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OBJECTIVE: In current era of minimally invasive thoracic surgery, an accurate estimation of postoperative pulmonary function in patient with marginal pulmonary reservoir is important as it can guide to determine optimal extent of safe surgical resection at the segmental level. Integrated Single-Photon Emission Computed Tomography/Computed Tomography(SPECT/CT) provides patient-specific 3-dimensional images, which can overcome limitations of planar images related to overlaps of anatomic segments and variability of lobar shape which can vary according to patient’s underlying pulmonary conditions. We compared SPECT/CT with planar perfusion scintigraphy(PPS) in terms of predicting postoperative pulmonary function.
METHODS: From March to October 2015, we selected 12 patients whose predicted FEV1 or DLCO were under 80% of normal. SPECT/CT was performed using Technetium-99m-labeled macroaggregate of albumin and PPS was conducted at the same time. We compared predicted postoperative values calculated from PPS and SPECT/CT and analyzed the differences of two methods according to the underlying lung disease.
RESULTS: The median age was 65 year-old(range:53-82). Underlying lung diseases varied; bronchiectasis, obstructive lung disease, emphysematous lung, interstitial lung disease, and chronic empyema. The median preoperative predicted FEV1 and DLCO were 76.5%(range:28%-111%) and 65%(range:31%-118%), respectively. The median estimated ppoFEV1 using PPS and SPEC/CT were 59.2%(28.0%-101.8%) and 60.2%(26.4%-101.2%), respectively. We found significant correlation between two methods evaluating lobar perfusion(RUL;r=0.663,RLL;r=0.883,LUL;r=0.734,LLL;r=0.706) except for RML(p=0.339,r=0.303). We found if the patient had localized destructive lesions (patients #1, #2, #3, and #8), the ppoFEV1 estimated by SPECT/CT and that measured by PPS were different over 5% points. On the other hand, if the patients had either diffuse parenchymal abnormality or obstructive lung disease without definite parenchymal lesions, the ppoFEV1 estimated both methods showed similar values.
CONCLUSIONS: SPECT/CT seems to be useful in estimating postoperative pulmonary function if patients have localized parenchymal destructive lesion. In patients with either diffuse parenchymal disease or normal lung, PPS can provide comparable postoperative lung function with SPECT/CT. Additionally, SPECT/CT may guide surgeon to decide extent of segmentectomy as it can visually display the amount of perfusion.