title: Prediction of functional reserves after lung resection: comparison between quantitative computed tomography, scintigraphy, and anatomy.
abstract: OBJECTIVE
  We prospectively compared five techniques to estimate predicted postoperative function (ppo F) after lung resection: recently proposed quantitative CT scans (CT), perfusion scans (Q), and three anatomical formulae based on the number of segments (S), functional segments (FS), and subsegments (SS) to be removed.
  
  
  METHODS
  Four parameters were assessed: FEV(1), FVC, DL(CO) and VO(2max), measured preoperatively and 6 months postoperatively in 44 patients undergoing pulmonary resection, comparing their ppo value to the postoperatively measured value.
  
  
  RESULTS
  The correlations (r) obtained with the five methods were for CT: FEV(1) = 0.91, FVC = 0.86, DL(CO) = 0.84, VO(2max) = 0.77; for Q: 0.92, 0.90, 0.85, 0.85; for S: 0.88, 0.86, 0.84, 0.75; for FS: 0.88, 0.85, 0.85, 0.75, and for SS: 0.88, 0.86, 0.85, 0.75, respectively. The mean difference between ppo values and postoperatively measured values was smallest for Q estimates and largest for anatomical estimates using S. Stratification of the extent of resection into lobectomy (n = 30) + wedge resections (n = 4) versus pneumonectomy (n = 10) resulted in persistently high correlations for Q and CT estimates, whereas all anatomical correlations were lower after pneumonectomy.
  
  
  CONCLUSIONS
  We conclude that both Q- and CT-based predictions of postoperative cardiopulmonary function are useful irrespective of the extent of resection, but Q-based results were the most accurate. Anatomically based calculations of ppo F using FS or SS should be reserved for resections not exceeding one lobe.
authors.affiliation: Respiratory Division, Department of Internal Medicine, Institute of Nuclear Medicine, Department of Surgery, University Hospital, Basel, Switzerland. ctb@sun.ac.za
authors.forename: Chris T
authors.initials: CT
authors.lastname: Bolliger
authors.forename: Claudius
authors.initials: C
authors.lastname: Gückel
authors.forename: Hermann
authors.initials: H
authors.lastname: Engel
authors.forename: Susanne
authors.initials: S
authors.lastname: Stöhr
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Wyser
authors.forename: Andreas
authors.initials: A
authors.lastname: Schoetzau
authors.forename: James
authors.initials: J
authors.lastname: Habicht
authors.forename: Markus
authors.initials: M
authors.lastname: Solèr
authors.forename: Michael
authors.initials: M
authors.lastname: Tamm
authors.forename: André P
authors.initials: AP
authors.lastname: Perruchoud
mesh_terms: D000368:Aged; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011013:Pneumonectomy; D011184:Postoperative Period; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012129:Respiratory Function Tests; D013147:Spirometry; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity