School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.
Department of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Respiration. 2021;100(9):886-897. doi: 10.1159/000515336. Epub 2021 Mar 26.
Quantitative planar ventilation-perfusion (VQ) has a complementary role in target lobe selection for endobronchial valve lung volume reduction (EBV-LVR), especially in homogenous disease. We investigated a novel method of lung lobar quantitation using VQ single-photon emission computed tomography (SPECT) with computed tomography (CT) to generate a parameter called the ventilation-perfusion differential index (VQDI).
The aim of this study was to validate VQDI as a parameter for target lobe selection in EBV-LVR against the gold standard test of quantitative computed tomography (qCT).
This study was a prospective, multi-centre, single-blinded, observational study of EBV-LVR patients. Baseline and 3-month post intervention VQ SPECT and qCT were performed. The target lobe was chosen using qCT and planar VQ report (CTTL) whilst blinded to VQDI. Post EBV-LVR, our nuclear physician, blinded to CTTL, selected a target lobe using deidentified VQDI (VQDITL). Inter-rater agreement between CTTL and VQDITL was calculated by Kappa statistic. Treatment outcomes were analysed with a linear mixed-effects model.
There was a high concordance between CTTL and VQDITL in 16 patients (89%, Kappa statistic = 0.85). Post EBV-LVR, our subjects showed significant changes in FEV1 (mean difference [MD] +150 mL, p < 0.001), target lobe volume reduction (MD -973 mL, p < 0.001), residual volume (MD -800 mL, p < 0.001), and St. George's Respiratory Questionnaire score (MD -11, p = 0.001). Improvements in 6-minute walk distances did not reach statistical significance.
In this study of treatment responders, EBV-LVR target lobe selection using VQDI concurs with qCT and thus supports its value for this purpose. It complements qCT and may potentially be of synergistic value especially in homogenous emphysema.
定量平面通气灌注（VQ）在支气管内瓣肺减容术（EBV-LVR）的目标肺叶选择中具有互补作用，尤其是在同质疾病中。我们研究了一种使用 VQ 单光子发射计算机断层扫描（SPECT）与计算机断层扫描（CT）生成称为通气灌注差异指数（VQDI）的新型肺叶定量方法。
本研究旨在通过定量计算机断层扫描（qCT）的金标准测试验证 VQDI 作为 EBV-LVR 目标肺叶选择的参数。
这是一项前瞻性、多中心、单盲、观察性 EBV-LVR 患者研究。进行基线和干预后 3 个月的 VQ SPECT 和 qCT。目标肺叶的选择使用 qCT 和平面 VQ 报告（CTTL）进行，而 VQDI 则处于盲态。EBV-LVR 后，我们的核医学医师在不知道 CTTL 的情况下，使用去识别的 VQDI（VQDITL）选择目标肺叶。通过 Kappa 统计计算 CTTL 和 VQDITL 之间的组内一致性。采用线性混合效应模型分析治疗结果。
在 16 名患者中，CTTL 和 VQDITL 之间存在高度一致性（89%，Kappa 统计量=0.85）。EBV-LVR 后，我们的研究对象在 FEV1（平均差异[MD] +150 mL，p<0.001）、目标肺叶体积减少（MD-973 mL，p<0.001）、残气量（MD-800 mL，p<0.001）和圣乔治呼吸问卷评分（MD-11，p=0.001）方面均有显著变化。6 分钟步行距离的改善未达到统计学意义。
在这项针对治疗应答者的研究中，使用 VQDI 进行 EBV-LVR 目标肺叶选择与 qCT 一致，因此支持其在该目的中的价值。它补充了 qCT，尤其是在同质肺气肿中，可能具有协同价值。
