平面肺灌注闪烁显像术预测术后 FEV1 在肺切除术中的准确性如何？两种处理方法的比较。

Is the predicted postoperative FEV1 estimated by planar lung perfusion scintigraphy accurate in patients undergoing pulmonary resection? Comparison of two processing methods.

机构信息

Department of Nuclear Medicine, Hacettepe University Medical Faculty, Sihhiye, 06100 Ankara, Turkey.

出版信息

Ann Nucl Med. 2010 Jul;24(6):447-53. doi: 10.1007/s12149-010-0378-6. Epub 2010 Apr 9.

DOI:10.1007/s12149-010-0378-6

PMID:20379857

Abstract

BACKGROUND

Estimation of postoperative forced expiratory volume in 1 s (FEV1) with radionuclide lung scintigraphy is frequently used to define functional operability in patients undergoing lung resection. We conducted a study to outline the reliability of planar quantitative lung perfusion scintigraphy (QLPS) with two different processing methods to estimate the postoperative lung function in patients with resectable lung disease.

METHODS

Forty-one patients with a mean age of 57 +/- 12 years who underwent either a pneumonectomy (n = 14) or a lobectomy (n = 27) were included in the study. QLPS with Tc-99m macroaggregated albumin was performed. Both three equal zones were generated for each lung [zone method (ZM)] and more precise regions of interest were drawn according to their anatomical shape in the anterior and posterior projections [lobe mapping method (LMM)] for each patient. The predicted postoperative (ppo) FEV1 values were compared with actual FEV1 values measured on postoperative day 1 (pod1 FEV1) and day 7 (pod 7 FEV1).

RESULTS

The mean of preoperative FEV1 and ppoFEV1 values was 2.10 +/- 0.57 and 1.57 +/- 0.44 L, respectively. The mean of Pod1FEV1 (1.04 +/- 0.30 L) was lower than ppoFEV1 (p < 0.0001) but increased on day 7 (1.31 +/- 0.32 L) (p < 0.0001); however, it never reached the predicted values. Zone and LMMs estimated mean ppoFEV1 as 1.56 +/- 0.45 and 1.57 +/- 0.44 L, respectively. Both methods overestimated the actual value by 50% (ZM), 51% (LMM) and 19% (ZM), 20% (LMM) for pod 1 and pod 7, respectively. This overestimation was more pronounced in patients with chronic lung disease and hilar tumors. No significant differences were observed between ppoFEV1 values estimated by ZM or by LMM (p > 0.05).

CONCLUSIONS

PpoFEV1 values predicted by both the zone and LMMs overestimated the actual measured lung volumes in patients undergoing pulmonary resection in the early postoperative period. LMM is not superior to ZM.

摘要

背景

放射性核素肺闪烁显像术（radionuclide lung scintigraphy）估测术后第 1 秒用力呼气量（forced expiratory volume in 1 s，FEV1）常用于评估可手术的肺部疾病患者的手术功能。我们进行了一项研究，旨在明确两种不同处理方法的平面定量肺灌注闪烁显像术（quantitative lung perfusion scintigraphy，QLPS）估算可手术肺部疾病患者术后肺功能的可靠性。

方法

本研究纳入了 41 例患者，年龄均数为 57±12 岁，行全肺切除术（n=14）或肺叶切除术（n=27）。患者接受 Tc-99m 聚合白蛋白 QLPS。对于每例患者，两种方法均生成三个等区（zone method，ZM），并根据前后位的解剖形状绘制更精确的感兴趣区（lobe mapping method，LMM）。术后预测的第 1 秒用力呼气量（predicted postoperative FEV1，ppoFEV1）与术后第 1 天（pod1 FEV1）和第 7 天（pod 7 FEV1）实际测量的第 1 秒用力呼气量进行比较。

结果

术前 FEV1 和 ppoFEV1 的平均值分别为 2.10±0.57 和 1.57±0.44 L。术后第 1 天（pod1 FEV1）的平均值为 1.04±0.30 L，低于 ppoFEV1（p<0.0001），术后第 7 天（pod 7 FEV1）升高至 1.31±0.32 L（p<0.0001），但仍未达到预测值。ZM 和 LMM 分别估计平均 ppoFEV1 为 1.56±0.45 和 1.57±0.44 L。两种方法在术后第 1 天和第 7 天都高估了实际值 50%（ZM）和 51%（LMM）和 19%（ZM）和 20%（LMM）。在慢性肺部疾病和肺门肿瘤患者中，这种高估更为明显。ZM 和 LMM 预测的 ppoFEV1 值之间无显著差异（p>0.05）。