定量CT、核素肺灌注及解剖分段法预测肺癌切除术后肺功能对比的初步研究

目的 对定量CT(QCT)、核素肺灌注扫描和解剖分段法预测肺癌切除术后肺功能的准确性进行初步的对比研究.方法 分析12例手术治疗的肺癌患者资料.术前均行肺功能检查、呼吸门控QCT扫描及核素肺灌注扫描.术前肺功能测毋第1秒用力呼气容积(FEV1.0)、努力肺活量(FVC)和一氧化碳弥散最(DLco).对CT资料和核素肺灌注扫描资料分别进行定量分析,根据QCT、核素肺灌注扫描及解剖分段法相应计算术后肺功能的公式,得出FEV1.0、FVC和DLco预测值,并与术后2个月时患者肺功能复查测量的实际值进行配对t检验及Pearson相关性检验.应用Bland-Altman分析对QCT、核素肺灌注扫描及解剖分段法所得到的肺功能预测值进行一致性检验.结果 QCT、核素肺灌注扫描及解剖分段法对患者术后肺功能各指标的预测值:FVC分别为(3.05±0.82)、(2.98±0.75)、(2.98±0.86)L;FEV1.0分别为(2.20±0.81)、(2.17±0.78)、(2.16±0.84)L;DLco分别为(5.95±2.10)、(5.85±1.98)、(5.87±2.23)mmol·min-1·kPa-1;FVC、FEV1.0及DLco术后实测值分别为:(3.09±0.72)L、(2.23±0.81)L、(5.59±2.01)mmol·min-1·kPa-1;3种方法 预测值与术后临床肺功能实测值的相关系数:FVC分别为0.87、0.80、0.86;FEV1.0分别为0.93、0.91、0.93;DLco分别为0.93、0.95、0.93(P值均<0.01).结论 QCT、核素肺灌注扫描及解剖分段法均可以作为预测肺癌切除术后肺功能的有效手段,预测值均具有良好的准确性.     

核素肺显像与功能测定预测肺切除术后肺功能

用放射性核素肺显像预测肺切除术后的肺功能。方法 ２５例均经手术，病理证实的患者中，原发性肺癌１８例，转移性肺癌１例，肺良性病变６例，通过１９例肺部手术患者术前１秒钟用力呼气容积预测值与手术后１个月和１年的实测值进行对比分析。结果 放射性核素肺灌注显像法预测值与术后１个月和１年实测值均显著相关，ｒ分别为０．９７１８、０．９８８９，Ｐ均〈０．０１。放射性核素肺通气显像法预测值与术后１个月和１年实测值也     

放射性核素显像及心血管造影对Fontan术后肺血流灌注的随访

目的通过放射性核素显像和心血管造影,观察心外全腔静脉一肺动脉连接（ETCPC）手术后完全旷置右心对肺血流灌注的长期影响。方法回顾性分析1990年3月至2005年12月间行ETCPC手术的53例[男29例,女24例,平均年龄（10．8±6．1）岁]患者资料。其中43例随访资料完整的患者均于术后1个月内（早期）及5年（中期）随访时行”1rcmIMAA肺灌注显像和心血管造影检查,并分别计算各肺段灌注比值、PVR及肺动脉指数。采用配对t检验分析患者早、中期的肺血流分布变化。结果”TcmMAA肺灌注显像结果示,中期随访与早期随访患者的肺总放射性计数值差异无统计学意义[（701．91±8．26）×10^3计数／s和（698．93±12．0）×103计数／s;t=0．38,P〉0．05],右肺／左肺灌注比值（1．06±0．01和1．03±0．03;t=1．12,P〉0．05）及下腔静脉右肺灌注比值（0．61±0．06和0．60±0．06;t=0．74,P〉0．05）无有意义的改变,全肺上段／下段比值下降（0．72±0．20和0．75±0．01;t=2．54,P〈0．05）,肺下叶背段灌注比例升高（0．12±0．00和0．10±0．03;t=2．16,P〈0．05）。中期随访患者的PVR下降[（142．98±2．61）dyn·s·cm-5（1dyn·S·cm-5=0．1kPa·S·L-1）和（146．95±2．54）dyn·s·cm-5;t=2．08,P〈0．05],腔静脉压下降[（9．35±0．24）mmHg（1mmHg：0．133kPa）和（9．95±0．23）mmHg;t=2．69,P〈0．05],动脉血氧饱和度未见明显改变[（92．70±0．30）％和（92．86±0．29）％;t=1.12,P〉0．05]。5例患者术后早期存在肺动脉造影与核素显像明显不匹配。结论在研究功能性肺血流灌注方面,放射性核素显像效果优于心血管造影。Fontan循环的长期弱动力、无搏动血流会引起肺血流坠积性重新分布。     

