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Postoperative Lung Function in Lung Cancer Patients: Comparative Analysis of Predictive Capability of MRI, CT, and SPECT

¹ Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
² Division of Cardiovascular, Thoracic, and Pediatric Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
³ Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.

OBJECTIVE. The purpose of this study was to prospectively compare the utility of dynamic contrast-enhanced perfusion MRI in the prediction of postoperative lung function in patients with lung cancer with the utility of quantitative and qualitative assessment of CT and perfusion SPECT.

SUBJECTS AND METHODS. One hundred fifty lung cancer patients (87 men, 63 women) underwent dynamic perfusion MRI, MDCT, perfusion SPECT, and measurement of preoperative and postoperative forced expiratory volume in the first second of expiration (FEV₁) expressed as percentage of predicted value. Postoperative FEV₁ was predicted with dynamic perfusion MRI by semiquantitative assessment of the perfusion of whole lungs and resected segments of lungs, with quantitative assessment of functional lung volume on CT with commercially available software, with qualitative assessment of CT on the basis of the number of segments of total and resected lung, and with perfusion SPECT by assessment of uptake of microaggregated albumin particles in whole lungs and resected segments of lungs. Correlation and limits of agreement between actual and predicted postoperative FEV₁ values were statistically evaluated.

RESULTS. Actual postoperative FEV₁ had stronger correlation with postoperative FEV₁ predicted from perfusion MRI (r = 0.87, p < 0.0001) and quantitative CT (r = 0.88, p < 0.0001) than with postoperative FEV₁ predicted from qualitative CT (r = 0.83, p < 0.0001) and perfusion SPECT (r = 0.83, p < 0.0001). The limits of agreement between the actual postoperative FEV₁ and postoperative FEV₁ predicted from perfusion MRI (5.3% ± 11.8% [mean ± 2 SD]) were smaller than the values for postoperative FEV₁ predicted from qualitative CT (6.8% ± 14.4%) and perfusion SPECT (5.1% ± 14.0%) and was almost equal to the value for postoperative FEV₁ predicted from quantitative CT (5.0% ± 11.6%).

CONCLUSION. Dynamic perfusion MRI is more accurate in prediction of the postoperative lung function of patients with lung cancer than are qualitative CT and perfusion SPECT and may be at least as accurate as quantitative CT.

Keywords: cancer • lung cancer • lungs • MRI • perfusion • SPECT

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