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1
Department of Radiology, Kaohsiung Veterans General Hospital, 386 Ta-chung 1st
Rd., Kaohsiung, 813, Taiwan.
2
School of Medicine, National Yang-Ming University, 155, Li-Nong St., Sec. 2,
Peitou, Taipei, Taiwan, R.O.C.
3
Division of Respiratory Care, Department of Medicine, Kaohsiung Veterans
General Hospital, Kaohsiung, 813, Taiwan, R.O.C.
4
Present address: Division of Respiratory and Critical Care Medicine, Duke
University Medical Center, Erwin Rd., Durham, NC 27710.
5
Present address: Department of Medicine, Maria Parham Hospital, 566 Ruin Creek
Rd., P. O. Drawer 59, Henderson, NC 27536.
6
Department of Surgery, Division of Thoracic Surgery, Kaohsiung Veterans
General Hospital, Kaohsiung, 813, Taiwan R.O.C.
7
Division of Nuclear Medicine, Kaohsiung Veterans General Hospital, Kaohsiung,
813, Taiwan, R.O.C.
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.
SUBJECTS AND 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.
CONCLUSION. Given its simplicity, we proposed that quantitative CT be widely used in predicting postoperative FEV1.
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