^99Tc^m—MIBI静息门控心肌灌注显像在心肌梗死干细胞移植治疗中的价值

目的用^99Tc^m-甲氧基异丁基异腈（MIBI）静息门控心肌灌注显像的方法,评价急性心肌梗死（AMI）患者自体骨髓间质干细胞（MSC）移植术治疗的疗效。方法AMI患者31例,均行经皮冠状动脉介入治疗（PCI）术,其中18例患者作为试验组,于PCI术后行自体MSC移植术治疗,PCI术后拒绝行细胞移植治疗的13例患者作为对照组。于PCI术前,术后1,3和6个月进行^99Tc^m-MIBI静息门控心肌灌注断层显像,评价心肌血流灌注及心功能改善程度。统计学处理采用SPSS11．0软件,行t检验。结果所有患者术后1个月放射性稀疏节段数明显减少,术后3个月和6个月放射性缺损节段数试验组（2．37±1．09和2．21±0．93）较对照组（3．24±0．93和3．21±1．05）明显减少（t=2．32,2．79,P均〈0．05）;与术前[（35．4±16．7）％和（32．8±15．9）％]相比,术后6个月试验组[（57．2±14．3）％]和对照组[（44．8±11．7）％]患者左心室射血分数（LVEF）均显著升高（t=4．27,2．18,P均〈0．05）,试验组患者LVEF明显高于对照组（t=2．58,P〈0．05）。结论心肌梗死患者自体MSC移植术后,应用^99Tc^m-MIBI静息门控心肌灌注显像随访和评价疗效有一定临床价值。     

MR增强肺灌注成像对肺动脉栓塞治疗疗效评价的可行性及准确性

目的 评价MR肺灌注成像(MRPP)对肺动脉栓塞治疗疗效的可行性及在随访中的作用.方法 60例可疑肺栓塞患者,将MRPP作为常规检查,其中27例同时进行了放射性核素肺通气-灌注显像扫描.将放射性核素肺通气-灌注显像与MRPP进行一致性检验,验证MRPP诊断肺栓塞的可行性.所有患者中有22例抗凝或溶栓治疗后3 d至1个月内进行了MRPP复查,通过分析治疗前后MRPP中肺实质的信号强度变化率(TROS),时间-峰值曲线以及肺动脉主干的相关参数(血流峰值、平均流速、单位时间内流量等),对MR增强肺灌注成像在肺动脉栓塞治疗疗效评价方面的可行性及准确性进行评估.获得的数据采用t检验、秩和检验进行统计学分析.结果 MRPP与放射性核素肺通气-灌注显像具有很好的一致性(以患者为研究对象时Kappa值为0.705,而肺叶、段及亚段的一致性分别为0.7632、0.8280、0.7344).两种方法比较,治疗前后MRPP肺实质强化率分别为(2.86±2.48)和(6.72±2.54)倍(t=3.370,P＜0.01),峰值时间分别为(13.98±5.60)和(12.33±3.63)s(t=3.930,P＜0.01),肺动脉干血流峰值分别为(60.39±15.17)和(69.93±13.22)cm/s(t=2.930,P=0.01),平均流速分别为(11.68±5.46)和(13.54±4.18)cm/s(t=2.380,P＜0.05),差异均有统计学意义,而单位时间内的流量分别为(80.57±24.87)和(85.48±11.81)ml/s,差异无统计学意义(t=0.860,P＞0.05).结论 MRPP与放射性核素肺通气-灌注显像具有很好的一致性.MRPP具有更高的空间分辨率和时间分辨率,并能够对肺血流进行半定量分析.对肺栓塞的诊断和治疗后的评估具有重要的临床意义.     

