Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Sep;14(9):3234-3244.
doi: 10.21037/jtd-22-383.

Reliability of dynamic perfusion digital radiography as an alternative to pulmonary perfusion scintigraphy in predicting postoperative lung function and complications

Jun Hanaoka  1 , Takuya Shiratori  1 , Keigo Okamoto  1 , Ryosuke Kaku  1 , Yo Kawaguchi  1 , Yasuhiko Ohshio  1 , Akinaga Sonoda  2
Affiliations

Reliability of dynamic perfusion digital radiography as an alternative to pulmonary perfusion scintigraphy in predicting postoperative lung function and complications

Jun Hanaoka et al. J Thorac Dis. 2022 Sep.

Abstract

Background: Accurate perioperative risk assessment can enhance the perioperative management of patients undergoing radical surgery for lung cancer. In this study, we compared the accuracy of predicting perioperative complications by lung function values, estimated by blood flow ratios (BFRs), to determine whether dynamic perfusion digital radiography (DPDR) could substitute for pulmonary perfusion scintigraphy (PPS).

Methods: Patients scheduled for radical surgery for lung cancer who underwent simultaneous dynamic chest radiography (DCR) and lung perfusion scintigraphy were assessed. We confirmed the agreement between two methods in the assessment of the BFR and its predicted postoperative (ppo) value. Besides, the best spirometry thresholds for the risk of perioperative respiratory or cardiovascular complications were calculated from a receiver operating characteristic (ROC) analysis. The imaging methods were compared for sensitivity and specificity.

Results: Among the 44 cases enrolled, DPDR and PPS showed high correlations in BFR (r=0.868, P<0.01) and its postoperative value (r=0.975, P<0.01) and between the predicted and measured spirometry values. In both imaging modalities, the estimated postoperative diffusing capacity test for carbon monoxide (DLco) had the best prediction [area under the curve (AUC) >0.7] for respiratory complications within 1 month (with different cut-offs for same target cases). For predicting, respiratory complications within 1-3 months after surgery, these values were similar between two modalities. Furthermore, the ppoDLco values from both imaging methods were excellent indicators of the induction of postoperative long term oxygen therapy, with the AUC greater than 0.8.

Conclusions: This study showed that simple and less invasive DPDR can be a good alternative to PPS for predicting postoperative pulmonary function values and the risk of postoperative respiratory complications. This new imaging modality will offer new insights and possible functional analyses of pulmonary circulation.

Keywords: Dynamic perfusion digital radiography (DPDR); postoperative complication; prediction of postoperative respiratory function; pulmonary perfusion scintigraphy (PPS).

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jtd.amegroups.com/article/view/10.21037/jtd-22-383/coif). JH received a research grant from Konica Minolta Inc. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow diagram of the study. Forty-four patients, in whom DPDR and PPS were simultaneously imaged, were analyzed, excluding those with diseases other than lung cancer (n=3), wedge resection of the lung (n=3), and refusal of informed consent (n=4). DPDR, dynamic perfusion digital radiography; PPS, pulmonary perfusion scintigraphy.
Figure 2
Figure 2
Pulmonary perfusion imaging. Pulmonary perfusion was evaluated by visualizing the degree of the waveform correlation. Cross-correlation value changes (red line) between pixel value changes on the lung ROI (green line) and sign-inverted pixel value changes on the ventricle ROI (blue line) were calculated by cross-correlation calculation processing. The cross-correlation value changes are displayed in red shades on each frame of the chest dynamic image. ROI, region of interest.
Figure 3
Figure 3
Comparison between BFR obtained from DPDR and PPS. Correlation between the BFRs of the affected side obtained from DPDR and PPS. BFR, blood flow ratio; DPDR, dynamic perfusion digital radiography; PPS, pulmonary perfusion scintigraphy.
See this image and copyright information in PMC

Comment in

References

    1. Eguchi T, Bains S, Lee MC, et al. Impact of Increasing Age on Cause-Specific Mortality and Morbidity in Patients With Stage I Non-Small-Cell Lung Cancer: A Competing Risks Analysis. J Clin Oncol 2017;35:281-90. 10.1200/JCO.2016.69.0834 - DOI - PMC - PubMed
    1. Fernandez FG, Kosinski AS, Burfeind W, et al. The Society of Thoracic Surgeons Lung Cancer Resection Risk Model: Higher Quality Data and Superior Outcomes. Ann Thorac Surg 2016;102:370-7. 10.1016/j.athoracsur.2016.02.098 - DOI - PMC - PubMed
    1. Okami J, Higashiyama M, Asamura H, et al. Pulmonary resection in patients aged 80 years or over with clinical stage I non-small cell lung cancer: prognostic factors for overall survival and risk factors for postoperative complications. J Thorac Oncol 2009;4:1247-53. 10.1097/JTO.0b013e3181ae285d - DOI - PubMed
    1. Onaitis MW, Furnary AP, Kosinski AS, et al. Prediction of Long-Term Survival After Lung Cancer Surgery for Elderly Patients in The Society of Thoracic Surgeons General Thoracic Surgery Database. Ann Thorac Surg 2018;105:309-16. 10.1016/j.athoracsur.2017.06.071 - DOI - PubMed
    1. Ferguson MK, Watson S, Johnson E, et al. Predicted postoperative lung function is associated with all-cause long-term mortality after major lung resection for cancer. Eur J Cardiothorac Surg 2014;45:660-4. 10.1093/ejcts/ezt462 - DOI - PMC - PubMed