Prediction Of Postoperative Pulmonary Function Research Articles

Effect of resected lung lobe on the prediction of postoperative pulmonary function.

This study examined whether a resected lung lobe can affect the accuracy of postoperative forced expiratory volume in 1 s (FEV1) predicted using the subsegment counting method and three-dimensional computed tomography (3D-CT) volumetry. Overall, 125 patients who underwent lobectomy through video-assisted thoracic surgery were enrolled in this retrospective study. Pulmonary function tests were performed preoperatively and postoperatively at 3 months. We defined the accuracy index as the ratio of predicted postoperative FEV1 to measured postoperative FEV1 and compared the accuracy index of the subsegment counting method and 3D-CT volumetry. Factors affecting the accuracy index were also examined. The accuracy index of the subsegment counting method was 0.94 ± 0.12, versus 0.93 ± 0.11 for 3D-CT volumetry (P = 0.539). There was a significant difference among the resected lobes in the accuracy index of the subsegment counting method (P < 0.001) but not in that of 3D-CT volumetry (P = 0.370). The resected lobe, the number of staples used for interlobar dissection and interstitial pneumonia were significantly associated with the accuracy index of the subsegment counting method (all P < 0.001). The number of staples and interstitial pneumonia were significantly associated with the accuracy index of 3D-CT volumetry (P < 0.001, respectively), whereas the resected lobe was not a significant factor (P = 0.240). The resected lobe affected the accuracy of the subsegment counting method but not that of 3D-CT volumetry. Furthermore, 3D-CT volumetry predicted postoperative FEV1 independent of the resected lobe.

Dynamic perfusion digital radiography for predicting pulmonary function after lung cancer resection

BackgroundAccurate prediction of postoperative pulmonary function is important for ensuring the safety of patients undergoing radical resection for lung cancer. Dynamic perfusion digital radiography is an excellent and easy imaging method for detecting blood flow in the lung compared with the less-convenient conventional lung perfusion scintigraphy. As such, the present study aimed to confirm whether dynamic perfusion digital radiography can be evaluated in comparison with pulmonary perfusion scintigraphy in predicting early postoperative pulmonary function and complications.MethodsDynamic perfusion digital radiography and spirometry were performed before and 1 and 3 months after radical resection for lung cancer. Correlation coefficients between blood flow ratios calculated using dynamic perfusion digital radiography and pulmonary perfusion scintigraphy were then confirmed in the same cases. In all patients who underwent dynamic perfusion digital radiography, the correlation predicted values calculated from the blood flow ratio, and measured values were examined. Furthermore, ppo%FEV1 or ppo%DLco values, which indicated the risk for perioperative complications, were examined.ResultsA total of 52 participants who satisfied the inclusion criteria were analyzed. Blood flow ratios measured using pulmonary perfusion scintigraphy and dynamic perfusion digital radiography showed excellent correlation and acceptable predictive accuracy. Correlation coefficients between predicted FEV1 values obtained from dynamic perfusion digital radiography or pulmonary perfusion scintigraphy and actual measured values were similar. All patients who underwent dynamic perfusion digital radiography showed excellent correlation between predicted values and those measured using spirometry. A significant difference in ppo%DLco was observed for respiratory complications but not cardiovascular complications.ConclusionsOur study demonstrated that dynamic perfusion digital radiography can be a suitable alternative to pulmonary perfusion scintigraphy given its ability for predicting postoperative values and the risk for postoperative respiratory complications. Furthermore, it seemed to be an excellent modality because of its advantages, such as simplicity, low cost, and ease in obtaining in-depth respiratory functional information.Trial registrationRegistered at UMIN on October 25, 2017. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_his_list.cgi?recptno=R000033957Registration number: UMIN000029716

Prediction of pulmonary function after major lung resection using lung perfusion scintigraphy with single-photon emission computed tomography/computed tomography.