SPECT肺灌注与CT异机融合图像评价非小细胞肺癌肺功能的价值

目的 探讨SPECT肺灌注与CT异机融合图像评价Ⅲ期非小细胞肺癌(NSCLC)患者区域肺功能的意义.方法 选择Ⅲ期NSCLC患者32例,治疗前行肺功能测试和胸部CT扫描,并在相同体位下行SPECT肺灌注显像,两套图像均传至Philips Pinnacle3放射治疗计划系统,依据外标记点进行手动异机图像融合.参考CT与SPECT肺灌注融合图像,按灌注缺损区与肿瘤病灶的大小关系分为4级:0级为无灌注受损;1级为肿瘤及其周围局部肺灌注受损;2级为1叶肺灌注受损;3级为超过1叶肺灌注受损.采用SPSS 13.0软件,行PearsonX2检验.结果 32例Ⅲ期NSCLC患者中,31例有程度不等的肺灌注缺损,其中1级13例,2级8例,3级10例.中央型NSCLC患者肺灌注缺损较周围型NSCLC患者严重,差异有统计学意义(X2=10.495,P＜0.05).8例患者肺功能测试有不同程度的异常.CT与SPECT肺灌注融合图像阳性率96.9%(31/32),较肺功能测试阳性率25.0%(8/32)高,差异有统计学意义(X2=34.724,P＜0.05).结论 SPECT肺灌注与CT异机融合图像能更好显示Ⅲ期NSCLC患者区域肺组织的功能状况,为此类患者制订手术方案、预测术后肺功能、优化放疗计划等提供更多的信息.     

慢性血栓栓塞性肺动脉高压患者核素肺通气/灌注分布异质性的初步定量研究

目的 研究核素肺通气/灌注（V/Q）SPECT显像在慢性血栓栓塞性肺动脉高压(CTEPH)分布异质性中的应用,探讨分布异质性定量指标与肺动脉压力之间的相关性。 方法 收集中国医学科学院阜外医院2018年2月至12月经右心导管及肺动脉造影确诊的CTEPH患者20例（CTEPH组）,其中男性12例、女性8例,年龄（48.75±14.07）岁;13名正常健康者作为对照组,其中男性7名、女性6名,年龄（54.46±8.56）岁。CTEPH组患者和对照组健康者均行肺V/Q SPECT显像及同床位低剂量CT扫描,CTEPH患者在一周内行超声心动检查,估测肺动脉收缩压（PASP）。通过图像重建和分析,获得肺V/Q放射性分布异质性指标LogSD_V、LogSD_Q和LogSD_VQR（SD为标准差;V、Q、VQR分别为通气、灌注的放射性计数及二者的比值）。在CT图像上采用肺CT阈值的方法自动勾画左肺、右肺和全肺的感兴趣区,并将之复制于肺灌注图像上,获得左肺、右肺和全肺的标准化摄取值（SUV）,包括SUV的峰值（SUV_peak）、最大值（SUV_max）、最小值（SUV_min）、平均值（SUV_mean）和标准差（SUV_SD）,其中SUV_SD代表肺灌注放射性分布的异质性。2组之间的比较采用t检验,分布异质性指标与PASP的相关性采用Pearson相关性分析。 结果 健康对照组的肺V/Q放射性分布曲线呈对称性单峰状分布,而CTEPH组的肺V/Q放射性分布曲线呈非对称性的多峰分布。与健康对照组相比,CTEPH组的LogSD_V、LogSD_VRQ、全肺灌注的SUV_peak、SUV_max、SUV_SD均明显升高,且差异均有统计学意义（LogSD_V:0.56±0.16对0.31±0.11,t=4.91,P=0.000;LogSD_VQR:0.61±0.15对0.40±0.14,t=3.89,P=0.001;SUV_peak:19.12±7.94对10.81±4.05,t=3.48,P=0.002;SUV_max:20.19±8.30对11.44±4.33,t=3.49,P=0.001;SUV_SD:3.54±1.44 对2.42±0.91,t=2.50,P=0.018）;而2组的LogSD_Q、SUV_mean和SUV_min 的差异均无统计学意义。CTEPH组的PASP为（72.80±0.15） mmHg,LogSD_VQR与PASP呈中等程度相关（R=0.544,P=0.013）。 结论 核素肺V/Q显像可定量评估CTEPH患者肺V/Q放射性分布的异质性,同时可反映CTEPH患者肺动脉压力的状态。     

