Ventilation/perfusion SPECT/CT in patients with pulmonary emphysema^[*]

Summary

The purpose of this study was to evaluate the reproducibility of a new software based analysing system for ventilation/perfusion single-photon emission computed tomography/ computed tomography (V/P SPECT/CT) in patients with pulmonary emphysema and to compare it to the visual interpretation. Patients, material and methods: 19 patients (mean age: 68.1 years) with pulmonary emphysema who underwent V/P SPECT/CT were included. Data were analysed by two independent observers in visual interpretation (VI) and by software based analysis system (SBAS). SBAS PMOD version 3.4 (Technologies Ltd, Zurich, Switzerland) was used to assess counts and volume per lung lobe/per lung and to calculate the count density per lung, lobe ratio of counts and ratio of count density. VI was performed using a visual scale to assess the mean counts per lung lobe. Interobserver variability and association for SBAS and VI were analysed using Spearman's rho correlation coefficient. Results: Interobserver agreement correlated highly in perfusion (rho: 0.982, 0.957, 0.90, 0.979) and ventilation (rho: 0.972, 0.924, 0.941, 0.936) for count/count density per lobe and ratio of counts/count density in SBAS. Interobserver agreement correlated clearly for perfusion (rho: 0.655) and weakly for ventilation (rho: 0.458) in VI. Conclusions: SBAS provides more reproducible measures than VI for the relative tracer uptake in V/P SPECT/CTs in patients with pulmonary emphysema. However, SBAS has to be improved for routine clinical use.

Zusammenfassung

Ziel dieser Studie ist die Evaluation der Reproduzierbarkeit Software basierter Analyse von Ventilations-/Perfusions SPECT/CT Untersuchungen in Patienten mit Lungenemphysem und deren Vergleich mit der visuellen Bildinterpretation. Patienten, Material und Methode: 19 Patienten (Durchschnittsalter: 68,1 Jahre) mit Lungenemphysem, die sich einer V/P SPECT/CT unterzogen wurden eingeschlossen. Die Datenanlyse erfolgte durch zwei unabhängige Observer mittels visueller Interpretation (VI) und Software basierten Analyse Systems (SBAS). SBAS PMOD Version 3.4 (Technologies Ltd, Zurich, Switzerland) wurde genutzt, um die Counts und das Volumen pro Lungenlappen/Lunge zu erheben und die Countdichte pro Lunge, die Countratio pro Lungenlappen und die Ratio der Countdichte zu kalkulieren. VI der Counts pro Lungenlappen erfolgte mithilfe einer visuellen Skala. Interobserver-Variabilität und Assoziation für SBAS und VI wurde mittels Spearman- Korrelation berechnet. Ergebnisse: Die übereinstimmung der Interobserver korrelierte hoch in der Perfusion (rho: 0,982; 0,957; 0,90; 0,979) und Ventilation (rho: 0,972; 0,942; 0,941; 0,936) für Counts/Countdichte pro Lungenlappen und Ratio der Counts/ Countdichte unter Verwendung des SBAS. Die übereinstimmung der Interobserver korrelierte klar für die Perfusion (rho: 0,655) und schwach für die Ventilation (rho: 0,458) in der VI. Schlussfolgerung: SBAS für V/P SPECT/ CT erzielt -im Vgl. zur VI-reproduzierbarere Messungen des relativen Traceruptakes in Patienten mit Lungenemphysem. Dennoch sollte die SBAS vor ihrem routinemäßigen Einsatz in der Klinik verbessert werden.

Keywords

V/P SPECT/CT - pulmonary emphysema - software-based analysing

Schlüsselwörter

V/P SPECT/CT - Software basierte Analyse - Lungenemphysem

^* This work has been presented orally on RSNA 2013, SNMMI 2014 and DGN 2014.