Precise prediction of postoperative pulmonary function is extremely important for accurately evaluating the risk of perioperative morbidity and mortality after major surgery for lung cancer. This study aimed to compare the accuracy of a single-photon emission computed tomography/computed tomography (SPECT/CT) method that we recently developed for predicting postoperative pulmonary function versus the accuracy of both the conventional simplified calculating (SC) method and the method using planar images of lung perfusion scintigraphy. The relationship between the postoperative observed % values of the forced expiratory volume in 1 second (FEV1) or diffusing capacity for carbon monoxide (DLCO or DLCO') and the % predicted postoperative (%ppo) values of FEV1, DLCO, or DLCO' calculated by the three methods were analyzed in 30 consecutive patients with lung cancer undergoing lobectomy. The relationship between the postoperative observed % values and %ppo values calculated by the three methods exhibited a strong correlation (Pearson r>0.8, two-tailed p<0.0001). The limits of agreement between the postoperative % values and %ppo values did not differ among the three methods. The absolute values of the differences between the postoperative % values and %ppo values for FEV1 and DLCO' were comparable among the three methods, whereas those for DLCO of SPECT/CT were significantly higher than those of the planar method. Conversely, in patients with preoperative %DLCO' of <80% predicted, the absolute values of the differences between the postoperative %DLCO' and %ppoDLCO' of SPECT/CT tended to be smaller than those of the SC and planar methods. The accuracy of SPECT/CT for predicting postoperative pulmonary function is comparable with that of conventional methods in most cases, other than in some patients with diffusion impairment.

Prediction of post-operative pulmonary function after lobectomy for primary lung cancer: A comparison among counting method, effective lobar volume, and lobar collapsibility using inspiratory/expiratory CT

PurposeTo compare the predictabilities of postoperative pulmonary function after lobectomy for primary lung cancer among counting method, effective lobar volume, and lobar collapsibility. MethodsForty-nine patients who underwent lobectomy for primary lung cancer were enrolled. All patients underwent inspiratory/expiratory CT and pulmonary function tests 2 weeks before surgery and postoperative pulmonary function tests 6–7 months after surgery. Pulmonary function losses (ΔFEV1.0 and ΔVC) were calculated from the pulmonary function tests. Predictive postoperative pulmonary function losses (ppoΔFEV1.0 and ppoΔVC) were calculated using counting method, effective volume, and lobar collapsibility. Correlations and agreements between ΔFEV1.0 and ppoFEV1.0 and those between ΔVC and ppoΔVC were tested among three methods using Spearman’s correlation coefficient and Bland-Altman plots. ResultsΔFEV1.0 and ppoΔFEV1.0insp-exp were strongly correlated (r=0.72), whereas ΔFEV1.0 and ppoΔFEV1.0count and ΔFEV1.0 and Pred. ΔFEV1.0eff.vol. were moderately correlated (r=0.50, 0.56). ΔVC and ppoΔVCeff.vol. (r=0.71) were strongly correlated, whereas ΔVC and ppoΔVCcount, and ΔVC and ppoΔVC insp-exp were moderately correlated (r=0.55, 0.42). ConclusionsVolumetry from inspiratory/expiratory CT data could be useful to predict postoperative pulmonary function after lobectomy for primary lung cancer.

Perfusion lung scintigraphy for the prediction of postoperative residual pulmonary function in patients with lung cancer.

Accurate prediction of postoperative pulmonary function in patients with non-small cell lung cancer is crucial for proper qualification for surgery, the only effective therapeutic method. The aim of the study was to select the most accurate method for acquisition and processing of lung perfusion scintigraphy (LPS) combined with spirometry for prediction of postoperative pulmonary function in patients qualified for surgery. LPS was performed in 70 patients (40 males, 30 females), with preoperative spirometry (mean FEV1preop = 2.26 ± 0.72 L), after administration of 185 MBq of 99mTc-microalbumin/macroaggregate, using planar (appa) and SPECT/CT methods. Predicted postoperative lung function (FEV1pred) was calculated as a part of active lung parenchyma to remain after surgery. A non-imaging segment counting method was also applied. FEV1pred(appa, SPECT, SPECT/CT, segm.) were further compared with actual FEV1postop values obtained from postoperative spirometry. In the whole studied group (47 lobectomies, 23 pneumonectomies) mean value of FEV1postop was equal to 1.76 (± 0.56) L. FEV1pred(appa, SPECT, SPECT/CT, segm.) were equal to 1.75 (± 0.58) L, 1.71 (± 0.57) L, 1.72 (± 0.57) L and 1.57 (± 0.58) L, respectively. A segment counting method systematically lowered predicted FEV1 values (p < 10-5). Moreover, in 31 patients with FEV1preop < 2 L error of predicted values was assessed with Bland-Altman method. Mean absolute differences FEV1postop - FEV1pred amounted to: appa - (0.04 ± 0.13) L, SPECT - (0.07 ± 0.14) L, SPECT/CT - (0.06 ± 0.14) L and segm. - (0.21 ± 0.19) L, respectively. Lower limit of 95% confidence interval calculated for planar - optimal method, was equal to -220 mL (also determined separately in subgroups after lobectomy and pneumonectomy). This study shows that planar LPS may be applied for prediction of postoperative pulmonary function in patients qualified for pneumonectomy and lobectomy. If actual FEV1postop value is to be ≥ 800 mL, predicted value should exceed 1000 mL.

