Provost Karine, Leblond Antoine, Gauthier-Lemire Annie, Filion Édith, Bahig Houda, Lord Martin
Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and.
J Nucl Med Technol. 2017 Sep;45(3):185-192. doi: 10.2967/jnmt.117.191056. Epub 2017 Apr 13.
Planar perfusion scintigraphy with Tc-labeled macroaggregated albumin is often used for pretherapy quantification of regional lung perfusion in lung cancer patients, particularly those with poor respiratory function. However, subdividing lung parenchyma into rectangular regions of interest, as done on planar images, is a poor reflection of true lobar anatomy. New tridimensional methods using SPECT and SPECT/CT have been introduced, including semiautomatic lung segmentation software. The present study evaluated inter- and intraobserver agreement on quantification using SPECT/CT software and compared the results for regional lung contribution obtained with SPECT/CT and planar scintigraphy. Thirty lung cancer patients underwent ventilation-perfusion scintigraphy with Tc-macroaggregated albumin and Tc-Technegas. The regional lung contribution to perfusion and ventilation was measured on both planar scintigraphy and SPECT/CT using semiautomatic lung segmentation software by 2 observers. Interobserver and intraobserver agreement for the SPECT/CT software was assessed using the intraclass correlation coefficient, Bland-Altman plots, and absolute differences in measurements. Measurements from planar and tridimensional methods were compared using the paired-sample test and mean absolute differences. Intraclass correlation coefficients were in the excellent range (above 0.9) for both interobserver and intraobserver agreement using the SPECT/CT software. Bland-Altman analyses showed very narrow limits of agreement. Absolute differences were below 2.0% in 96% of both interobserver and intraobserver measurements. There was a statistically significant difference between planar and SPECT/CT methods ( < 0.001) for quantification of perfusion and ventilation for all right lung lobes, with a maximal mean absolute difference of 20.7% for the right middle lobe. There was no statistically significant difference in quantification of perfusion and ventilation for the left lung lobes using either method; however, absolute differences reached 12.0%. The total right and left lung contributions were similar for the two methods, with a mean difference of 1.2% for perfusion and 2.0% for ventilation. Quantification of regional lung perfusion and ventilation using SPECT/CT-based lung segmentation software is highly reproducible. This tridimensional method yields statistically significant differences in measurements for right lung lobes when compared with planar scintigraphy. We recommend that SPECT/CT-based quantification be used for all lung cancer patients undergoing pretherapy evaluation of regional lung function.
用锝标记的大颗粒白蛋白进行平面灌注闪烁扫描术常用于肺癌患者治疗前区域肺灌注的定量分析，尤其是呼吸功能较差的患者。然而，像在平面图像上那样将肺实质细分为矩形感兴趣区，并不能很好地反映真实的肺叶解剖结构。已引入了使用单光子发射计算机断层扫描（SPECT）和SPECT/计算机断层扫描（CT）的新三维方法，包括半自动肺分割软件。本研究评估了观察者间和观察者内使用SPECT/CT软件进行定量分析的一致性，并比较了用SPECT/CT和平面闪烁扫描术获得的区域肺贡献结果。30例肺癌患者接受了用锝标记的大颗粒白蛋白和锝- Technegas进行的通气-灌注闪烁扫描术。由2名观察者使用半自动肺分割软件在平面闪烁扫描术和SPECT/CT上测量区域肺对灌注和通气的贡献。使用组内相关系数、布兰德-奥特曼图和测量的绝对差值评估SPECT/CT软件的观察者间和观察者内一致性。使用配对样本检验和平均绝对差值比较平面法和三维法的测量结果。使用SPECT/CT软件时，观察者间和观察者内一致性的组内相关系数均处于优秀范围（高于0.9）。布兰德-奥特曼分析显示一致性界限非常窄。观察者间和观察者内测量结果中96%的绝对差值低于2.0%。对于所有右肺叶的灌注和通气定量分析，平面法和SPECT/CT法之间存在统计学显著差异（P<0.001），右中叶的最大平均绝对差值为20.7%。使用这两种方法对左肺叶的灌注和通气进行定量分析时均无统计学显著差异；然而，绝对差值达到了12.0%。两种方法的左右肺总贡献相似，灌注的平均差值为1.2%，通气的平均差值为2.0%。使用基于SPECT/CT的肺分割软件对区域肺灌注和通气进行定量分析具有高度可重复性。与平面闪烁扫描术相比，这种三维方法在右肺叶测量结果上产生了统计学显著差异。我们建议对所有接受区域肺功能治疗前评估的肺癌患者使用基于SPECT/CT的定量分析。
