><p>Associate Editor: Semra Bilaceroglu</p></fn></fn-group></notes></front><body><sec id="rcr2253-sec-0001"><title>Introduction</title><p id="rcr2253-para-0003">Endobronchial valves (EBVs) are one‐way valves implanted via bronchoscopy in patients with advanced emphysema. These allow air to leave but not to enter emphysematous portions of lung, with benefits including improved exercise tolerance, health status, and lung function. A recent meta‐analysis indicates that EBVs have superior efficacy and a good level of safety compared with standard medications <xref rid="rcr2253-bib-0001" ref-type="ref">1</xref>.</p><p id="rcr2253-para-0004">The basis for these improvements is not known with great certainty. Published studies demonstrate that functional improvements are greater in patients in whom hyperinflation is relieved, though improvements in 6‐min walk distance (6MWD) and symptom scores correlate poorly with reductions in residual volume (RV) and improvements in forced expiratory ratio in 1 s (FEV<sub>1</sub>) <xref rid="rcr2253-bib-0002" ref-type="ref">2</xref>. Recent studies indicate that changes in lung perfusion may be significant factors in predicting response to EBV <xref rid="rcr2253-bib-0003" ref-type="ref">3</xref>, <xref rid="rcr2253-bib-0004" ref-type="ref">4</xref>.</p><p id="rcr2253-para-0005">Ventilation–perfusion (V/Q) matching can be assessed non‐invasively by two‐dimensional (2D) planar V/Q scintigraphy or three‐dimensional (3D) single‐photon emission computed tomography (SPECT) which may be combined with CT (SPECT/CT). Our group has demonstrated the utility of V/Q photon emission tomography (PET)/computed tomography (CT) owing to improved spatial and temporal resolution compared with SPECT/CT <xref rid="rcr2253-bib-0005" ref-type="ref">5</xref>.</p></sec><sec id="rcr2253-sec-0002"><title>Case Report</title><p id="rcr2253-para-0006">A 71‐year‐old man with severe hyperinflation (residual volume 187% predicted) and functional limitation (6MWD 160 m) presented for EBV implantation. At baseline, he had a modified medical research council (mMRC) score of 3, requiring a wheelchair for mobility outside the home. He had completed pulmonary rehabilitation and was adherent to optimal chronic obstructive pulmonary disease (COPD) pharmacotherapy.</p><p id="rcr2253-para-0007">Pre‐procedure assessment included quantitative CT analysis to examine fissure integrity and emphysematous severity/distribution, and Gallium‐68 (Ga‐68) V/Q‐PET/CT using a technique we have previously described <xref rid="rcr2253-bib-0005" ref-type="ref">5</xref>. Briefly, ventilation images were acquired following inhalation of Galligas (Cyclomedia, Sydney, NSW, Australia), and perfusion following injection of Ga‐68 macroaggregated albumin. Quantitative assessment of V/Q matching was calculated by dividing the volume of normal V/Q, unmatched defects, and matched defects by the total lung volume <xref rid="rcr2253-bib-0005" ref-type="ref">5</xref>.</p><p id="rcr2253-para-0008">qCT indicated the left upper lobe (LUL) to be the optimal target, with integrity of the left oblique fissure, volume expansion, and high destruction scores (43% <910 HU). However, V/Q‐PET/CT demonstrated good LUL function contributing to 41% of overall lung perfusion (Table <xref rid="rcr2253-tbl-0002" ref-type="table-wrap">2</xref>). Significantly, the left lower lobe (LLL) contributed only 4% of perfusion and demonstrated a high proportion of unmatched V/Q (Table <xref rid="rcr2253-tbl-0002" ref-type="table-wrap">2</xref>). We therefore targeted the LLL despite reduced volume and lower severity score (35% <910 HU).