Perfusion Scintigraphy and Patient Selection for Lung Volume Reduction Surgery

Chandra, Divay; Lipson, David A.; Hoffman, Eric A.; Hansen‐Flaschen, John; Sciurba, Frank C.; DeCamp, Malcolm M.; Reilly, John J.; Washko, George R.

doi:10.1164/rccm.201001-0043oc

Cited by 46 publications

(31 citation statements)

References 21 publications

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“…After LVRS, SGRQ score decreased by more than 8 units in 40,32,20,10, and 13% compared with 9,8,8,4, and 7% after medical treatment at 1-5 years of follow-up (P , 0.001, Year 1-3; P ¼ 0.005, Year 4; P ¼ 0.12, Year 5) (Figure 4). …”

Section: Long-term Follow-up In Nett: Effect Of Lvrs Versus Medical Tmentioning

confidence: 98%

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The National Emphysema Treatment Trial (NETT)

Criner

Cordova

Sternberg

et al. 2011

Am J Respir Crit Care Med

178

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Substantial information regarding the role of lung volume reduction surgery (LVRS) in severe emphysema emanates from the National Emphysema Treatment Trial (NETT). The NETT was not a crossover trial and therefore was able to examine the effects of optimal medical management and LVRS on short-and long-term survival, as well as lung function, exercise performance, and quality of life. The NETT generated multiple insights into the preoperative, perioperative, and postoperative management of patients undergoing thoracotomy; described pain control techniques that were safe and effective; and emphasized the need to address nonpulmonary issues to optimize surgical outcomes. After the NETT, newer investigation has focused on bronchoscopic endobronchial interventions and other techniques less invasive than LVRS to achieve lung reduction. In this review, we summarize what we currently know about the role of LVRS in the treatment of severe emphysema as a result of insights gained from the NETT and provide a brief review of the newer techniques of lung volume reduction.Keywords: emphysema; COPD; lung volume reduction surgery Much of the information regarding lung volume reduction surgery (LVRS) emanates from the National Emphysema Treatment Trial (NETT). NETT was a multicenter prospective randomized controlled trial that compared optimal medical treatment, including pulmonary rehabilitation, with optimal medical treatment plus LVRS (1). NETT was not a crossover trial and thus was able to examine the effects of optimal medical management and LVRS on short-and long-term survival, as well as lung function, exercise performance, and quality of life.After NETT, newer investigation has focused on bronchoscopic endobronchial interventions and other techniques less invasive than LVRS to achieve lung reduction (2). Moreover, new data have surfaced regarding the effects of LVRS on ameliorating the manifestations of systemic inflammation (3), the cardiovascular ramifications of hyperinflation (4), and improved radiological techniques that identify optimal LVRS candidates (5).In this review, we summarize what we currently know about LVRS as a result of NETT in the treatment of severe emphysema and provide a brief review of lung volume reduction techniques. LVRS: BACKGROUNDData regarding LVRS before NETT mainly consisted of uncontrolled, single-center case series characterized by small patient numbers and substantial variability in selection criteria, surgical technique, duration of follow-up, and definitions of complications and outcomes (6-15).NETT was a randomized, controlled, multicenter, long-term trial that examined the effects of LVRS on the primary end points of survival and maximal exercise performance and the secondary end points of lung function, patient symptoms, and quality of life in contrast to medical therapy (16).In 2003, NETT first reported the effects of LVRS on survival and maximal exercise capacity in 1,218 patients with emphysema who were randomized to LVRS or medical treatment between January 1998 and July 2002 an...

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Section: Long-term Follow-up In Nett: Effect Of Lvrs Versus Medical Tmentioning

confidence: 98%

“…This is an intention-to-treat analysis. patients who had complete scintigraphy results at baseline (20). Low upper lobe perfusion was defined as less than 20% of total perfusion directed to the upper third of the lungs as measured on perfusion scintigraphy.…”

Section: Perfusion Scintigraphy and Patient Selection For Lvrsmentioning

confidence: 99%

The National Emphysema Treatment Trial (NETT)

Criner

Cordova

Sternberg

et al. 2011

Am J Respir Crit Care Med

178

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“…Every lung perfusion scintigram is craniocaudally divided into three equal parts. The upper part of regional perfusion is similar to the upper lobe of the lung, and the lower part is similar to that of the lower lobe (50). A series of studies found that BLVR would cause a decrease in target lung perfusion and increase ipsilateral non-target lobe and contralateral lung perfusion (51)(52)(53).…”

