title: Prediction of postoperative lung function in patients with lung cancer: comparison of quantitative CT with perfusion scintigraphy.
abstract: OBJECTIVE
  Prediction of postoperative lung function is important in preoperative evaluation of patients with lung cancer. Perfusion scintigraphy is the current method to assess the fractional contribution of lung function of the remaining lung. We developed a quantitative CT method and compared it with perfusion scintigraphy for predictions of postoperative forced expiratory volume in 1 sec (FEV1) in patients with lung cancer.
  
  
  METHODS
  Forty-four patients with lung cancer undergoing lung resection with preoperative CT and perfusion scintigraphy were enrolled. Quantitative CT used a dual threshold (-500 and -910 H) on standard preoperative CT to semiautomatically extract lung volume without emphysema or tumor and atelectasis, which we defined as "functional lung volume." Prediction was calculated from preoperative FEV1 multiplied by the fractional contribution of functional lung volume of the remaining lung by quantitative CT. Perfusion scintigraphy was the standard method. Predictions were correlated with postoperatively measured FEV1.
  
  
  RESULTS
  Both quantitative CT and perfusion scintigraphy predicted postoperative FEV1 well in patients who underwent pneumonectomy (n = 28, r = 0.88 vs r = 0.86) and in lobectomy (n = 16, r = 0.90 vs r = 0.80) (both, p < 0.001). There was good agreement between the two methods by the Bland-Altman method. In the four patients with low measured postoperative FEV1 (<40% predicted normal), quantitative CT had true-positive prediction in four and perfusion scintigraphy, in only two.
  
  
  CONCLUSIONS
  Given its simplicity, we proposed that quantitative CT be widely used in predicting postoperative FEV1.
authors.affiliation: Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-chung 1st Rd., Kaohsiung, 813, Taiwan.
authors.forename: Ming-Ting
authors.initials: MT
authors.lastname: Wu
authors.forename: Huay-Ben
authors.initials: HB
authors.lastname: Pan
authors.forename: Ambrose A
authors.initials: AA
authors.lastname: Chiang
authors.forename: Hon-Ki
authors.initials: HK
authors.lastname: Hsu
authors.forename: Huang-Chou
authors.initials: HC
authors.lastname: Chang
authors.forename: Nan-Jing
authors.initials: NJ
authors.lastname: Peng
authors.forename: Ping-Hong
authors.initials: PH
authors.lastname: Lai
authors.forename: Huei-Lung
authors.initials: HL
authors.lastname: Liang
authors.forename: Chien-Fang
authors.initials: CF
authors.lastname: Yang
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D003287:Contrast Media; D005541:Forced Expiratory Volume; D006801:Humans; D016014:Linear Models; D008168:Lung / Q000000981:diagnostic imaging*; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008176:Lung Volume Measurements; D011013:Pneumonectomy; D011237:Predictive Value of Tests; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D013147:Spirometry; D013668:Technetium Tc 99m Aggregated Albumin; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin