Leong Paul, Le Roux Pierre-Yves, Callahan Jason, Siva Shankar, Hofman Michael S, Steinfort Daniel P
Department of Respiratory Medicine Melbourne Health Melbourne Australia.
Division of Radiation Oncology and Cancer Imaging Peter MacCallum Cancer Centre Melbourne Australia.
Respirol Case Rep. 2017 Aug 10;5(5):e00253. doi: 10.1002/rcr2.253. eCollection 2017 Sep.
Endobronchial valves (EBVs) are increasingly deployed in the management of severe emphysema. Initial studies focussed on volume reduction as the mechanism, with subsequent improvement in forced expiratory volume in 1 s (FEV). More recent studies have emphasized importance of perfusion on predicting outcomes, though findings have been inconsistent. Gallium-68 ventilation-perfusion (V/Q) photon emission tomography (PET)/computed tomography (CT) is a novel imaging modality with advantages in spatial resolution, quantitation, and speed over conventional V/Q scintigraphy. We report a pilot case in which V/Q-PET/CT demonstrated discordant findings compared with quantitative CT analysis, and directed left lower lobe EBV placement. The patient experienced a significant improvement in 6-min walk distance (6MWD) without change in spirometry. Post-EBV V/Q-PET/CT demonstrated a marked decrease in unmatched (detrimental) V/Q areas and improvement in overall V/Q matching on post-EBV V/Q-PET/CT. These preliminary novel findings suggest that EBVs improve V/Q matching and may explain the observed functional improvements.
支气管内瓣膜（EBV）在重度肺气肿的治疗中应用越来越广泛。最初的研究聚焦于将肺容积减少作为其作用机制，随后1秒用力呼气量（FEV）得到改善。最近的研究强调了灌注在预测治疗结果方面的重要性，不过研究结果并不一致。镓-68通气-灌注（V/Q）正电子发射断层显像（PET）/计算机断层扫描（CT）是一种新型成像方式，与传统V/Q闪烁扫描相比，在空间分辨率、定量分析和速度方面具有优势。我们报告了一个试点病例，其中V/Q-PET/CT与定量CT分析相比显示出不一致的结果，并指导了左下叶EBV的放置。该患者6分钟步行距离（6MWD）显著改善，而肺功能测定未发生变化。EBV置入术后的V/Q-PET/CT显示不匹配（有害）的V/Q区域明显减少，且EBV置入术后的V/Q-PET/CT上总体V/Q匹配情况有所改善。这些初步的新发现表明，EBV可改善V/Q匹配，并可能解释所观察到的功能改善情况。
