Gallium-68 perfusion positron emission tomography/computed tomography to assess pulmonary function in lung cancer patients undergoing surgery

Abstract

BackgroundPre-operative evaluation of lung cancer patients relies on calculation of predicted post-operative (PPO) lung function based on split lung function testing. Pulmonary perfusion (Q) PET/CT can now be performed by substituting Technetium-99 m labeling of macroaggregated albumin (MAA) with Gallium-68. This study compares Q PET/CT with current recommended methods of pre-operative lung function assessment.MethodsTwenty-two patients planned for curative surgical resection (mean FEV1 77 %, SD 21 %; mean DLCO 66 %, SD 17 % predicted) underwent pre-operative Q PET/CT. Sixteen patients also underwent conventional lung scintigraphy. Lobar and lung split PPO lung function were calculated using Q PET/CT and current recommended methods, i.e. calculation based on anatomical segments for lobar function, and conventional perfusion scan for pneumonectomy. Bland-Altman statistics were used to calculate agreement between methods for PPO FEV1 and PPO DLCO.ResultsWhile mean split lobar functions were comparable, there was variation on an individual level between Q PET/CT and the anatomical method, with absolute difference over 5 % and 10 % in 37 % and 11 % of patients, respectively. For lobectomy the mean difference in PPO FEV1 was−1.2, but limits of agreement were−10 to 8.1 %. For DLCO, values were−1.1 % and−9.7 to 7.5 %, respectively. For pneumonectomy, PPO FEV1 values were−0.4 and−5.9 to 5.1 %. For DLCO, values were 0.3 % and−5.1 to 4.6 %.ConclusionsWhile anatomic estimation provides “fixed” results, split lobar functions computed with Q PET/CT vary widely, reflecting the intra and inter-individual variability of regional lung function. Further studies to assess the role of Q PET/CT in predicting peri-operative risk in lung cancer patients planned for lobectomy are warranted.

Intraoperative oxygen challenge for toleration of single lung ventilation in a patient with severe obstructive airway disease: A case report

“…Our institution has been at the forefront of preoperative risk stratification for patients with lung cancer undergoing lung resection, reporting methods such as the predicted postoperative product as a predictor of surgical mortality [18]. We have previously reported perioperative risk stratification in various populations including after induction therapy [19] and using advanced molecular imaging technologies [20]. In the present case, we further attempt to more accurately stratify an individual patient's risk in order to clearly communicate and engage in informed and shared decision making.…”

Head-to-Head Prospective Comparison of Quantitative Lung Scintigraphy and Segment Counting in Predicting Pulmonary Function in Lung Cancer Patients Undergoing Video-Assisted Thoracoscopic Lobectomy

“…Several previous studies did not compare the scintigraphyderived results with actual postoperative lung function tests, and some evaluated only FEV1 as a measure of the patient's lung function (14,15,18,19,21). In this study, the predicted results (ppo-FEV1 and ppoDLCO) according to the different quantification methods were compared with the postoperative tests, which are considered the gold standard, in a subgroup of 60 patients.…”

Correlation of positron emission tomography ventilation-perfusion matching with CT densitometry in severe emphysema

“…Percentage lobar ventilation, perfusion, and CT volume, as a percentage of total lung values, were recorded, along with normal ventilation/perfusion, matched, and unmatched defects for each lobe. The sum of matched/unmatched defects and normal ventilation was equal to 100%, as previously described [8].…”

“…The use of gallium-68 ( 68 Ga) ventilation/perfusion (VQ) positron emission tomography (PET)-CT imaging for assessment of regional/lobar lung function, including visualization of changes following endobronchial valve insertion, has previously been reported [7,8]. This technique allows regional assessment of VQ at a sublobar anatomical level with superior resolution to planar VQ and single photon emission tomography (SPECT) VQ imaging [9,10].…”