The following is a summary of “3D-Quantitated Single Photon Emission Computed Tomography/Computed Tomography: Impact on intended Management Compared to Lung Perfusion Scan in Marginal Candidates for Pulmonary Resection,” published in the November 2023 issue of Pulmonology by Mallaev, et al.
Studies have shown that SPECT/CT (single-photon emission computed tomography/computed tomography) is a more accurate and consistent way to measure lobar perfusion than planar lung perfusion scintigraphy. But no one knows what effect 3D-quantitated SPECT/CT has on planned treatment in candidates for lung surgery who are functionally borderline. For a study, researchers sought to figure out what effect this had. Candidates for lung removal were evaluated before surgery using the ERS/ESTS Algorithm and had lung perfusion imaging done before surgery.
They used standard planar scintigraphy methods and a 3-dimensional quantitative SPECT/CT method (CT Pulmo3D and xSPECT-Quant, Siemens) to figure out the lobar input to the total lung circulation. They looked at the difference between the estimated lobar circulation and the expected changes in lung function, and the amount of lung removal after surgery to see if there were any changes in the ability to operate. The result was measured in the hospital. One hundred twenty patients, 46 of whom were women, signed up. Patients’ mean age (±SD) was 68 ± 9 years old; 57.7% had lesions in the upper lobes, and 33.5% had lesions in the lower lobes. There was a range of values for FEV1 (forced expiratory volume in 1 second) and DLCO (diffusion capacity of lung for carbon monoxide). The median DLCO was 56.6% and the range was 47.1-67.4.
When compared to 3D-quantitated SPECT/CT, the planar posterior oblique method overestimated the perfusion of the lower lobes by 4% [2-7], while it underestimated the perfusion of the upper lobes by 5% (right [2-9], left [2.5-8]; P = <.0001). No difference was found between the two groups for the median difference. When 3D-quantitated SPECT/CT was used to figure out the ppo lung function instead of planar scintigraphy, 4 patients (3.3%), all of whom had tumors in the upper lobes, were deemed incurable. In some patients with upper lobe tumors, 3D-quantitated SPECT/CT would have changed the treatment plan from being able to be operated on to not being able to be operated on. Notably, the death rate after surgery was unusually high in this particular subset. 3D-quantitated SPECT/CT will be looked at more closely because it could help figure out the risk of surgery in people who aren’t very good at what they do.
Source: sciencedirect.com/science/article/abs/pii/S1525730423001456