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Respiratory muscle metabolic activity on PET/CT correlates with obstructive ventilatory defect severity and prognosis in patients undergoing lung cancer surgery |
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| Authors: | Kinan El Husseini Jean-Marc Baste Anne-Charlotte Bouyeure-Petit Elodie Lhuillier Antoine Cuvelier Pierre Decazes Pierre Vera Thomas Similowski Maxime Patout |
| Affiliation: | 1. Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, CHU Rouen, Rouen, France;2. Service de Chirurgie Thoracique, CHU Rouen, Rouen, France Contribution: Conceptualization (supporting), Methodology (equal), Resources (equal), Writing - review & editing (equal);3. Service de Médecine Nucléaire, Centre Henri Becquerel, Rouen, France Contribution: Conceptualization (supporting), Methodology (equal), Resources (equal), Writing - review & editing (equal);4. Unité de recherche clinique, Centre Henri Becquerel, Rouen, France Contribution: Conceptualization (supporting), Methodology (equal), Resources (equal), Writing - review & editing (equal);5. Service de Pneumologie, Oncologie Thoracique et Soins Intensifs Respiratoires, CHU Rouen, Rouen, France EA3830-GRHV, Institute for Research and Innovation in Biomedicine (IRIB), Normandie Université, UNIRouen, Rouen, France Contribution: Conceptualization (supporting), Methodology (equal), Project administration (equal), Resources (equal), Writing - review & editing (equal);6. Département R3S (Respiration, Réanimation, Réhabilitation respiratoire, Sommeil), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, France Inserm UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France Contribution: Formal analysis (equal), Supervision (supporting), Writing - review & editing (equal);7. Inserm UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France |
| Abstract: | Background and ObjectiveRespiratory muscle activity is increased in patients with chronic respiratory disease. 18F-FDG-PET/CT can assess respiratory muscle activity. We hypothesized that respiratory muscles metabolism was correlated to lung function impairment and was associated to prognosis in patients undergoing lung cancer surgery based on the research question whether respiratory muscle metabolism quantitatively correlates with the severity of lung function impairment in patients? Does respiratory muscle hypermetabolism have prognostic value?MethodsPatients undergoing 18F-FDG-PET/CT and pulmonary function tests prior to lung cancer surgery were identified. Maximum Standardized Uptake Value (SUVm) were measured in each respiratory muscle group (sternocleidomastoid, scalene, intercostal, diaphragm), normalized against deltoid SUVm. Respiratory muscle hypermetabolism was defined as SUVm >90th centile in any respiratory muscle group. Clinical outcomes were collected from a prospective cohort.ResultsOne hundred fifty-six patients were included, mostly male [110 (71%)], 53 (34%) with previous diagnosis of COPD. Respiratory muscle SUVm were: scalene: 1.84 [1.51–2.25], sternocleidomastoid 1.64 [1.34–1.95], intercostal 1.01 [0.84–1.16], diaphragm 1.79 [1.41–2.27]. Tracer uptake was inversely correlated to FEV1 for the scalene (r = −0.29, p < 0.001) and SCM (r = −0.17, p = 0.03) respiratory muscle groups and positively correlated to TLC for the scalene (r = 0.17, p = 0.04). Respiratory muscle hypermetabolism was found in 45 patients (28.8%), who had a lower VO2 max (15.4 [14.2–17.5] vs. 17.2 mL/kg/min [15.2–21.1], p = 0.07) and poorer overall survival when adjusting to FEV1% (p < 0.01).ConclusionOur findings show respiratory muscle hypermetabolism is associated with lung function impairment and has prognostic significance. 18F-FDG/PET-CT should be considered as a tool for assessing respiratory muscle activity and to identify high-risk patients. |
| Keywords: | lung cancer surgery lung physiology metabolic imaging PET/CT Positron emission tomography/computed tomography respiratory drive respiratory muscles |