Section: Other Predictorsmentioning

confidence: 90%

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

Wang

et al. 2016

BST

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“…Other imaging modalities such as perfusion magnetic resonance imaging, 27 perfusion scintigraphy, 10 and perfusion SPECT 28 can be used to quantify pulmonary perfusion. In COPD, changes in pulmonary perfusion assessed by perfusion scintigraphy or SPECT have been shown to correlate with the extent of emphysema as assessed by high-resolution CT and PFTs.…”

Section: Discussionmentioning

confidence: 99%

“…7,8 A study in 25 patients showed a superior prediction of postoperative outcome after LVRS for coregistered perfusion single-photon emission computed tomography (SPECT) and computed tomography (CT) as compared with planar scintigraphy, stand-alone SPECT, or qualitative assessment of stand-alone CT. 9 Data from more than 1000 patients undergoing LVRS within the National Emphysema Treatment Trial showed that LVRS reduces mortality in patients with upper lobeYpredominant emphysema only if there is low, rather than high, perfusion to the upper lung on scintigraphy. 10 Therefore, imaging of pulmonary emphysema should ideally assess the regional distribution of both parenchymal destruction and pulmonary perfusion simultaneously.…”

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confidence: 99%

Assessing Pulmonary Perfusion in Emphysema

Meinel¹,

Graef²,

Thieme³

et al. 2013

Investigative Radiology

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Objectives: The objective of this study was to determine whether automated quantification of lung perfused blood volume (PBV) in dual-energy computed tomographic pulmonary angiography (DE-CTPA) can be used to assess the severity and regional distribution of pulmonary hypoperfusion in emphysema. Materials and Methods: We retrospectively analyzed 40 consecutive patients (mean age, 67 [13] years) with pulmonary emphysema, who have no cardiopulmonary comorbidities, and a DE-CTPA negative for pulmonary embolism. Automated quantification of global and regional pulmonary PBV was performed using the syngo Dual Energy application (Siemens Healthcare). Similarly, the global and regional degrees of parenchymal hypodensity were assessed automatically as the percentage of voxels with a computed tomographic density less than j900 Hounsfield unit. Emphysema severity was rated visually, and pulmonary function tests were obtained by chart review, if available. Results: Global PBV generated by automated quantification of pulmonary PBV in the DE-CTPA data sets showed a moderately strong but highly significant negative correlation with residual volume in percentage of the predicted residual volume (r = j0.62; P = 0.002; n = 23) and a positive correlation with forced expiratory volume in 1 second in percentage of the predicted forced expiratory volume in 1 second (r = 0.67; P G 0.001; n = 23). Global PBV values strongly correlated with diffusing lung capacity for carbon monoxide (r = 0.80; P G 0.001; n = 15). Pulmonary PBV values decreased with visual emphysema severity (r = j0.46, P = 0.003, n = 40). Moderate negative correlations were found between global PBV values and parenchymal hypodensity both in a per-patient (r = j0.63; P G 0.001; n = 40) and per-region analyses (r = j0.62; P G 0.001; n = 40). Conclusions: Dual-energy computed tomographic pulmonary angiography allows simultaneous assessment of lung morphology, parenchymal density, and pulmonary PBV. In patients with pulmonary emphysema, automated quantification of pulmonary PBV in DE-CTPA can be used for a quick, reader-independent estimation of global and regional pulmonary perfusion, which correlates with several lung function parameters.Key Words: pulmonary emphysema, severity, distribution, pulmonary perfusion, dual-energy CT (Invest Radiol 2013;48: 79Y85) C hronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide.1,2 It is characterized by airflow limitation and lung inflammation resulting in a progressive deterioration in lung function. Emphysema is a common component of COPD, in which airway obstruction, inflammation, and aberrant activity of proteolytic enzymes cause irreversible destruction of the alveolar walls and enlargement of distal airspaces. Currently, screening for and early diagnosis of COPD and emphysema largely rely on spirometric lung function tests. 4 Spirometry, however, strongly depends on patients' cooperation and is unable to localize emphysematous changes within the lung. Because pulmonary e...

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Perfusion Scintigraphy and Patient Selection for Lung Volume Reduction Surgery

Cited by 46 publications

References 21 publications

The National Emphysema Treatment Trial (NETT)

The National Emphysema Treatment Trial (NETT)

Status of and prospects for bronchoscopic lung volume reduction for patients with severe emphysema

Assessing Pulmonary Perfusion in Emphysema

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