</p><p id="rcr2253-para-0009">At 4 weeks, there was significant clinical improvement with 6MWD improved to 240 m, 50% greater than baseline. mMRC improved to 2 at one month and he rejoined participation in community activities. Spirometry and plethysmographic changes were minimal (Table <xref rid="rcr2253-tbl-0001" ref-type="table-wrap">1</xref>).</p><table-wrap id="rcr2253-tbl-0001" xml:lang="en" orientation="portrait" position="float"><label>Table 1</label><caption><p>Pre‐ and post‐bronchodilator spirometry and body plethysmography.</p></caption><table frame="hsides" rules="groups"><col align="left" span="1"></col><col align="left" span="1"></col><col align="left" span="1"></col><thead valign="bottom"><tr style="border-bottom:solid 1px #000000"><th id="rcr2253-ent-0001" align="left" valign="bottom" rowspan="1" colspan="1">Parameter</th><th id="rcr2253-ent-0002" align="left" valign="bottom" rowspan="1" colspan="1">Prior to endobronchial valve insertion</th><th id="rcr2253-ent-0003" align="left" valign="bottom" rowspan="1" colspan="1">4 weeks after endobronchial valve insertion</th></tr></thead><tbody valign="top"><tr><td id="rcr2253-ent-0004" align="left" valign="top" rowspan="1" colspan="1">FEV<sub>1</sub></td><td id="rcr2253-ent-0005" align="left" valign="top" rowspan="1" colspan="1">0.7 L (26% predicted)</td><td id="rcr2253-ent-0006" align="left" valign="top" rowspan="1" colspan="1">0.7 L (25% predicted)</td></tr><tr><td id="rcr2253-ent-0007" align="left" valign="top" rowspan="1" colspan="1">FVC</td><td id="rcr2253-ent-0008" align="left" valign="top" rowspan="1" colspan="1">2.4 L (63% predicted)</td><td id="rcr2253-ent-0009" align="left" valign="top" rowspan="1" colspan="1">2.3 L (62% predicted)</td></tr><tr><td id="rcr2253-ent-0010" align="left" valign="top" rowspan="1" colspan="1">FEV<sub>1</sub>/FVC</td><td id="rcr2253-ent-0011" align="left" valign="top" rowspan="1" colspan="1">31%</td><td id="rcr2253-ent-0012" align="left" valign="top" rowspan="1" colspan="1">32%</td></tr><tr><td id="rcr2253-ent-0013" align="left" valign="top" rowspan="1" colspan="1">DLCO (unadjusted for haemoglobin)</td><td id="rcr2253-ent-0014" align="left" valign="top" rowspan="1" colspan="1">16 mL/mmHg/min (64% predicted)</td><td id="rcr2253-ent-0015" align="left" valign="top" rowspan="1" colspan="1">11 mL/mmHg/min (44% predicted)<xref ref-type="fn" rid="rcr2253-note-0003">*</xref></td></tr><tr><td id="rcr2253-ent-0016" align="left" valign="top" rowspan="1" colspan="1">KCO</td><td id="rcr2253-ent-0017" align="left" valign="top" rowspan="1" colspan="1">3.9 mL/mHg/min/L (103% predicted)</td><td id="rcr2253-ent-0018" align="left" valign="top" rowspan="1" colspan="1">3.1 mL/min/mHg/min (84% predicted)</td></tr><tr><td id="rcr2253-ent-0019" align="left" valign="top" rowspan="1" colspan="1">VA</td><td id="rcr2253-ent-0020" align="left" valign="top" rowspan="1" colspan="1">4.2 L (62% predicted)</td><td id="rcr2253-ent-0021" align="left" valign="top" rowspan="1" colspan="1">3.5 L (52% predicted)</td></tr><tr><td id="rcr2253-ent-0022" align="left" valign="top" rowspan="1" colspan="1">TLC</td><td id="rcr2253-ent-0023" align="left" valign="top" rowspan="1" colspan="1">7.8 L (116% predicted)</td><td id="rcr2253-ent-0024" align="left" valign="top" rowspan="1" colspan="1">7.4 