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Comparative Study
. 2021;100(12):1186-1195.
doi: 10.1159/000517598. Epub 2021 Aug 10.

Dual-Energy Computed Tomography Compared to Lung Perfusion Scintigraphy to Assess Pulmonary Perfusion in Patients Screened for Endoscopic Lung Volume Reduction

Hester A Gietema  1 , Kim H M Walraven  2 , Rein Posthuma  2   3   4 , Cristina Mitea  1 , Dirk-Jan Slebos  5 , Lowie E G W Vanfleteren  6
Affiliations
Comparative Study

Dual-Energy Computed Tomography Compared to Lung Perfusion Scintigraphy to Assess Pulmonary Perfusion in Patients Screened for Endoscopic Lung Volume Reduction

Hester A Gietema et al. Respiration. 2021.

Abstract

Background: Endoscopic lung volume reduction (ELVR) using one-way endobronchial valves is a technique to reduce hyperinflation in patients with severe emphysema by inducing collapse of a severely destroyed pulmonary lobe. Patient selection is mainly based on evaluation of emphysema severity on high-resolution computed tomography and evaluation of lung perfusion with perfusion scintigraphy. Dual-energy contrast-enhanced CT scans may be useful for perfusion assessment in emphysema but has not been compared against perfusion scintigraphy.

Aims: The aim of the study was to compare perfusion distribution assessed with dual-energy contrast-enhanced computed tomography and perfusion scintigraphy.

Material and methods: Forty consecutive patients with severe emphysema, who were screened for ELVR, were included. Perfusion was assessed with 99mTc perfusion scintigraphy and using the iodine map calculated from the dual-energy contrast-enhanced CT scans. Perfusion distribution was calculated as usually for the upper, middle, and lower thirds of both lungs with the planar technique and the iodine overlay.

Results: Perfusion distribution between the right and left lung showed good correlation (r = 0.8). The limits of agreement of the mean absolute difference in percentage perfusion per region of interest were 0.75-5.6%. The upper lobes showed more severe perfusion reduction than the lower lobes. Mean difference in measured pulmonary perfusion ranged from -2.8% to 2.3%. Lower limit of agreement ranged from -8.9% to 4.6% and upper limit was 3.3-10.0%.

Conclusion: Quantification of perfusion distribution using planar 99mTc perfusion scintigraphy and iodine overlays calculated from dual-energy contrast-enhanced CTs correlates well with acceptable variability.

Keywords: Bronchoscopic lung volume reduction; Computed tomography, lung; Dual-energy computed tomography; Emphysema; Perfusion scan; Scintigraphy.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Lung scintigraphy (a) and iodine overlay in coronal (b) and axial (c) plane of one of the ELVR candidates showing severe perfusion defects in both upper zones, but most severe in the right upper zone. The lungs were divided in a upper, middle, and lower third (d) to calculate the relative perfusions. ELVR, endoscopic lung volume reduction.
Fig. 2
Fig. 2
Relative perfusion of right (a) and left (b) lung assessed with 99mTc pulmonary scintigraphy (x-axis) and computed from the iodine overlay calculated from contrast-enhanced dual-energy computed tomography (y-axis).
Fig. 3
Fig. 3
Box and whisker plot of differences in regional perfusion. Y-axis shows difference between relative perfusion measured by 99mTc perfusion scintigraphy and relative perfusion calculated by the iodine overlay. RU, right upper; RM, right middle; RL, Right lower; LU, left upper, LM, left middle; LL, left lower.
Fig. 4
Fig. 4
Bland and Altman plots of the 6 regions of interest.
See this image and copyright information in PMC

References

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