^99Tc^m-MIBI运动负荷-静息心肌灌注显像对冠心病患者经皮腔内冠状动脉血管成形术的疗效评价

目的 用^99Tc^m-甲氧基异丁基异腈（^99Tc^m-MIBI）运动-静息心肌灌注显像评价经皮腔内冠状动脉成形术（PTCA）的疗效。方法20例冠心病患者在PTCA术前和术后应用^99Tc^m-MIBI行运动负荷．静息心肌灌注显像,并对图像进行半定量分析。其中8例患者于术后6个月再次心肌灌注显像。结果对20例患者的27支冠状动脉呈狭窄病变进行PTCA,术前血管的平均狭窄为（84．3±9．2）％,术后平均残留狭窄减为（31．2±9．1）％。运动负荷-静息显像显示可逆性缺损（心肌缺血）的心肌节段数由术前的55个（30．6％）减为术后的10个（5．6％）,差异有显著性（x^2=38．02,P〈0．005）。术后心肌灌注的改善率为81．8％,8例患者术后6个月心肌显像显示3例出现缺血节段,冠状血管造影证实为再狭窄。结论^99Tc^m-MIBI运动负荷-静息心肌灌注显像是一种有效的无创性的判断PTCA术后疗效及再狭窄的方法。     

^99Tcm-聚合白蛋白肺灌注显像对肺栓塞溶栓疗效的评价

目的 探讨^99Tcm-聚合白蛋白（^99Tcm-MAA）肺灌注显像评价肺栓塞溶栓治疗的价值。方法对54例急性肺栓塞的患者进行回顾性分析,所有患者均由^99Tcm-MAA肺灌注显像结合X线胸片检查确诊,并于溶栓治疗1周后复查肺灌注显像,部分病例于治疗3个月后再次复查。结果54例急性肺栓塞患者溶拴治疗前^99Tcm-MAA肺灌注显像共观察到347个受损肺段,X线胸片均无相应肺段或亚肺段异常。溶栓治疗后1周复查肺灌注显像,164个受损肺段（47．3％）恢复正常;3个月后再次复查,199个受损肺段（57．4％）恢复正常（χ^2=10．68,P〈0．05）。结论^99Tcm-MAA肺灌注显像是一种无创的诊断方法,对肺栓塞溶栓治疗效果的评估有重要价值。     

门控心肌灌注显像在经皮冠状动脉介入治疗中的临床价值

目的探讨99Tcm-甲氧基异丁基异腈（MIBI）腺苷负荷门控心肌灌注显像（G-MID在经皮冠状动脉介入治疗（PCI）术前后的l临床应用价值。方法对54例行PCI的冠心病患者,术前2周行99Tcm-MIBI腺苷负荷＋静息G—MPI,并随访6个月,于PCI术后1个月、6个月复查腺苷负荷＋静息G-MPI显像。采用左心室20个节段0～4分的5分制半定量评分方法,分别计算每个室壁节段的腺苷负荷评分（SS）及静息评分（RS）,两者的差值为差分值（DS）,用于评估缺血的程度。综合每个节段腺苷负荷-静息G—MPI的评分,将其结果分为可逆性缺血（RD）和固定缺损（FD）。采用SPSS11．5软件,计量资料行独立样本t检验,计数资料行x2检验。结果（1）PCI术前根据心肌显像灌注异常节段划分,共有435个节段异常（RD、FD分别为323和112个）,术后1个月312个节段RD改善,62个节段FD改善,PCI术后1个月RD的改善率（96．59％）明显好于FD（55．36％）,差异有统计学意义（x2=117．30,P〈0．01）;术后6个月有12个节段进一步改善（RD3个、FD9个）,术后6个月RD改善较FD明显,两者差异有统计学意义（97．52％与63．39％,x2=96．919,P〈0．01）。（2）PCI术前RD、FD的SS分别为3．31±0．624和3．64±0．487,术后1个月分别为1．69±0．668和3．14±0．683,术后6个月分别为1．39±0．728和3．03±0．506,术前与术后1个月RD、FD的SS差异有统计学意义,t=10．569,2．348,P均〈0．05;术前与术后6个月RD、FD的SS差异有统计学意义,t=11．991,2．720,P均〈0．05;术后1个月与术后6个月RD、FD的sS差异无统计学意义,t=1．885,0．784,P=0．068,0．435。结论G-MPI对PCI术有一定的指导意义并可较好地评价PCI术疗效。     

Reliability of quantitative computed tomography to predict postoperative lung function in patients with chronic obstructive pulmonary disease having a lobectomy