L (110% predicted)</td></tr><tr><td id="rcr2253-ent-0025" align="left" valign="top" rowspan="1" colspan="1">RV</td><td id="rcr2253-ent-0026" align="left" valign="top" rowspan="1" colspan="1">4.9 L (187% predicted)</td><td id="rcr2253-ent-0027" align="left" valign="top" rowspan="1" colspan="1">5.0 L (190% predicted)</td></tr><tr><td id="rcr2253-ent-0028" align="left" valign="top" rowspan="1" colspan="1">RV/TLC</td><td id="rcr2253-ent-0029" align="left" valign="top" rowspan="1" colspan="1">62% predicted</td><td id="rcr2253-ent-0030" align="left" valign="top" rowspan="1" colspan="1">67% predicted</td></tr><tr><td id="rcr2253-ent-0031" align="left" valign="top" rowspan="1" colspan="1">6‐min walk distance</td><td id="rcr2253-ent-0032" align="left" valign="top" rowspan="1" colspan="1">160 m</td><td id="rcr2253-ent-0033" align="left" valign="top" rowspan="1" colspan="1">280 m</td></tr><tr><td id="rcr2253-ent-0034" align="left" valign="top" rowspan="1" colspan="1">Resting spo2, spo2 nadir</td><td id="rcr2253-ent-0035" align="left" valign="top" rowspan="1" colspan="1">92%, 90% at 1 min</td><td id="rcr2253-ent-0036" align="left" valign="top" rowspan="1" colspan="1">94%, 91% at 4 min</td></tr></tbody></table><table-wrap-foot><fn id="rcr2253-note-0002"><p>FEV<sub>1</sub>, forced expiratory volume in 1 s; FVC, forced vital capacity.</p></fn><fn id="rcr2253-note-0003"><label>*</label><p>DLCO likely underestimated as patient did not inhale to >85% FVC; at 5 months, repeat DLCO was 58% predicted.</p></fn></table-wrap-foot></table-wrap><p id="rcr2253-para-0010">V/Q‐PET/CT at 4 weeks demonstrated no significant change in LLL volume but major changes in V/Q matching (Table <xref rid="rcr2253-tbl-0002" ref-type="table-wrap">2</xref> and Fig. <xref rid="rcr2253-fig-0001" ref-type="fig">1</xref>). Within the LLL, normal V/Q remained low (<10%) but unmatched V/Q decreased from 67 to 16%. There was also a substantial reduction in unmatched V/Q in non‐target lobes.</p><table-wrap id="rcr2253-tbl-0002" xml:lang="en" orientation="portrait" position="float"><label>Table 2</label><caption><p>Ventilation and perfusion relationships at baseline and post‐EBV.</p></caption><table frame="hsides" rules="groups"><col align="left" span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="." span="1"></col><col align="char" char="" span="1"></col><col align="char" char="." span="1"></col><col align="left" span="1"></col><thead valign="bottom"><tr style="border-bottom:solid 1px #000000"><th id="rcr2253-ent-0037" align="left" valign="bottom" rowspan="1" colspan="1"></th><th id="rcr2253-ent-0038" align="center" valign="bottom" rowspan="1" colspan="1">Left lung</th><th id="rcr2253-ent-0039" align="center" valign="bottom" rowspan="1" colspan="1">Left lower lobe (target lobe)</th><th id="rcr2253-ent-0040" align="center" valign="bottom" rowspan="1" colspan="1">Left upper lobe</th><th id="rcr2253-ent-0041" align="center" valign="bottom" rowspan="1" colspan="1">Right lung</th><th id="rcr2253-ent-0042" align="center" valign="bottom" rowspan="1" colspan="1">Right lower lobe</th><th id="rcr2253-ent-0043" align="center" valign="bottom" rowspan="1" colspan="1">Right middle lobe</th><th id="rcr2253-ent-0044" align="center" valign="bottom" rowspan="1" colspan="1">Right upper lobe</th><th id="rcr2253-ent-0045" align="center" valign="bottom" rowspan="1" colspan="1">Whole lung</th></tr></thead><tbody valign="top"><tr><td colspan="9" align="left" id="rcr2253-ent-0046" valign="top" rowspan="1">V/Q‐PET/CT baseline</td></tr><tr><td id="rcr2253-ent-0047" align="left" valign="top" rowspan="1" colspan="1">Ventilation (%)</td><td id="rcr2253-ent-0048" align="char" valign="top" rowspan="1" colspan="1">46</td><td id="rcr2253-ent-0049" align="char" valign="top" rowspan="1" colspan="1">7</td><td id="rcr2253-ent-0050" align="char" valign="top" rowspan="1" colspan="1">38</td><td id="rcr2253-ent-0051" align="char" valign="top" rowspan="1" colspan="1">54</td><td id="rcr2253-ent-0052" align="char" valign="top" rowspan="1" colspan="1">7</td><td id="rcr2253-ent-0053" align="char" valign="top" rowspan="1" colspan="1">6</td><td id="rcr2253-ent-0054" align="char" valign="top" rowspan="1" colspan="1">41</td><td id="rcr2253-ent-0055" align="left" valign="top" rowspan="1" colspan="1">N/A</td></tr><tr><td id="rcr2253-ent-0056" align="left" valign="top" rowspan="1" colspan="1">Perfusion (%)</td><td id="rcr2253-ent-0057" align="char" valign="top" rowspan="1" colspan="1">45</td><td id="rcr2253-ent-0058" align="char" valign="top" rowspan="1" colspan="1">4</td><td id="rcr2253-ent-0059" align="char" valign="top" rowspan="1" colspan="1">41</td><td id="rcr2253-ent-0060" align="char" valign="top" rowspan="1" colspan="1">55</td><td id="rcr2253-ent-0061" align="char" valign="top" rowspan="1" colspan="1">4</td><td id="rcr2253-ent-0062" align="char" valign="top" rowspan="1" colspan="1">5</td><td id="rcr2253-ent-0063" align="char" valign="top" rowspan="1" colspan="1">46</td><td id="rcr2253-ent-0064" align="left" valign="top" rowspan="1" colspan="1">N/A</td></tr><tr><td id="rcr2253-ent-0065" align="left" valign="top" rowspan="1" colspan="1">CT volume (%)</td><td id="rcr2253-ent-0066" align="char" valign="top" rowspan="1" colspan="1">47</td><td style="bgcolor:#white" id="rcr2253-ent-0067" align="char" valign="top" rowspan="1" colspan="1">13</td><td id="rcr2253-ent-0068" align="char" valign="top" rowspan="1" colspan="1">34</td><td id="rcr2253-ent-0069" align="char" valign="top" rowspan="1" colspan="1">53</td><td id="rcr2253-ent-0070" align="char" valign="top" rowspan="1" colspan="1">11</td><td id="rcr2253-ent-0071" align="char" valign="top" rowspan="1" colspan="1">7</td><td id="rcr2253-ent-0072" align="char" valign="top" rowspan="1" colspan="1">34</td><td id="rcr2253-ent-0073" align="left" valign="top" rowspan="1" colspan="1">N/A</td></tr><tr><td id="rcr2253-ent-0074" align="left" valign="top" rowspan="1" colspan="1">Matched V/Q defects (%)</td><td id="rcr2253-ent-0075" align="char" valign="top" rowspan="1" colspan="1">13</td><td id="rcr2253-ent-0076" align="char" valign="top" rowspan="1" colspan="1">30</td><td id="rcr2253-ent-0077" align="char" valign="top" rowspan="1" colspan="1">6</td><td id="rcr2253-ent-0078" align="char" valign="top" rowspan="1" colspan="1">10</td><td id="rcr2253-ent-0079" align="char" valign="top" rowspan="1" colspan="1">21</td><td id="rcr2253-ent-0080" align="char" valign="top" rowspan="1" colspan="1">20</td><td id="rcr2253-ent-0081" align="char" valign="top" rowspan="1" colspan="1">5</td><td id="rcr2253-ent-0082" align="left" valign="top" rowspan="1" colspan="1">12</td></tr><tr><td id="rcr2253-ent-0083" align="left" valign="top" rowspan="1" colspan="1">Unmatched V/ Q defects (%)</td><td id="rcr2253-ent-0084" align="char" valign="top" rowspan="1" colspan="1">37</td><td id="rcr2253-ent-0085" align="char" valign="top" rowspan="1" colspan="1">67</td><td