Lung volume reduction surgery for emphysema: correlation of CT and V/Q imaging with physiologic mechanisms of improvement in lung function.
OBJECTIVE
To compare the relationship between computer-derived and visually assessed ventilation-perfusion (V/Q) scintigraphy and computed tomographic (CT) scores in evaluating disease severity and distribution in identifying optimal candidates for lung volume reduction surgery (LVRS) and to correlate these radiologic indices with physiologic measures of outcome.


METHODS
In 39 patients, preoperative V/Q and CT scans were visually scored by two radiologists for disease severity and distribution. Results were compared with computer-derived scores for the same cohort. These indices were correlated with clinical improvement measured with forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), and ratio of FEV(1) to FVC.


RESULTS
The disease distribution scores measured with the different methods correlated closely: computer-based and visually assessed CT scores (r = 0.89, P <.001), computer-based and visually assessed V/Q scores (r = 0.83, P <.001), visually assessed CT and V/Q scores (r = -0.50, P <.001), and computer-derived CT and V/Q scores (r = -0.57, P =.015). Similarly, a statistically significant correlation was noted between each of the radiologic methods and clinical outcome measurements (P <.001).


CONCLUSIONS
CT and V/Q preoperative assessment, with either visual scoring or computer-based algorithms, are nearly equivalent in their utility in predicting improvement in FEV(1) measures.
Hunsaker
Andetta R
AR
Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA. ahunsaker@partners.org
Ingenito
Edward P
EP
Reilly
John J
JJ
Costello
Philip
P
D004646:Emphysema / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D014692:Ventilation-Perfusion Ratio