OBJECTIVE: To verify the reliability of quantitative computed tomography (CT) to estimate the postoperative lung function in patients with mild to severe chronic obstructive pulmonary disease (COPD) who underwent a lobectomy. METHODS: Nine COPD patients with lung cancer having a lung lobectomy with preoperative CT were enrolled. By applying a density mask technique and a specific equation, predicted postoperative forced expiratory volume in 1 second (FEV1) and vital capacity (VC) were calculated. Predicted values were correlated with postoperative measured values. RESULTS: Estimated FEV1 and VC were always significantly lower than the corresponding postoperative values; however, CT-estimated postresection FEV1 values were better than the postresection VC values (biases between estimated and measured values were -0.14 and -0.536 L, respectively, according to the Bland-Altman method). Quantitative CT predicted postoperative FEV1 (r = 0.97, P < 0.001) and VC (r = 0.93, P < 0.001) well in all patients, however. CONCLUSIONS: Quantitative CT may be an alternative tool to perfusion scan to predict postresection lung function, even in patients with borderline pulmonary function undergoing a lobectomy.     

Dynamic perfusion MRI versus perfusion scintigraphy: prediction of postoperative lung function in patients with lung cancer

OBJECTIVE: The purpose of this study was to determine the capability of dynamic perfusion MRI as an alternative to pulmonary perfusion scintigraphy for prediction of postoperative lung function in patients with lung cancer. SUBJECTS AND METHODS. Sixty patients with lung cancer (35 men, 25 women) underwent dynamic perfusion MRI, perfusion scintigraphy, and preoperative and postoperative pulmonary function tests (forced expiratory volume in 1 sec [FEV(1)]). Perfusion MRIs were obtained with a 3D turbo field-echo sequence (TR/TE, 2.7/0.6; flip angle, 40 degrees; matrix, 128 x 96) using a 1.5-T scanner. Regional blood flow was calculated from the signal intensity-time curves after bolus injection of contrast medium on MRI (Q(MRI)) and uptake ratios of radioisotope on perfusion scintigraphy (Q(PS)). Postoperative lung functions predicted by MRI (FEV(1,MRI)) and perfusion scintigraphy (FEV(1,PS)) were calculated from preoperative FEV(1) and regional Qs. To determine the capability of MRI as an alternative to scintigraphy, we evaluated correlations and the limits of agreement between predicted FEV(1,MRI) and postoperative FEV(1) and between predicted FEV(1,PS) and postoperative FEV(1). RESULTS: The correlation coefficient of postoperative FEV(1) with FEV(1,MRI) (r = 0.93, p < 0.0001) was better than that with FEV(1,PS) (r = 0.89, p < 0.0001). The limits of agreement between postoperative FEV(1) and predicted FEV(1,MRI) (0.9% +/- 10.4%) were smaller than those between postoperative FEV(1) and predicted FEV(1,PS) (2.1% +/- 13.2%). CONCLUSION: Dynamic perfusion MRI is a feasible alternative to pulmonary perfusion scintigraphy for predicting postoperative lung function in patients with lung cancer.     

Prediction of postoperative pulmonary function using perfusion magnetic resonance imaging of the lung

PURPOSE: To assess semiquantitatively the regional distribution of lung perfusion using magnetic resonance (MR) perfusion imaging.MATERIALS AND METHODS: Subjects were 20 consecutive patients with bronchogenic carcinoma, who underwent MR imaging (MRI) and radionuclide (RN) perfusion scans for preoperative evaluation. Three-dimensional (3D) images of whole lungs were obtained before and 7 seconds after bolus injection of contrast material (5 ml of Gd-DTPA). Subtraction images were constructed from these dynamic images. Lung areas enhanced with the contrast material were measured and multiplied by changes in signal intensity, summed for the whole lung, and the right-to-left lung ratios were calculated. The predicted postoperative forced expiratory volume in 1 second (FEV1) was estimated using MR and RN perfusion ratios.RESULTS: The correlation between perfusion ratios derived from the MR and RN studies was excellent (r = 0.92). Sixteen of 20 patients underwent surgery, and 12 patients had postoperative pulmonary function tests. The predicted FEV1 derived from the MR perfusion ratio correlated well with the postoperative FEV1 in the 12 patients (r = 0.68).CONCLUSION: Perfusion MRI is suitable for semiquantitative evaluation of regional pulmonary perfusion.     

