title: Evaluation of patients undergoing lung volume reduction surgery: ancillary information available from computed tomography.
abstract: OBJECTIVE
  A number of imaging techniques have been used for the pre-operative assessment of patients for lung volume reduction surgery (LVRS). We evaluated whether data currently acquired from perfusion scintigrams and cine MR of the diaphragm are obtainable from high resolution CT (HRCT) of the thorax.
  
  
  METHODS
  Thirty patients taking part in a randomized controlled trial of LVRS against maximal medical therapy were evaluated. HRCT examinations (n= 30) were scored for (i) the extent and distribution of emphysema; (ii) the extent of normal pulmonary vasculature; and (iii) diaphragmatic contour, apparent defects and herniation. On scintigraphy, (n= 28), perfusion of the lower thirds of both lungs, as a proportion of total lung perfusion (LZ/T(PERF)), was expressed as a percentage of predicted values (derived from 10 normal control subjects). On cine MR (n= 25) hemidiaphragmatic excursion and coordination were recorded.
  
  
  RESULTS
  Extensive emphysema was present on HRCT (60% +/- 13.2%). There was strong correlation between the extent of normal pulmonary vasculature on HRCT and on perfusion scanning (r(s)= 0.85, P< 0.00005). Hemidiaphragmatic incoordination on MR was weakly associated with hemidiaphragmatic eventration on HRCT (P= 0.04).
  
  
  CONCLUSIONS
  The strong correlation between lung perfusion assessed by HRCT and lung perfusion on scintigraphy suggests that perfusion scintigraphy is superfluous in the pre-operative evaluation of patients with emphysema for LVRS.
authors.affiliation: Department of Radiology, The Royal Brompton Hospital, London, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Cleverley
authors.forename: S R
authors.initials: SR
authors.lastname: Desai
authors.forename: A U
authors.initials: AU
authors.lastname: Wells
authors.forename: H
authors.initials: H
authors.lastname: Koyama
authors.forename: S
authors.initials: S
authors.lastname: Eastick
authors.forename: M A
authors.initials: MA
authors.lastname: Schmidt
authors.forename: C L
authors.initials: CL
authors.lastname: Charrier
authors.forename: P D
authors.initials: PD
authors.lastname: Gatehouse
authors.forename: P
authors.initials: P
authors.lastname: Goldstraw
authors.forename: J R
authors.initials: JR
authors.lastname: Pepper
authors.forename: D M
authors.initials: DM
authors.lastname: Geddes
authors.forename: D M
authors.initials: DM
authors.lastname: Hansell
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011656:Pulmonary Emphysema / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014692:Ventilation-Perfusion Ratio