Improved prediction of lobar perfusion contribution using technetium-99m–labeled macroaggregate of albumin single photon emission computed tomography/computed tomography with attenuation correction

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 148; no. 5; pp. 2345 - 2352
• Main Authors: Toney, Lauren K., MS, MD, Wanner, Michelle, BS, Miyaoka, Robert S., PhD, Alessio, Adam M., PhD, Wood, Douglas E., MD, Vesselle, Hubert, PhD, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2014
• Subjects: Cardiothoracic Surgery; Forced Expiratory Volume; Humans; Lung - blood supply; Lung - diagnostic imaging; Lung - physiopathology; Lung - surgery; Lung Neoplasms - diagnosis; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - physiopathology; Lung Neoplasms - surgery; Multimodal Imaging; Patient Selection; Perfusion Imaging - methods; Pneumonectomy; Predictive Value of Tests; Preoperative Care; Pulmonary Circulation; Radiopharmaceuticals; Reproducibility of Results; Technetium Tc 99m Aggregated Albumin; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; computed tomography; ROIs; regions-of-interest; 36; 29; single photon emission computed tomography; volume-of-interest; Tc-99m MAA; MAA; SPECT; technetium-99m–labeled macroaggregate of albumin; 3D; CT; VOI; 10.2; FEV1; macro-aggregated of albumin; forced expiratory volume in 1 second; ppoFEV1; 3-dimensional; predicted postoperative FEV1; 10; COPD; chronic obstructive pulmonary disease
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2014.04.036

Objective Lung cancer resection can require removal of an entire lobe and, at times, bilobectomy or pneumonectomy. Many patients will also have significantly compromised lung function that requires limiting the extent of surgery or could preclude surgery altogether. The preoperative assessment should include predicted postoperative forced expiratory volume in 1 second (ppoFEV1), because a ppoFEV1 of <40% predicts significantly increased perioperative morbidity. The ppoFEV1 can be estimated by multiplying the preoperative FEV1 by the residual perfused territory percentage, as predicted on planar perfusion scintigraphy (PPS). However, ppoFEV1 using PPS has shown variable correlation with spirometry-measured postoperative FEV1. Methods We propose an improved method for assessing regional lung perfusion in preoperative lung surgery patients. Patients undergo single photon emission computed tomography/computed tomography (SPECT/CT) imaging with attenuation correction using the conventional perfusion agent, technetium-99m–labeled macroaggregate of albumin. The CT image provides information for manual segmentation of each lobe. These segmentations are applied to the SPECT images to determine lobar perfusion. This proposed method was compared with PPS. Results This technique was evaluated in 17 patients. As expected, the perfusion contributions of the right and left lungs, calculated from SPECT/CT, correlated closely with those obtained from PPS (Pearson r = 0.995). However, the lobar perfusion contributions obtained by PPS and SPECT/CT were significantly different, by 2 methods of comparison (Hotelling's P  = 1.7 × 10−6 and P  = 1.7 × 10−4 ). Conclusions This new SPECT/CT technique provides an anatomically more accurate assessment of lobar perfusion. This technique can refine which patients should be operative candidates and allow better prediction of postoperative function in contrast to the anatomically inaccurate planar scintigraphic predictions, which often underestimate the postoperative FEV1. This new technique is expected to have a significant effect on the resectability of patients with lung cancer.