肺灌注扫描与单光子发射计算机断层扫描/计算机断层扫描在预测肺功能临界患者肺切除术后肺功能方面的比较

Comparison between lung perfusion scan and single-photon emission computed tomography/computed tomography for predicting postoperative lung function after pulmonary resection in patients with borderline lung function.

作者信息

Na Kwon Joong, Park Samina, Lee Hyun Joo, Park In Kyu, Kang Chang Hyun, Kim Young Tae

机构信息

Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National College of Medicine, Seoul, Korea.

出版信息

Eur J Cardiothorac Surg. 2020 Dec 1;58(6):1228-1235. doi: 10.1093/ejcts/ezaa211.

DOI:10.1093/ejcts/ezaa211

PMID:32879936

Abstract

OBJECTIVES

We compared the usefulness of single-photon emission computed tomography/computed tomography (SPECT/CT) and lung perfusion scintigraphy (LPS) for predicting postoperative lung function by comparing patients with borderline lung function.

METHODS

A total of 274 patients who underwent simultaneous LPS and SPECT/CT and had a forced expiratory volume in 1 s (FEV1) or diffusing capacity for carbon monoxide (DLCO) under 80% were included. The % uptake by LPS was calculated by the posterior-oblique method. The concordance and difference of the % uptake, predicted postoperative (ppo) FEV1 and ppoDLCO as determined by 2 methods were evaluated. The association between ppo values and actual postoperative FEV1 and DLCO was examined. Subgroup analysis was conducted in redo-operation cases.

RESULTS

The % uptake of each lobe, except the right middle lobe, showed fair concordance (concordance correlation coefficients for right upper, middle, lower, left upper and lower lobe = 0.61, 0.37, 0.71, 0.66 and 0.69, respectively). ppoFEV1 and ppoDLCO also revealed high concordance between both methods (concordance correlation coefficient = 0.93 for ppoFEV1 and concordance correlation coefficient = 0.92 for ppoDLCO) without a significant difference (P = 0.42 for ppoFEV1; P = 0.31 for ppoDLCO). Both ppoFEV1 and ppoDLCO showed a significantly high correlation with the actual FEV1 (r = 0.77, P < 0.01 for LPS, r = 0.77, P < 0.01 for SPECT/CT) and DLCO (r = 0.62, P < 0.01 for LPS, r = 0.62, P < 0.01 for SPECT/CT). High concordance of % uptake, ppoFEV1 and ppoDLCO was present in redo-operation patients.

CONCLUSIONS

Both LPS and SPECT/CT showed high predictability for actual postoperative lung function, and LPS showed good performance to estimate ppoFEV1 and ppoDLCO with reference to SPECT/CT, even in redo-operation cases.

摘要

目的

通过比较肺功能临界患者，我们比较了单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）和肺灌注闪烁扫描（LPS）在预测术后肺功能方面的效用。

方法

纳入274例同时接受LPS和SPECT/CT检查且1秒用力呼气量（FEV1）或一氧化碳弥散量（DLCO）低于80%的患者。LPS的摄取百分比通过后斜位法计算。评估两种方法测定的摄取百分比、预测术后（ppo）FEV1和ppoDLCO的一致性和差异。检查ppo值与实际术后FEV1和DLCO之间的关联。对再次手术病例进行亚组分析。

结果

除右中叶外，各肺叶的摄取百分比显示出较好的一致性（右上叶、中叶、下叶、左上叶和下叶的一致性相关系数分别为0.61、0.37、0.71、0.66和0.69）。ppoFEV1和ppoDLCO在两种方法之间也显示出高度一致性（ppoFEV1的一致性相关系数 = 0.93，ppoDLCO的一致性相关系数 = 0.92），且无显著差异（ppoFEV1的P = 0.42；ppoDLCO的P = 0.31）。ppoFEV1和ppoDLCO与实际FEV1（LPS的r = 0.77，P < 0.01；SPECT/CT的r = 0.77，P < 0.01）和DLCO（LPS的r = 0.62，P < 0.01；SPECT/CT的r = 0.62，P < 0.01）均显示出显著的高度相关性。再次手术患者的摄取百分比、ppoFEV1和ppoDLCO具有高度一致性。