Kovacević-Kuśmierek Katarzyna, Kozak Józef, Pryt Łukasz, Bieńkiewicz Małgorzata, Cichocki Paweł, Kuśmierek Jacek, Płachcińska Anna
Department of Quality Control and Radiological Protection, Medical University of Łódź, Poland.
Nucl Med Rev Cent East Eur. 2015;18(2):70-7. doi: 10.5603/NMR.2015.0018.
Accurate prediction of postoperative pulmonary function in patients with non-small cell lung cancer is crucial for proper qualification for surgery, the only effective therapeutic method. The aim of the study was to select the most accurate method for acquisition and processing of lung perfusion scintigraphy (LPS) combined with spirometry for prediction of postoperative pulmonary function in patients qualified for surgery.
LPS was performed in 70 patients (40 males, 30 females), with preoperative spirometry (mean FEV1preop = 2.26 ± 0.72 L), after administration of 185 MBq of 99mTc-microalbumin/macroaggregate, using planar (appa) and SPECT/CT methods. Predicted postoperative lung function (FEV1pred) was calculated as a part of active lung parenchyma to remain after surgery. A non-imaging segment counting method was also applied. FEV1pred(appa, SPECT, SPECT/CT, segm.) were further compared with actual FEV1postop values obtained from postoperative spirometry.
In the whole studied group (47 lobectomies, 23 pneumonectomies) mean value of FEV1postop was equal to 1.76 (± 0.56) L. FEV1pred(appa, SPECT, SPECT/CT, segm.) were equal to 1.75 (± 0.58) L, 1.71 (± 0.57) L, 1.72 (± 0.57) L and 1.57 (± 0.58) L, respectively. A segment counting method systematically lowered predicted FEV1 values (p < 10-5). Moreover, in 31 patients with FEV1preop < 2 L error of predicted values was assessed with Bland-Altman method. Mean absolute differences FEV1postop - FEV1pred amounted to: appa - (0.04 ± 0.13) L, SPECT - (0.07 ± 0.14) L, SPECT/CT - (0.06 ± 0.14) L and segm. - (0.21 ± 0.19) L, respectively. Lower limit of 95% confidence interval calculated for planar - optimal method, was equal to -220 mL (also determined separately in subgroups after lobectomy and pneumonectomy).
This study shows that planar LPS may be applied for prediction of postoperative pulmonary function in patients qualified for pneumonectomy and lobectomy. If actual FEV1postop value is to be ≥ 800 mL, predicted value should exceed 1000 mL.
准确预测非小细胞肺癌患者术后肺功能对于确定手术（唯一有效的治疗方法）的合适人选至关重要。本研究的目的是选择最准确的方法来采集和处理肺灌注闪烁显像（LPS）并结合肺量计，以预测适合手术患者的术后肺功能。
对70例患者（40例男性，30例女性）进行LPS检查，术前进行肺量计检查（术前平均第一秒用力呼气容积[FEV1preop]=2.26±0.72L），静脉注射185MBq的99mTc - 微白蛋白/大聚合体后，采用平面显像（appa）和SPECT/CT方法。预测的术后肺功能（FEV1pred）作为术后剩余活性肺实质的一部分进行计算。还应用了非显像节段计数法。将FEV1pred（appa、SPECT、SPECT/CT、节段计数法）与术后肺量计检查获得的实际FEV1postop值进一步比较。
在整个研究组（47例肺叶切除术，23例全肺切除术）中，FEV1postop的平均值等于1.76（±0.56）L。FEV1pred（appa、SPECT、SPECT/CT、节段计数法）分别等于1.75（±0.58）L、1.71（±0.57）L、1.72（±0.57）L和1.57（±0.58）L。节段计数法系统性地降低了预测的FEV1值（p<10-5）。此外，对31例FEV·preop<2L的患者，用Bland - Altman方法评估预测值的误差。FEV1postop - FEV1pred的平均绝对差值分别为：appa -（0.04±0.13）L、SPECT -（0.07±0.14）L·SPECT/CT -（0.06±0.14）L和节段计数法 -（0.21±0.19）L。为平面显像 - 最佳方法计算的95%置信区间下限等于 - 220mL（在肺叶切除术和全肺切除术后的亚组中也分别确定）。
本研究表明，平面LPS可用于预测适合全肺切除术和肺叶切除术患者的术后肺功能。如果实际FEV1postop值要≥800mL，预测值应超过1000mL。
