title: Measurement of preoperative lobar lung function with computed tomography ventilation imaging: progress towards rapid stratification of lung cancer lobectomy patients with abnormal lung function.
abstract: OBJECTIVE
  In lung cancer preoperative evaluation, functional lung imaging is commonly used to assess lobar function. Computed tomography ventilation (CT-V) imaging is an emerging lung function imaging modality. We compared CT-V imaging assessment of lobar function and its prediction of postoperative lung function to that achieved by (i) positron emission tomography ventilation (PET-V) imaging and (ii) the standard anatomical segment counting (ASC) method. We hypothesized (i) that CT-V and PET-V have similar relative lobar function and (ii) that functional imaging and anatomic assessment (ASC) yield different predicted postoperative (ppo) lung function and therefore could change clinical management.
  
  
  METHODS
  In this proof-of-concept study, 11 patients were subjected to pulmonary function tests, CT-V and PET-V imaging. The Bland-Altman plot, Pearson's correlation and linear regression analysis were used to assess the agreement between the CT-V-, PET-V- and ASC-based quantification of lobar function and in the ppo lung function.
  
  
  RESULTS
  CT-V and PET-V imaging demonstrated strong correlations in quantifying relative lobar function (r = 0.96; P < 0.001). A Wilcoxon-signed rank test showed no significant difference in the lobar function estimates between the two imaging modalities (P = 0.83). The Bland-Altman plot also showed no significant differences. The correlation between ASC-based lobar function estimates with ventilation imaging was low, r < 0.45; however, the predictions of postoperative lung function correlated strongly between all three methods.
  
  
  CONCLUSIONS
  The assessment of lobar function from CT-V imaging correlated strongly with PET-V imaging, but had low correlations with ASC. CT-V imaging may be a useful alternative method in preoperative evaluation for lung cancer patients.
authors.affiliation: Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia.
authors.forename: Enid M
authors.initials: EM
authors.lastname: Eslick
authors.affiliation: Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Dale L
authors.initials: DL
authors.lastname: Bailey
authors.affiliation: Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Department of Sleep and Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Harris
authors.affiliation: Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kipritidis
authors.affiliation: Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Stevens
authors.affiliation: Sydney Medical School - Northern, University of Sydney, St Leonards, NSW, Australia Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Bob T
authors.initials: BT
authors.lastname: Li
authors.affiliation: Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bailey
authors.affiliation: Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Denis
authors.initials: D
authors.lastname: Gradinscak
authors.affiliation: Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Pollock
authors.affiliation: Department of Sleep and Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Htun
authors.affiliation: School of Public Health and Community Medicine, University of New South Wales, Kensington, NSW, Australia.
authors.forename: Robin
authors.initials: R
authors.lastname: Turner
authors.affiliation: Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Eade
authors.affiliation: Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Ali
authors.initials: A
authors.lastname: Aslani
authors.affiliation: Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Graeme
authors.initials: G
authors.lastname: Snowdon
authors.affiliation: Radiation Physics Laboratory, Sydney Medical School - Central, University of Sydney, Sydney, NSW, Australia paul.keall@sydney.edu.au.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Keall
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D016014:Linear Models; D008168:Lung / Q000503:physiopathology* / Q000601:surgery; D008175:Lung Neoplasms / Q000145:classification / Q000453:epidemiology / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D049268:Positron-Emission Tomography; D011184:Postoperative Period; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed
keywords: Anatomical segment counting; CT ventilation imaging; Lobar; Predicted postoperative lung function