id="rcr2253-ent-0086" align="char" valign="top" rowspan="1" colspan="1">26</td><td id="rcr2253-ent-0087" align="char" valign="top" rowspan="1" colspan="1">34</td><td id="rcr2253-ent-0088" align="char" valign="top" rowspan="1" colspan="1">76</td><td id="rcr2253-ent-0089" align="char" valign="top" rowspan="1" colspan="1">44</td><td id="rcr2253-ent-0090" align="char" valign="top" rowspan="1" colspan="1">18</td><td id="rcr2253-ent-0091" align="left" valign="top" rowspan="1" colspan="1">35</td></tr><tr><td id="rcr2253-ent-0092" align="left" valign="top" rowspan="1" colspan="1">Normal V/Q (%)</td><td id="rcr2253-ent-0093" align="char" valign="top" rowspan="1" colspan="1">50</td><td id="rcr2253-ent-0094" align="char" valign="top" rowspan="1" colspan="1">3</td><td id="rcr2253-ent-0095" align="char" valign="top" rowspan="1" colspan="1">68</td><td id="rcr2253-ent-0096" align="char" valign="top" rowspan="1" colspan="1">56</td><td id="rcr2253-ent-0097" align="char" valign="top" rowspan="1" colspan="1">3</td><td id="rcr2253-ent-0098" align="char" valign="top" rowspan="1" colspan="1">36</td><td id="rcr2253-ent-0099" align="char" valign="top" rowspan="1" colspan="1">77</td><td id="rcr2253-ent-0100" align="left" valign="top" rowspan="1" colspan="1">53</td></tr><tr><td colspan="9" align="left" id="rcr2253-ent-0101" valign="top" rowspan="1">V/Q‐PET/CT post‐EBV</td></tr><tr><td id="rcr2253-ent-0102" align="left" valign="top" rowspan="1" colspan="1">Ventilation (%)</td><td id="rcr2253-ent-0103" align="char" valign="top" rowspan="1" colspan="1">43</td><td id="rcr2253-ent-0104" align="char" valign="top" rowspan="1" colspan="1">6</td><td id="rcr2253-ent-0105" align="char" valign="top" rowspan="1" colspan="1">38</td><td id="rcr2253-ent-0106" align="char" valign="top" rowspan="1" colspan="1">57</td><td id="rcr2253-ent-0107" align="char" valign="top" rowspan="1" colspan="1">9</td><td id="rcr2253-ent-0108" align="char" valign="top" rowspan="1" colspan="1">9</td><td id="rcr2253-ent-0109" align="char" valign="top" rowspan="1" colspan="1">38</td><td id="rcr2253-ent-0110" align="left" valign="top" rowspan="1" colspan="1">N/A</td></tr><tr><td id="rcr2253-ent-0111" align="left" valign="top" rowspan="1" colspan="1">Perfusion (%)</td><td id="rcr2253-ent-0112" align="char" valign="top" rowspan="1" colspan="1">45</td><td id="rcr2253-ent-0113" align="char" valign="top" rowspan="1" colspan="1">5</td><td id="rcr2253-ent-0114" align="char" valign="top" rowspan="1" colspan="1">40</td><td id="rcr2253-ent-0115" align="char" valign="top" rowspan="1" colspan="1">55</td><td id="rcr2253-ent-0116" align="char" valign="top" rowspan="1" colspan="1">7</td><td id="rcr2253-ent-0117" align="char" valign="top" rowspan="1" colspan="1">8</td><td id="rcr2253-ent-0118" align="char" valign="top" rowspan="1" colspan="1">41</td><td id="rcr2253-ent-0119" align="left" valign="top" rowspan="1" colspan="1">N/A</td></tr><tr><td id="rcr2253-ent-0120" align="left" valign="top" rowspan="1" colspan="1">CT volume (%)</td><td id="rcr2253-ent-0121" align="char" valign="top" rowspan="1" colspan="1">46</td><td id="rcr2253-ent-0122" align="char" valign="top" rowspan="1" colspan="1">14</td><td id="rcr2253-ent-0123" align="char" valign="top" rowspan="1" colspan="1">32</td><td id="rcr2253-ent-0124" align="char" valign="top" rowspan="1" colspan="1">54</td><td id="rcr2253-ent-0125" align="char" valign="top" rowspan="1" colspan="1">15</td><td id="rcr2253-ent-0126" align="char" valign="top" rowspan="1" colspan="1">9</td><td