• References

• 1 Bajc M, Bitzen U, Olsson B. et al. Lung ventilation/perfusion SPECT in the artificially embolized pig. J Nucl Med 2002; 43: 640-647.
• 2 Bajc M, Olsson CG, Olsson B. et al. Diagnostic evaluation of planar and tomographic ventilation/perfusion lung images in patients with suspected pulmonary emboli. Clin Physiol Funct Imaging 2004; 24: 249-256.
• 3 Celli BR, MacNee W. Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. Eur Respi J 2004; 23: 932-946.
• 4 E D. Nuklearmedizin Funktionsdiagnostik. 1979
• 5 Gasparini S, Zuccatosta L, Bonifazi M. et al. Bronchoscopic treatment of emphysema: state of the art. Respiration 2012; 84: 250-263.
• 6 Gutte H, Mortensen J, Jensen CV. et al. Comparison of V/Q SPECT and planar V/Q lung scintigraphy in diagnosing acute pulmonary embolism. Nucl Med Commun 2010; 31: 82-86.
• 7 Jamadar DA, Kazerooni EA, Martinez FJ. et al. Semi-quantitative ventilation/perfusion scintigraphy and single-photon emission tomography for evaluation of lung volume reduction surgery candidates: description and prediction of clinical outcome. Eur J Nucl Med 1999; 26: 734-742.
• 8 Jogi J, Ekberg M, Jonson B. et al. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT. Eur J Nucl Med 2011; 38: 1344-52.
• 9 Kontogianni K, Gerovasili V, Gompelmann D. et al. Effectiveness of endobronchial coil treatment for lung volume reduction in patients with severe heterogeneous emphysema and bilateral incomplete fissures: a six-month follow-up. Respiration 2014; 88: 52-60.
• 10 Magnussen JS, Chicco P, Palmer AW. et al. Single-photon emission tomography of a computerised model of pulmonary embolism. Eur J Nucl Med 1999; 26: 1430-1438.
• 11 Roach PJ, Bailey DL, Harris BE. Enhancing lung scintigraphy with single-photon emission computed tomography. Semin Nucl Med 2008; 38: 441-449.
• 12 Roach PJ, Bailey DL, Schembri GP. et al. Transition from planar to SPECT V/Q scintigraphy: rationale, practicalities, and challenges. Semin Nucl Med 2010; 40: 397-407.
• 13 Roach PJ, Gradinscak DJ, Schembri GP. et al. SPECT/CT in V/Q scanning. Semin Nucl Med 2010; 40: 455-566.
• 14 Sciurba FC, Ernst A, Herth FJ. et al. A randomized study of endobronchial valves for advanced emphysema. N Engl J 2010; 363: 1233-1244.
• 15 Suga K. Technical and analytical advances in pulmonary ventilation SPECT with xenon-133 gas and Tc-99m-Technegas. Ann Nucl Med 2002; 16: 303-310.
• 16 Suga K, Kawakami Y, Zaki M. et al. Pulmonary perfusion assessment with respiratory gated 99mTc macroaggregated albumin SPECT: preliminary results. Nucl Med Commun 2004; 25: 183-193.
• 17 Suga K, Yasuhiko K, Zaki M. et al. Assessment of regional lung functional impairment with co-registered respiratory-gated ventilation/perfusion SPET-CT images: initial experiences. Eur J Nucl Med 2004; 31: 240-249.
• 18 Ue H, Haneishi H, Iwanaga H. et al. Nonlinear motion correction of respiratory-gated lung SPECT images. IEEE Trans Med Imaging 2006; 25: 486-495.
• 19 Wagner M, Ficker JH. Interventional therapy of pulmonary emphysema. Dtsch Med Wochenschr 2012; 137: 594-600.
• 20 Wagner Jr HN, Sabiston Jr. DC, McAfee JG. et al. Diagnosis of Massive Pulmonary Embolism in Man by Radioisotope Scanning. N Engl J Med 1964; 271: 377-384.
• 21 West JB. Blood flow to the lung and gas exchange. Anesthesiology. 1974; 41: 124-138.
• 22 Yuan ST, Frey KA, Gross MD. et al. Semiquantification and classification of local pulmonary function by V/Q single photon emission computed tomography in patients with non-small cell lung cancer: potential indication for radiotherapy planning. J Thorac Oncol 2011; 6: 71-78.