双源CT双能量肺灌注成像对肺栓塞的初步研究

目的 探讨双源CT双能量扫描肺灌注成像的临床诊断价值.方法 选择临床怀疑肺动脉栓塞30例患者行双源CT双能量扫描,生成140、80 kV和融合系数为0.3的3组数据.根据融合数据的CT肺动脉造影(CTPA)图像将患者分为肺栓塞组和正常组.采用双能量评估软件将薄层重建数据进行灌注成像分析,将双肺野分为上、中、下3部分,正常组受试者肺组织灌注定量的双侧比较行配对t检验,2组间肺组织灌注量比较行独立样本t检验,并对融合图像行MinIP,评估肺组织通气情况.结果 正常组(16例)肺灌注均匀,无明显灌注缺损及减弱,灌注定量分析显示左、右全肺的灌注量分别为(27±7)、(28±8)HU,两侧比较差异无统计学意义(t=-1.73,P＞0.05);左肺上、中、下部的灌注量分别为(23±6)、(24±6)、(28±8)HU,右肺上、中、下部灌注量分别为(26±8)、(27±8)、(28±9)HU,两侧分别比较差异均无统计学意义(t值分别为-1.91、-1.96、-1.73,P值均＞0.05).肺栓塞组(14例)CTPA图像显示肺动脉干、段及亚段充盈缺损,肺灌注成像表现为栓塞血管所支配肺野区域的灌注缺损或缺失,灌注定量分析显示全肺及中、下肺的灌注量分别为(22±5)、(22±8)、(21±8)HU,与正常组分别比较差异均有统计学意义(t值分别为-2.10、-2.32、-2.63,P值均＜0.05＝.MinIP显示通气异常区与灌注异常区具有良好的一致性.结论 双源CT双能量扫描可用于肺栓塞的诊断,有利于肺栓塞的早期发现和精确解剖定位.

Abstract：

Objective To explore the diagnostic values of dual energy lung perfusion in the diagnosis of pulmonary embolism by using dual-source CT (DSCT). Methods Thirty patients with clinically suspected pulmonary embolism underwent dual-energy scanning with dual-source CT. The scanned data were integrated into three groups including 140, 80 kV and coefficient of 0.3. According to the CT pulmonary angiography (CTPA) of the fusion data, the patients were divided into pulmonary embolism group and normal group. The thin-slice reconstruction of data was analyzed using dual-energy perfusion imaging analysis software. The lung field was divided into upper, middle and lower part to make quantitative analysis of lung tissue perfusion. Paired t-tests were used in the normal patients to compare bilateral lungs, and independent samples t-tests were applied to compare the embolism group and normal group, while minimum intensity projection images (MinIP) were utilized in the assessment of lung ventilation. Results Dual energy CT showed symmetrical homogeneous perfusion in 16 normal cases, without significant perfusion defects. Quantitative analysis showed that left and right lung perfusion were (27 ± 7) and (28 ± 8 ) HU respectively, and no significant difference was found between the two sides ( t=-1.73, P ＞0.05 ).Perfusion of the left upper, middle and lower lung was ( 23 ± 6), (24 ± 6), and (28 ± 8) HU respectively, while the perfusion of right upper, middle and lower lung was (26 ±8), (27 ±8), and (28 ±9) HU respectively, showing no statistical significant difference between the two sides (t=-1.91, -1.96,-1.73 ,P＞0.05 ). Angiography of pulmonary embolism group(14 cases)showed filling defects in the pulmonary trunk, segments and sub-segments. Pulmonary perfusion imaging showed low perfusion or defectsin lung field that dominated by embolic vessels. Quantitative analysis showed that the perfusion of the whole lung and the middle and lower lung were (22 ±5), (22 ±8), and (21 ±8) HU in the embolism group,which were significantly different from the normal group (t=-2. 10, -2.32, -2.63, P＜0.05).Minimum intensity projection images showed a good consistency of abnormal ventilation zone area and perfusion abnormalities. Conclusions Pulmonary perfusion status, especially pulmonary embolism, can be analyzed by dual energy CT scanning. It helps to early discover and precisely locate the embolism.     