id="rcr2253-ent-0127" align="char" valign="top" rowspan="1" colspan="1">29</td><td id="rcr2253-ent-0128" align="left" valign="top" rowspan="1" colspan="1">N/A</td></tr><tr><td id="rcr2253-ent-0129" align="left" valign="top" rowspan="1" colspan="1">Matched V/Q defects (%)</td><td id="rcr2253-ent-0130" align="char" valign="top" rowspan="1" colspan="1">31</td><td id="rcr2253-ent-0131" align="char" valign="top" rowspan="1" colspan="1">75</td><td id="rcr2253-ent-0132" align="char" valign="top" rowspan="1" colspan="1">12</td><td id="rcr2253-ent-0133" align="char" valign="top" rowspan="1" colspan="1">26</td><td id="rcr2253-ent-0134" align="char" valign="top" rowspan="1" colspan="1">56</td><td id="rcr2253-ent-0135" align="char" valign="top" rowspan="1" colspan="1">40</td><td id="rcr2253-ent-0136" align="char" valign="top" rowspan="1" colspan="1">7</td><td id="rcr2253-ent-0137" align="left" valign="top" rowspan="1" colspan="1">29</td></tr><tr><td id="rcr2253-ent-0138" align="left" valign="top" rowspan="1" colspan="1">Unmatched V/Q defects (%)</td><td id="rcr2253-ent-0139" align="char" valign="top" rowspan="1" colspan="1">13</td><td id="rcr2253-ent-0140" align="char" valign="top" rowspan="1" colspan="1">16</td><td id="rcr2253-ent-0141" align="char" valign="top" rowspan="1" colspan="1">11</td><td id="rcr2253-ent-0142" align="char" valign="top" rowspan="1" colspan="1">14</td><td id="rcr2253-ent-0143" align="char" valign="top" rowspan="1" colspan="1">25</td><td id="rcr2253-ent-0144" align="char" valign="top" rowspan="1" colspan="1">15</td><td id="rcr2253-ent-0145" align="char" valign="top" rowspan="1" colspan="1">7</td><td id="rcr2253-ent-0146" align="left" valign="top" rowspan="1" colspan="1">13</td></tr><tr><td id="rcr2253-ent-0147" align="left" valign="top" rowspan="1" colspan="1">Normal V/Q</td><td id="rcr2253-ent-0148" align="char" valign="top" rowspan="1" colspan="1">56</td><td id="rcr2253-ent-0149" align="char" valign="top" rowspan="1" colspan="1">9</td><td id="rcr2253-ent-0150" align="char" valign="top" rowspan="1" colspan="1">76</td><td id="rcr2253-ent-0151" align="char" valign="top" rowspan="1" colspan="1">60</td><td id="rcr2253-ent-0152" align="char" valign="top" rowspan="1" colspan="1">19</td><td id="rcr2253-ent-0153" align="char" valign="top" rowspan="1" colspan="1">46</td><td id="rcr2253-ent-0154" align="char" valign="top" rowspan="1" colspan="1">86</td><td id="rcr2253-ent-0155" align="left" valign="top" rowspan="1" colspan="1">58</td></tr></tbody></table><table-wrap-foot><fn id="rcr2253-note-0004"><p>CT, computed tomography; EBV, endobronchial valve; PET, photon emission tomography.</p></fn><fn id="rcr2253-note-0005"><p>Ventilation, perfusion, and CT volume results are expressed as percentage of whole lung volume; matched, unmatched, and normal V/Q results are expressed as percentage of lobe volume.</p></fn></table-wrap-foot></table-wrap><fig fig-type="Figure" xml:lang="en" id="rcr2253-fig-0001" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Ventilation–perfusion (V/Q) relationships at baseline and post‐endobronchial valve by Gallium‐68 (Ga‐68) V/Q photon emission tomography/computed tomography (PET/CT). Sagittal images of V/Q relationships at baseline and post‐left lower lobe endobronchial valve insertion. In the bottom third of the figure, areas of unmatched V/Q defects (red) are fewer post‐valve insertion. Areas of normal V/Q matching (green), and areas of matched V/Q defects (blue) are increased post‐valve insertion.