title: Gallium-68 perfusion positron emission tomography/computed tomography to assess pulmonary function in lung cancer patients undergoing surgery.
abstract: BACKGROUND
  Pre-operative evaluation of lung cancer patients relies on calculation of predicted post-operative (PPO) lung function based on split lung function testing. Pulmonary perfusion (Q) PET/CT can now be performed by substituting Technetium-99 m labeling of macroaggregated albumin (MAA) with Gallium-68. This study compares Q PET/CT with current recommended methods of pre-operative lung function assessment.
  
  
  METHODS
  Twenty-two patients planned for curative surgical resection (mean FEV1 77 %, SD 21 %; mean DLCO 66 %, SD 17 % predicted) underwent pre-operative Q PET/CT. Sixteen patients also underwent conventional lung scintigraphy. Lobar and lung split PPO lung function were calculated using Q PET/CT and current recommended methods, i.e. calculation based on anatomical segments for lobar function, and conventional perfusion scan for pneumonectomy. Bland-Altman statistics were used to calculate agreement between methods for PPO FEV1 and PPO DLCO.
  
  
  RESULTS
  While mean split lobar functions were comparable, there was variation on an individual level between Q PET/CT and the anatomical method, with absolute difference over 5 % and 10 % in 37 % and 11 % of patients, respectively. For lobectomy the mean difference in PPO FEV1 was-1.2, but limits of agreement were-10 to 8.1 %. For DLCO, values were-1.1 % and-9.7 to 7.5 %, respectively. For pneumonectomy, PPO FEV1 values were-0.4 and-5.9 to 5.1 %. For DLCO, values were 0.3 % and-5.1 to 4.6 %.
  
  
  CONCLUSIONS
  While anatomic estimation provides "fixed" results, split lobar functions computed with Q PET/CT vary widely, reflecting the intra and inter-individual variability of regional lung function. Further studies to assess the role of Q PET/CT in predicting peri-operative risk in lung cancer patients planned for lobectomy are warranted.
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, VIC, 3002, Australia. pierre-yves.leroux@chu-brest.fr.|Nuclear Medicine department, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France. pierre-yves.leroux@chu-brest.fr.|Service de médecine nucléaire, CHRU de Brest, 29609, Brest Cedex, France. pierre-yves.leroux@chu-brest.fr.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Le Roux
authors.affiliation: The University of Melbourne, Parkville, Australia.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Leong
authors.affiliation: The University of Melbourne, Parkville, Australia.|Department of Surgery, Austin Health, Heidelberg, Australia.|Department of Surgery, Royal Melbourne Hospital and Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, VIC, 3002, Australia.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Barnett
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, VIC, 3002, Australia.|The University of Melbourne, Parkville, Australia.
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Hicks
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, VIC, 3002, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Callahan
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, VIC, 3002, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Eu
authors.affiliation: Department of Cancer Medicine, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, VIC, 3002, Australia.|Department of Respiratory Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia.
authors.forename: Renee
authors.initials: R
authors.lastname: Manser
authors.affiliation: Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, VIC, 3002, Australia. michael.hofman@petermac.org.|The University of Melbourne, Parkville, Australia. michael.hofman@petermac.org.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Hofman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005710:Gallium Radioisotopes; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging; D011013:Pneumonectomy / Q000009:adverse effects; D000072078:Positron Emission Tomography Computed Tomography; D057234:Preoperative Period; D019275:Radiopharmaceuticals
chemical_list: D005710:Gallium Radioisotopes; D019275:Radiopharmaceuticals
keywords: Gallium-68; Lung cancer; PET/CT; Perfusion; Surgery