Prediction of postoperative pulmonary function: preliminary comparison of single-breath dual-energy xenon CT with three conventional methods

To assess the use of xenon ventilation maps (Xe-images) for predicting postoperative pulmonary function. After study approval by the institutional review board, written informed consent was obtained from 30 patients with lung tumors who underwent pre- and postoperative spirometry, pulmonary perfusion SPECT and dual-energy CT (80 kV and 140 kV/Sn) after single-breath inspiration of 35 % xenon. Xe-images were calculated by three-material decomposition. Sum of pixel values of the part to be resected (A) and of the whole lung (B) on Xe-images or lung perfusion SPECT, and volumes or the number of segments of the part to be resected (A) and of the whole lung (B) on Xe-images were enumerated, respectively. We multiplied (1 - A/B) by each preoperative value from spirometry for prediction. Predictions by each of the four methods were compared with postoperative values. Predicted values for vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) by the four methods regressed significantly with measured values (R (2) = 0.56-0.77, p < 0.001 for all). Analysis of Xe-images can predict postoperative VC, FVC and FEV1 with accuracy comparable to that of CT volumetry.

Hepatoblastoma Metastasis Confined to the Pulmonary Artery: Report of a Case

Here, we report a case of hepatoblastoma metastasis to the left pulmonary artery which was resected by left lingular segmentectomy plus left lower lobectomy in 5-year-old girl. She had previously undertaken right upper lobectomy and multiple lung partial resections on bilateral lungs as hepatoblastoma metastatectomies. Prediction of postoperative pulmonary function based on perfusion scan merged with CT image and the measurement by CT volumetry, showed that left lingular segmentectomy plus left lower lobectomy could preserve 78% of the preoperative functional values and resection was done. Three weeks after the operation, her condition recovered to the preoperative level. Pathological examination showed that the metastasis was tumor embolism of hepatoblastoma which extended into the pulmonary arterial wall, which to our knowledge, has not been previously reported.

Vibration Response Imaging in Prediction of Pulmonary Function After Major Pulmonary Resection

PURPOSE: Perfusion or ventilation lung scan with pulmonary function test is currently used for prediction of postoperative pulmonary function in patients undergoing major pulmonary resection. The vibratory response imaging (VRI) is a novel bedside imaging technique that displays vibration energy of lung sounds generated during the respiratory cycle as a real-time structural and functional image of the respiratory process. We measured the predicted postoperative (ppo) lung function using perfusion lung scan and VRI, and compared its results with the actual postoperative pulmonary functions results.

CLC020 POSTER Prediction of postoperative pulmonary function in patients undergoing lung resection

CLC020 POSTER Prediction of postoperative pulmonary function in patients undergoing lung resection

Breath-hold single-photon emission tomography and computed tomography for predicting residual pulmonary function in patients with lung cancer