</p></caption><graphic id="nlm-graphic-3" xlink:href="RCR2-5-na-g001"></graphic></fig></sec><sec id="rcr2253-sec-0003"><title>Discussion</title><p id="rcr2253-para-0011">We have used pre‐procedure V/Q‐PET/CT to direct EBV therapy in this patient and achieved an excellent functional improvement. This is despite minimal changes in lobar volumes. Symptomatic benefit has mostly been ascribed to relief from hyperinflation; however, more recent studies demonstrate that redistribution of pulmonary perfusion may also be significant. Our report advances understanding of the physiology underlying the symptomatic responses to EBV. V/Q‐PET/CT demonstrates marked improvement in V/Q matching, leading to reduction in physiologic dead space ventilation, which we believe is the mechanism for improvement in our patient.</p><p id="rcr2253-para-0012">The literature examining the effect of EBVs on V/Q so far has largely focused on perfusion, with lesser examination of the role of ventilation, and no examination of V/Q matching. Pizarro et al. <xref rid="rcr2253-bib-0004" ref-type="ref">4</xref> used planar V/Q and found increased contralateral perfusion, whereas Thomsen et al. <xref rid="rcr2253-bib-0003" ref-type="ref">3</xref> used SPECT/CT to identify no predictive value of target lobe perfusion, but instead that high ipsilateral non‐target lobe perfusion predicted 6MWD improvement. Our report provides a basis for these seemingly contradictory findings.</p><p id="rcr2253-para-0013">V/Q‐PET/CT has greater spatial and temporal resolution <xref rid="rcr2253-bib-0005" ref-type="ref">5</xref> compared with conventional scintigraphic techniques described previously <xref rid="rcr2253-bib-0003" ref-type="ref">3</xref>, <xref rid="rcr2253-bib-0004" ref-type="ref">4</xref>, enabling accurate quantification of sub‐lobar physiologic function. Neither group performed respiratory gating, and both analysed images in 2D, which is inherently limited by the superimposition of structures, compromising assessment of lobar anatomy thereby negating accurate quantitation.</p><sec id="rcr2253-sec-0004"><title>Disclosure Statements</title><p id="rcr2253-para-0014">No conflict of interest declared.</p><p id="rcr2253-para-0015">Appropriate written informed consent was obtained for publication of this case report and accompanying images.</p></sec></sec></body><back><ref-list content-type="cited-references" id="rcr2253-bibl-0001"><title>References</title><ref id="rcr2253-bib-0001"><label>1</label><mixed-citation publication-type="journal" id="rcr2253-cit-0001"><string-name><surname>Liu</surname><given-names>H</given-names></string-name>, <string-name><surname>Xu</surname><given-names>M</given-names></string-name>, <string-name><surname>Xie</surname><given-names>Y</given-names></string-name>, et al. <year>2015</year><article-title>Efficacy and safety of endobronchial valves for advanced emphysema: a meta analysis</article-title>. <source>J. Thorac. Dis.</source><volume>7</volume>:<fpage>320</fpage>–<lpage>328</lpage>. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.3978/j.issn.2072-1439.2014.11.04">https://doi.org/10.3978/j.issn.2072‐1439.2014.11.04</ext-link>.