Clinic of Thoracic Surgery, University Hospital Basel, Basel, Switzerland.
Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Clin Lung Cancer. 2023 Nov;24(7):621-630. doi: 10.1016/j.cllc.2023.07.006. Epub 2023 Jul 29.
Based on previous studies, single-photon emission computed tomography/computed tomography (SPECT/CT) has been proven more accurate and reproducible than planar lung perfusion scintigraphy to assess lobar perfusion. However, the impact of 3D-quantitated SPECT/CT on intended management in functionally marginal candidates for pulmonary resection is unknown. The evaluation of this impact was the main aim of this study.
Consecutive candidates for lung resection underwent preoperative evaluation according to ERS/ESTS Algorithm and underwent preoperative lung perfusion imaging. The lobar contribution to the total lung perfusion was estimated using established planar scintigraphic methods and 3-dimensional quantitative SPECT/CT method (CT Pulmo3D and xSPECT-Quant, Siemens). The difference in estimated lobar perfusion with resulting changes in predicted postoperative (ppo) lung function and extent of lung resection were analyzed to reveal possible changes in operability. In-hospital outcome was assessed.
One hundred twenty patients (46 females) were enrolled. The mean age (±SD) of patients was 68 ± 9 years, target lesions were in upper lobes in 57.7% and in lower lobes in 33.5%. The median FEV1 (forced expiratory volume in 1 second) was 70.5% (IQR 52-84) and median DLCO (diffusion capacity of lung for carbon monoxide) was 56.6% [47.1-67.4]. The planar posterior oblique method, compared to 3D-quantitated SPECT/CT, underestimated the perfusion of upper lobes by a median difference of 5% (right [2-9], left [2.5-8]; P = <.0001), while it overestimated the perfusion of lower lobes (left by 4% [2-7], right by 6% [2-9]; P = <.0001). In contrast to planar scintigraphy-based evaluation, 4 patients (3.3%), all with upper lobe lesions, were classified as inoperable when 3D-quantitated SPECT/CT was used for calculation of the ppo lung function.
In selected patients with upper lobe lesions, 3D-quantitated SPECT/CT would have changed the treatment strategy from operable to inoperable. Importantly, postoperative mortality in this particular subgroup was disproportionally high. 3D-quantitated SPECT/CT shall be further evaluated as it might improve preoperative risk stratification in functionally marginal candidates.
基于既往研究，单光子发射计算机断层扫描/计算机断层扫描（SPECT/CT）在评估肺叶灌注方面比平面肺灌注闪烁显像更准确、更具可重复性。然而，3D 定量 SPECT/CT 对肺切除功能边缘候选者的预期管理的影响尚不清楚。本研究的主要目的是评估这种影响。
连续入选肺切除术患者，按照 ERS/ESTS 算法进行术前评估，并进行术前肺灌注显像。采用既定的平面闪烁显像方法和 3 维定量 SPECT/CT 方法（CT Pulmo3D 和 xSPECT-Quant，西门子）评估每个肺叶的灌注量。分析估计的肺叶灌注差异导致预测术后（ppo）肺功能和肺切除范围的变化，以揭示手术可行性的变化。评估住院期间的结局。
共纳入 120 例患者（46 例女性）。患者的平均年龄（±SD）为 68±9 岁，靶病变位于上叶 57.7%，下叶 33.5%。中位 FEV1（1 秒用力呼气容积）为 70.5%（IQR 52-84），中位 DLCO（一氧化碳弥散量）为 56.6%[47.1-67.4]。与 3D 定量 SPECT/CT 相比，平面后斜位法低估了上叶灌注，中位数差异为 5%（右[2-9]，左[2.5-8]；P<.0001），而高估了下叶灌注（左叶 4%[2-7]，右叶 6%[2-9]；P<.0001）。与基于平面闪烁显像的评估相比，当使用 3D 定量 SPECT/CT 计算 ppo 肺功能时，4 例（3.3%）患者被归类为不能手术，这些患者均有上叶病变。
在选择的上叶病变患者中，3D 定量 SPECT/CT 可能会将治疗策略从可手术改为不可手术。重要的是，该亚组的术后死亡率不成比例地高。3D 定量 SPECT/CT 应进一步评估，因为它可能改善功能边缘候选者的术前风险分层。
