title: Perfusion scintigraphy in the evaluation for lung volume reduction surgery: correlation with clinical outcome.
abstract: OBJECTIVE
  To identify preoperative pulmonary perfusion scintigraphic findings that might be associated with clinical outcomes after lung volume reduction surgery.
  
  
  METHODS
  Preoperative perfusion scintigrams in 103 patients (56 men, 47 women; age range, 41-76 years; mean age, 61 years +/- 9) were reviewed and graded for emphysematous heterogeneity (from isolated areas to diffuse distribution), extent of maximally perfused lung, and lobar predominance (upper-lobe vs lower-lobe asymmetry). These findings were correlated with clinical outcome on the basis of pulmonary function, arterial blood gas levels, and exercise test results before and 6 months after surgery.
  
  
  RESULTS
  Among the 96 patients who survived surgery, there was an average improvement of 47% in the forced expiratory volume in 1 second (FEV1), of 20% in arterial oxygen tension, and of 20% in the 6-minute walking distance. Scintigraphic markers correlated best with FEV1 improvement. The strongest scintigraphic predictor of increase in FEV1 was upper-lobe predominance (r = .38, P < .001), which was followed by heterogeneity (r = .31, P = .002). The seven patients who died had a significantly lower percentage of maximally perfused lung than the survivors (25% vs 34%, P = .004).
  
  
  CONCLUSIONS
  Perfusion scintigraphy can provide modest prognostic information in patients who undergo evaluation for lung volume reduction surgery.
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo., USA.
authors.forename: S C
authors.initials: SC
authors.lastname: Wang
authors.forename: K C
authors.initials: KC
authors.lastname: Fischer
authors.forename: R M
authors.initials: RM
authors.lastname: Slone
authors.forename: D S
authors.initials: DS
authors.lastname: Gierada
authors.forename: R D
authors.initials: RD
authors.lastname: Yusen
authors.forename: S S
authors.initials: SS
authors.lastname: Lefrak
authors.forename: T K
authors.initials: TK
authors.lastname: Pilgram
authors.forename: J D
authors.initials: JD
authors.lastname: Cooper
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D011877:Radionuclide Imaging; D012189:Retrospective Studies