<pub-id pub-id-type="pmid">25922709</pub-id></mixed-citation></ref><ref id="rcr2253-bib-0002"><label>2</label><mixed-citation publication-type="journal" id="rcr2253-cit-0002"><string-name><surname>Klooster</surname><given-names>K</given-names></string-name>, <string-name><surname>ten Hacken</surname><given-names>NHT</given-names></string-name>, <string-name><surname>Hartman</surname><given-names>JE</given-names></string-name>, et al. <year>2015</year><article-title>Endobronchial valves for emphysema without interlobar collateral ventilation</article-title>. <source>N. Engl. J. Med.</source><volume>373</volume>:<fpage>2325</fpage>–<lpage>2335</lpage>. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1056/NEJMoa1507807">https://doi.org/10.1056/NEJMoa1507807</ext-link>.<pub-id pub-id-type="pmid">26650153</pub-id></mixed-citation></ref><ref id="rcr2253-bib-0003"><label>3</label><mixed-citation publication-type="journal" id="rcr2253-cit-0003"><string-name><surname>Thomsen</surname><given-names>C</given-names></string-name>, <string-name><surname>Theilig</surname><given-names>D</given-names></string-name>, <string-name><surname>Herzog</surname><given-names>D</given-names></string-name>, et al. <year>2016</year><article-title>Lung perfusion and emphysema distribution affect the outcome of endobronchial valve therapy</article-title>. <source>Int. J. Chron. Obstruct. Pulmon. Dis.</source><volume>11</volume>:<fpage>1245</fpage>–<lpage>1259</lpage>. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.2147/COPD.S101003">https://doi.org/10.2147/COPD.S101003</ext-link>.<pub-id pub-id-type="pmid">27354783</pub-id></mixed-citation></ref><ref id="rcr2253-bib-0004"><label>4</label><mixed-citation publication-type="journal" id="rcr2253-cit-0004"><string-name><surname>Pizarro</surname><given-names>C</given-names></string-name>, <string-name><surname>Ahmadzadehfar</surname><given-names>H</given-names></string-name>, <string-name><surname>Essler</surname><given-names>M</given-names></string-name>, et al. <year>2015</year><article-title>Effect of endobronchial valve therapy on pulmonary perfusion and ventilation distribution</article-title>. <source>PLoS One</source><volume>10</volume>:<fpage>e0118976</fpage><ext-link ext-link-type="uri" xlink:href="https://doi.org/10.1371/journal.pone.0118976">https://doi.org/10.1371/journal.pone.0118976</ext-link>.<pub-id pub-id-type="pmid">25822624</pub-id></mixed-citation></ref><ref id="rcr2253-bib-0005"><label>5</label><mixed-citation publication-type="journal" id="rcr2253-cit-0005"><string-name><surname>Roux</surname><given-names>P‐YL</given-names></string-name>, <string-name><surname>Siva</surname><given-names>S</given-names></string-name>, <string-name><surname>Steinfort</surname><given-names>DP</given-names></string-name>, et al. <year>2015</year><article-title>Correlation of 68Ga ventilation–perfusion PET/CT with pulmonary function test indices for assessing lung function</article-title>. <source>J. Nucl. Med.</source><volume>56</volume>:<fpage>1718</fpage>–<lpage>1723</lpage>. <ext-link ext-link-type="uri" xlink:href="https://doi.org/10.2967/jnumed.115.162586">https://doi.org/10.2967/jnumed.115.162586</ext-link>.<pub-id pub-id-type="pmid">26338892</pub-id></mixed-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/Asie/explor/AustralieFrV1/Data/Pmc/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 0012589 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Pmc/Corpus/biblio.hfd -nk 0012589 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/Asie
|area= AustralieFrV1
|flux= Pmc
|étape= Corpus
|type= RBID
|clé=
|texte=
}}
| This area was generated with Dilib version V0.6.33. |  |