Effect of exercise on lung-perfusion scanning in patients with bronchogenic carcinoma

Abstract

The aim of this study was to determine whether perfusion-scintillation scanning, used as a predictive pre-operative index of lung functionality in patients with lung cancer, is affected by the level of pulmonary blood flow (PBF).Twenty patients with primary lung cancer underwent spirometry and a radionuclideperfusion scan (macroaggregated albumin particles labelled with 99m Technetium) both at rest and during the last minute of a ramp-like increase in work rate until exhaustion.On average, the perfusion of the lung with the tumour was significantly reduced by the same magnitude at rest and during exercise (mean ¡ SD: -9 ¡ 6% versus -10 ¡ 4% of the cardiac output), regardless of the extent of the tumour. However, subject-by-subject analysis revealed that in two patients, a larger decrease in the perfusion of the lung with the tumour was observed during exercise than at rest (-11% and -17%, respectively). This leads to an underestimation of predictive postoperative functional parameters if resting values are used in these patients.The use of perfusion scintigraphy at rest therefore gives a clear picture of the functionality of the lung before resection in most patients requiring surgery. Eur Respir J 2002; 20: 710-716.

Perfusion Scintigraphy and Patient Selection for Lung Volume Reduction Surgery

“…Perfusion scintigraphy is another commonly available test for assessing the distribution of emphysema. Unlike chest CT, which defines only the anatomic distribution of emphysema, perfusion imaging also reflects regional lung function (5). Although the role of perfusion scintigraphy in patient selection for LVRS has been investigated by multiple prior studies, the results have been inconclusive (6)(7)(8)(9)(10)(11).…”

“…The likely reason why lung perfusion provides additional prognostic information in patients known to have upper lobe predominance on chest CT is because unlike chest CT, which is a purely anatomical measure of emphysema distribution, lung perfusion also reflects regional lung function (5,23). A combination of structural (chest CT) and functional (perfusion scintigraphy) upper lobe predominance may give a better summary of emphysema distribution for the purpose of patient selection for LVRS rather than structural disease alone.…”

Ventilation/perfusion lung scintigraphy: what is still needed? A review considering technetium-99m-labeled macro-aggregates of albumin

“…For this reason current nuclear-medical guidelines [16,17] state that they will include LPS for pre-operative function evaluation in future versions. Today, the combination of lung function tests and quantitative V/Q LS is routinely used to predict the post-operative lung function of lung-carcinoma patients [144,145]. Tc-99m-MAA is the method of choice, with exact and reproducible quantification of static lung perfusion [146].…”

Improving Image Quality of Bronchial Arteries with Virtual Monochromatic Spectral CT Images

“…We have demonstrated that optimal energy level existed in spectral CT pulmonary angiography to provide the best contrast-to-noise ratio for displaying bronchial arteries. The clear depiction of bronchial artery is very important for determining the blood supplies to lung tumors[ 7 ] and the origin and extent of hemoptysis[ 8 , 9 ].Arterial infusion chemotherapy and bronchial arterial embolism are often used on hemoptysis, and the preoperative understanding of the 3D anatomy, such as the number of bronchial artery, its origin and course, as well as diameter, will contribute to the formulation and implementation of the treatment. For interventional treatment of lung cancer patients, it also can effectively reduce the suppository by mistake or omission of blood vessels, thereby reducing the complications of interventional treatment[ 10 – 12 ].…”