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DOI: 10.3413/Nukmed-0729-15-03
Preoperative assessment of relative pulmonary lobar perfusion fraction in lung cancer patients[*]
A rather simple three-dimensional CT-based vs. planar image-derived quantificationPräoperative Abschätzung der relativen lobären Perfusionsanteile bei Patienten mit Bronchialkarzinom3D versus planare QuantifizierungPublication History
received:
03 March 2015
accepted in revised form:
18 May 2015
Publication Date:
28 December 2017 (online)
Summary
Preoperative quantification of (relative) pulmonary lobar perfusion fraction using scintigraphy is established in predicting lung function after pulmonary surgery. Aim was to develop an easy and truly anatomical method for relative pulmonary lobar perfusion fraction quantification using SPECT/CT and to compare results with those from planar analyses in lung cancer patients. Patients, methods: 36 patients with operable lung cancer, borderline lung function referred to pre-operative quantification. Perfusion SPECT-data were acquired p.i. of 163±9 MBq 99mTc-MAA, subsequent low-dose-CT (SymbiaT, Siemens). Iterative Flash3D-reconstruction, manual 3D segmentation of all lobes using PMOD. VOI transfer to coregistered perfusion SPECTdata, calculation of lobar fractions. Modelbased calculation of relative lobar fractions based on planar data, analysis of planar vs. 3D results using t-test. Results: Significant differences (p<0.05) between the results from 3D method and planar imaging were found for right upper and middle lobe and both lower lobes. Maximum differences ranged from 10.9% (left upper lobe) to 22.9% (right upper lobe). Conclusions: Relative pulmonary lobar perfusion fraction can easily be obtained by an anatomically driven 3D quantification. Results yielded by this method and the traditional planar approach differed greatly, possibly affecting eligibility for lung surgery in individual patients. Considering these results a 3D approach should be used whenever possible.
Zusammenfassung
Die Quantifizierung der (relativen) lobären Perfusionsanteile ist ein etabliertes Verfahren in der präoperativen Abschätzung der postoperativen Lungenfunktion. Ziel der Studie ist die Entwicklung einer auf der individuellen Patientenanatomie basierenden Methode zur Beurteilung der relativen Perfusionsanteile mittels SPECT/CT. Zudem sollen die Ergebnisse einer planaren gegenüber einer 3D-Analyse verglichen werden. Patienten, Material, Methoden: 36 Patienten (operables Bronchialkarzinom, grenzwertige Lungenfunktion), überwiesen zur prä-OP-Perfusions-SPECT. SPECT-Akquisition p.i. von 163±9 MBq 99mTc- MAA, anschließend low-dose-CT (SymbiaT, Siemens). Iterative Flash-3D-Rekonstruktion, manuelle Segmentierung der low-dose-CT mit PMOD, Transfer der VOIs auf die SPECTStudien, Kalkulation der relativen Lappenanteile. Modellbasierte Kalkulation der relativen Lappenanteile (planare Daten). Berechnung der Mittelwerte der relativen Lappenanteile und der absoluten Differenzen, Analyse der Ergebnisse mittels T-Test. Ergebnisse: Signifikant (p<0,05) unterschiedliche Lappenanteile für rechten Oberlappen, Mittellappen und beide Unterlappen. Maximale Differenzen reichten von 10,9% (linker Oberlappen) bis 22,9% (rechter Oberlappen). Schlussfolgerung: Die relativen lobären Perfusionsanteile können mit der anatomisch-basierten 3D-Quantifizierung relativ einfach bestimmt werden. Die 3D-Ergebnisse weichen teils sehr erheblich von der modellbasierten Berechnung (planare Szintigrafie) ab. Diese Abweichungen können möglicherweise die Indikationsstellung zur Operation beeinflussen, daher sollte – wann immer möglich – präoperativ ein 3D-Ansatz verwendet werden.
Keywords
Quantitative lung perfusion SPECT/CT - 3D-quantification - lung cancer - estimated postoperative FEV 1.0Schlüsselwörter
Quantitative Lungenperfusions-SPECT/CT - 3D-Quantifizierung - Bronchialkarzinom - postoperativ zu erwartende FEV 1.0* Parts of this work have been presented at the annual meetings of the SNMMI and DGN 2013.
** Daniela Knollmann and Andreas Meyer have contributed equally to this work.
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References
- 1 Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307-310.
- 2 Bolliger CT, Perruchoud AP. Functional evaluation of the lung resection candidate. Eur Respir J 1998; 11: 198-212.
- 3 Bria WF, Kanarek DJ, Kazemi H. Prediction of postoperative pulmonary function following thoracic operations. Value of ventilation-perfusion scanning. J Thorac Cardiovasc Surg 1983; 86: 186-192.
- 4 Hirose Y, Imaeda T, Doi H. et al. Lung perfusion SPECT in predicting postoperative pulmonary function in lung cancer. Ann Nucl Med 1993; 7: 123-126.
- 5 Imaeda T, Kanematsu M, Asada S. et al. Prediction of pulmonary function after resection of primary lung cancer. Utility of inhalation-perfusion SPECT imaging. Clin Nucl Med 1995; 20: 792-799.
- 6 Markos J, Mullan BP, Hillman DR. et al. Preoperative assessment as a predictor of mortality and morbidity after lung resection. Am Rev Respir Dis 1989; 139: 902-910.
- 7 Mende T, Orlick M, Fischbeck O. et al. Risk assessment of bronchial cancer surgery using quantitative lung perfusion scintigraphy. Nuklearmedizin 1990; 29: 274-277.
- 8 Ohno Y, Koyama H, Nogami M. et al. State-of-the-art radiological techniques improve the assessment of postoperative lung function in patients with non-small cell lung cancer. Eur J Radiol 2011; 77: 97-104.
- 9 Roach PJ, Gradinscak DJ, Schembri GP. et al. SPECT/CT in V/Q scanning. Semin Nucl Med 2010; 40: 455-466.
- 10 Suga K, Kawakami Y, Zaki M. et al. Clinical utility of co-registered respiratory-gated 99mTc-Technegas/MAA SPECT-CT images in the assessment of regional lung functional impairment in patients with lung cancer. Eur J Nucl Med Mol Imaging 2004; 31: 1280-1290.