Correlation of the perfusion scintigram with pulmonary functions in chronic obstructive pulmonary disease]

We carried out ventilation-perfusion scintigraphy and pulmonary function tests in 21 patients with chronic obstructive pulmonary disease. We used 99mTc-macroaggregate for perfusion scintigram and 133Xe gas for ventilation scintigram. We added the radioactivities of rebreathing phase and made lung volume image using computer. Regions of interest (ROIs) were derived from radioactivities in each image. ROIs on lung volume image included each whole lung and those on perfusion image included the areas which had relatively high radioactivity. We counted the area of ROIs on lung volume (L) and perfusion (P) images. Then we used the ratio of perfusion to lung volume (P/L) as a parameter of pulmonary perfusion. P/L had the significant correlations with the vital capacity, the actual FEV1.0, arterial oxygen partial pressure, diffusing capacity, RV/TLC and peak flow rate. These results suggested that P/L was a useful parameter of pulmonary perfusion in chronic obstructive pulmonary disease.     

肺通气/灌注显像用于肺容积 减少术的病例选择

目的 评价肺通气／灌注（Ｖ／Ｐ）显像对慢性阻塞性肺病（ＣＯＰＤ）肺容积减少术（ＬＶＲＳ）病例的选择及手术部位和范围确定的价值。方法 １２８例ＣＯＰＤ患者（均为男性，年龄４５～７６岁）进行Ｖ／Ｐ显像，其中２９例（年龄４５～７４岁）进行ＬＶＲＳ治疗，术后３～６个月复查，通气显像采用＾９９Ｔｃ＾ｍ－ＤＴＰＡ气溶胶吸入法，灌注显像用＾９９Ｔｃ＾ｍ－人血清聚合白蛋白（ＭＡＡ）静注法，根据显像类型分成①局灶型     

Prediction of postoperative lung function in patients with lung cancer: comparison of quantitative CT with perfusion scintigraphy

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.     

The prognostic value of perfusion lung scintigraphy in patients who underwent single-lung transplantation for emphysema and pulmonary fibrosis.

The objective of this study was to evaluate the role of quantitative perfusion lung scintigraphy (QPLS) in predicting the development of chronic rejection in patients who underwent single-lung transplantation. METHODS: Eighteen patients (15 men, 3 women; age range, 41-60 y; mean age, 54.6+/-6.0 y) who underwent single-lung transplantation for emphysema (n = 14) or pulmonary fibrosis (n = 4) were studied. Patients were evaluated using QPLS and pulmonary function tests before surgery and at 1-3 mo and 1-3 y after transplantation. Relative perfusion of the transplanted lung was calculated from standard perfusion lung scintigrams. Values for forced expiratory volume in the first second (FEV1) were obtained from lung function tests at the same time points. The maximal and minimal relative perfusion and FEV1 values in the early (1-3 mo) and late (1-3 y) follow-up periods were identified for each patient. Receiver operating curve (ROC) analysis was performed on all parameters. RESULTS: In total, 82 lung scans were performed (mean, 4.8+/-1.55 per patient) and 484 FEV1 test determinations were obtained (mean, 30.0+/-15.6 per patient) during a follow-up period ranging from 8 to 84 mo (mean, 39.6+/-19.3 mo). In 7 of the 18 patients, chronic rejection developed, whereas 11 patients had a favorable outcome. No significant difference was found in the number of complications (acute rejection and infection episodes) between patients with a favorable outcome and patients with chronic rejection, up to 1 y after transplantation. At 1-3 mo, minimal relative perfusion values were 67.1%+/-12.2% in the favorable outcome group and 50.8%+/-9.6% in the chronic rejection group (P = 0.02). Before surgery and at 1-3 y, minimal relative perfusion was not significantly different between the 2 groups. The difference in maximal relative perfusion at 1-3 y was marginally significant, with 76.5%+/-8.9% in the favorable group and 64.3%+/-15.0% in the chronic rejection group (P = 0.051). FEV1 values were not significantly different preoperatively and 1-3 mo after surgery between the chronic rejection and the favorable outcome groups. Late in the follow-up period (1-3 y), FEV1 values in the chronic rejection and favorable outcome groups were 35.6%+/-7.9% and 56.9%+/-13.6%, respectively (P = 0.002). ROC analysis of minimal relative perfusion at 1-3 mo identified a threshold of 57% under which the sensitivity and specificity for chronic rejection were 83% and 88%, respectively. Minimal FEV1 for the same period identified a threshold of 48% under which the sensitivity and the specificity were 80% and 67%, respectively. CONCLUSION: QPLS early after transplantation in our patients predicted the development of chronic rejection in patients with single-lung transplantation for emphysema and pulmonary fibrosis, whereas surgical complications, acute rejection, infection episodes, and lung function tests did not predict the outcome. This early prediction could not be obtained from lung function tests performed at the same time.