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Ventilation-Perfusion Scintigraphy to Predict Postoperative Pulmonary Function in Lung Cancer Patients Undergoing Pneumonectomy

Thida Win1, Angela D. Tasker2, Ashley M. Groves3, Carol White2, Andrew J. Ritchie4, Francis C. Wells4 and Clare M. Laroche1

1 Department of Thoracic Oncology, Papworth Hospital, Papworth Everard, Cambridge, CB3 8RE, United Kingdom.
2 Department of Radiology, Papworth Hospital, Cambridge, United Kingdom.
3 Institute of Nuclear Medicine, University College London, London, United Kingdom.
4 Department of Cardiothoracic Surgery, Papworth Hospital, Cambridge, United Kingdom.


Figure 1
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  		Fig. 1 —Anterior and posterior images from perfusion scintigram. Three equally sized regions of interest over lungs are shown. Counts in each zone were measured. Geometric means of anterior and posterior images were then used to calculate relative perfusion and ventilation for each zone for each lung. By this method, percentages were obtained for upper, middle, and lower zones of right and left lungs for both perfusion and ventilation.

 

Figure 2
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  		Fig. 2 —Histogram shows relationship and correlation (r) between predicted FEV1 and actual measured postoperative FEV1 using ventilation (V) scintigraphy, perfusion (Q) scintigraphy, and combined V/Q scintigraphy.

 

Figure 3
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  		Fig. 3 —Bland-Altman plot of actual postoperative FEV1 (in liters) and predicted postoperative FEV1 (in liters) using ventilation scintigraphy. If this relationship were perfect (no bias), all points would lie close to zero line on x-axis. Most points lie beneath this line, indicating that ventilation scintigraphy underestimates actual postoperative lung function.

 

Figure 4
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  		Fig. 4 —Bland-Altman plot of measured FEV1 (in liters) and predicted postoperative FEV1 (in liters) using perfusion scintigraphy. Equal points lie above and beneath zero line, indicating that perfusion scintigraphy underestimates actual postoperative lung function less than ventilation scintigraphy (as seen in Fig. 3).

 

Figure 5
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  		Fig. 5 —Histogram shows relationship and correlation (r) between predicted percentage FEV1 and actual measured postoperative percentage of predicted FEV1 using ventilation (V) scintigraphy, perfusion (Q) scintigraphy, and combined V/Q scintigraphy.

 

Figure 6
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  		Fig. 6 —Correlation between measured postoperative and predicted postoperative percentage of FEV1 using ventilation scintigraphy scan; r = 0.73.

 

Figure 7
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  		Fig. 7 —Correlation between measured postoperative and predicted postoperative percentage of FEV1 using perfusion scintigraphy scan; r = 0.60.

 

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