Prediction of postoperative lung function in patients with lung cancer: comparison of quantitative CT with perfusion scintigraphy.
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.
Wu
Ming-Ting
MT
Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-chung 1st Rd., Kaohsiung, 813, Taiwan.
Pan
Huay-Ben
HB
Chiang
Ambrose A
AA
Hsu
Hon-Ki
HK
Chang
Huang-Chou
HC
Peng
Nan-Jing
NJ
Lai
Ping-Hong
PH
Liang
Huei-Lung
HL
Yang
Chien-Fang
CF
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
D003287:Contrast Media; D019275:Radiopharmaceuticals; D013668:Technetium Tc 99m Aggregated Albumin