We sought to evaluate the utility of integrated breath-hold single-photon emission tomography and computed tomography imaging compared with that of simple calculation with the lung segment-counting technique for predicting residual pulmonary function in patients undergoing surgical intervention for lung cancer. A prospective series of 22 patients undergoing anatomic lung resection for cancer were enrolled in this study. Postoperative residual forced expiratory volume in 1 second was predicted by measuring the radioactivity counts of the affected lobes or segments to be resected within the entire lungs by placement of regions of interest on single-photon emission tomography and computed tomography images. Residual forced expiratory volume in 1 second was also estimated by using the segment-counting technique. Both predicted values agreed well with postoperative forced expiratory volume in 1 second. Although the residual forced expiratory volume in 1 second predicted by means of single-photon emission tomography and computed tomography correlated well with that predicted by using segment counting, the values were significantly underestimated by the segment-counting technique in 4 outliers with severe emphysema. There were 2 patients with borderline pulmonary functional reserve whose residual forced expiratory volume in 1 second values were predicted more accurately by means of single-photon emission tomography and computed tomography than by using segment counting. Integrated breath-hold single-photon emission tomography and computed tomography images allow the accurate prediction of postoperative pulmonary function but without statistical superiority over the simple segment-counting technique. Further study of the usefulness of single-photon emission tomography and computed tomography in patients with severe emphysema and borderline lung function should prove valuable because the segment-counting technique underestimates pulmonary functional reserve in these patients.

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

To assess semiquantitatively the regional distribution of lung perfusion using magnetic resonance (MR) perfusion imaging. 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. 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). Perfusion MRI is suitable for semiquantitative evaluation of regional pulmonary perfusion.

Nuclear medicine diagnosis of the lung

Scintigraphic recording of regional ventilation and perfusion with 99mTc-Aerosol and 99mTc-MAA remain in the foreground of nuclear medicine pulmonary diagnostics. The most important indication for ventilation scintigraphy is the prediction of postoperative pulmonary function, which is still performed in many hospitals with perfusion scintigraphy, and with which, in turn, intrapulmonary right-left shunts can be simply and also semiquantitatively recorded. Combined ventilation/perfusion scintigraphy offers a very high degree of sensitivity in the proof of acute pulmonary embolism, is therefore exceptionally well suited for exclusion diagnostics, while specificity compared to pulmonary angiography and spiral CT still needs some clarification. The self-cleaning mechanism of the lung can be quantitatively examined using mucociliary and resorptive clearance. The clinical areas of application are limited for methodical reasons. Primary diagnostics of bronchial carcinoma and dignity differentiation of solitary pulmonary nodules, preferably with 18F-FDG PET are gaining steadily in importance.

Assessment of Operative Risk in Patients Undergoing Lung Resection

Objective To evaluate the ability of preoperative variables to identify patients at increased risk for complications after lung resection and the usefulness of predicted postoperative FEV1 as a marker of risk for adverse outcomes. Design Prospective analysis of a cohort of patients undergoing pulmonary resection. Complication rates were analyzed according to preoperative pulmonary variables, demographic variables, procedure performed, and predicted postoperative FEV1. Predicted postoperative FEV1 was calculated using a formula estimating the decline in preoperative FEV1 based on the number of bronchopulmonary segments removed during surgery. Setting A major teaching hospital and tertiary referral center. Patients A consecutive series of patients undergoing pulmonary resection. Measurements and main results Medical complications were recorded as part of an ongoing clinical database. The overall complication rate was low (17 percent rate of any complication, 1 percent death rate). Univariate predictors of complications included age ≥ 60, male sex, history of smoking, a pneumonectomy procedure, and a low predicted postoperative FEV1. Hypercarbia (≥45 mm Hg) on preoperative arterial glood gas analysis, desaturation on exercise oximetry (≤ 90 percent), and a preoperative FEV1 less than 1 L were not predictive of complications. When the effect of these variables was controlled for in a multivariate analysis, a low predicted postoperative FEV1 remained the only significant independent predictor of complications. For each 0.2 L decrease in predicted FEV1, the odds ratio for complications was 1.46 (95 percent confidence interval [CI] 1.2 to 1.8). Conclusions: A low predicted postoperative FEV1 appears to be the best indicator of patients at high risk for complications, and it was the only significant correlate of complications when the effect of other potential risk factors was controlled for in a multivariate analysis. Pulmonary resection should not be denied on the basis of traditionally cited preoperative pulmonary variables, and a prediction of postoperative pulmonary function by a technique of simple calculation may be useful to identify patients at increased risk for medical complications.

Assessment of operative risk in patients undergoing lung resection. Importance of predicted pulmonary function.

To evaluate the ability of preoperative variables to identify patients at increased risk for complications after lung resection and the usefulness of predicted postoperative FEV1 as a marker of risk for adverse outcomes. Prospective analysis of a cohort of patients undergoing pulmonary resection. Complication rates were analyzed according to preoperative pulmonary variables, demographic variables, procedure performed, and predicted postoperative FEV1. Predicted postoperative FEV1 was calculated using a formula estimating the decline in preoperative FEV1 based on the number of bronchopulmonary segments removed during surgery. A major teaching hospital and tertiary referral center. A consecutive series of patients undergoing pulmonary resection. Medical complications were recorded as part of an ongoing clinical database. The overall complication rate was low (17 percent rate of any complication, 1 percent death rate). Univariate predictors of complications included age > or = 60, male sex, history of smoking, a pneumonectomy procedure, and a low predicted postoperative FEV1. Hypercarbia (> or = 45 mm Hg) on preoperative arterial blood gas analysis, desaturation on exercise oximetry (< or = 90 percent), and a preoperative FEV1 less than 1 L were not predictive of complications. When the effect of these variables was controlled for in a multivariate analysis, a low predicted postoperative FEV1 remained the only significant independent predictor of complications. For each 0.2 L decrease in predicted FEV1, the odds ratio for complications was 1.46 (95 percent confidence interval [CI] 1.2 to 1.8). A low predicted postoperative FEV1 appears to be the best indicator of patients at high risk for complications, and it was the only significant correlate of complications when the effect of other potential risk factors was controlled for in a multivariate analysis. Pulmonary resection should not be denied on the basis of traditionally cited preoperative pulmonary variables, and a prediction of postoperative pulmonary function by a technique of simple calculation may be useful to identify patients at increased risk for medical complications.

Comparison of Inhalation Scan and Perfusion Scan for the Prediction of Postoperative Pulmonary Function

Background Because of the common etiologic factor, such as smoking, lung cancer and chronic obstructive Pulmonary disease are often present in the same patient. The preoperative prediction of remaining pulmonary function after the resectional surgery is very important to prevent serious complication and postoperative respiratory failure. 99mTc-MAA perfusion scan has been used for the prediction of postoperative pulmonary function, but it may be inaccurate in case of large V/Q mismatching. We compared 99mTc-DTPA radioaerosol inhalation scan with 99mTc-MAA perfusion scan in predicting postoperative lung function. Method Preoperative inhalation scan and/or perfusion scan were performed and pulmonary function test were performed preoperatively and 2 month after operation. We predicted the postoperative pulmonary functions using the following equations. Postpneumonectomy FEV1=Preop FEV1x% of total function of lung to remain Results 1) The inhalation scan showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.94, 0.91, 0.87 respectively). 2) The perfusion scan also showed good correlations between measured and predicted FEV1, FVC and FEF25-75%. (correlation coefficiency; 0.86, 0.72, 0.97 respectively). 3) Among three parameters, FEV1 showed the best correlations in the prediction by lung scans. 4) Comparison between inhalation scan and perfusion scan in predicting pulmonary function did not show any significant differneces except FVC. Conclusion The inhalation scan and perfusion scan are very useful in the prediction of postoperative lung function and don't make a difference in the prediction of pulmonary function although the former showed a better correlation in FVC.

Prediction of postoperative pulmonary function following thoracic surgery for bronchial carcinoma : Cordiner A, De Carlo F, De Gennaro R, Pau F, Flore FC. Forlanini Hospital, Via Portuense 332, I-00149 Roma. Angiology 1991;42:985-9

Prediction of postoperative pulmonary function following thoracic surgery for bronchial carcinoma : Cordiner A, De Carlo F, De Gennaro R, Pau F, Flore FC. Forlanini Hospital, Via Portuense 332, I-00149 Roma. Angiology 1991;42:985-9

Prediction of Postoperative Pulmonary Function Following Thoracic Surgery for Bronchial Carcinoma

At present surgery is accepted as the most effective mode of therapy for carcinoma of the lung. Because the lack of respiratory reserve is the major determinant of postoperative function, it is useful to identify the patient, who is at significant risk. Eighteen patients with lung cancer (mean age = 56 +/- 6.5 years) were studied preoperatively (preop) and postoperative (postop) (three to four months after lung resection) by spirometry, measurement of arterial blood gases, and quantitative lung scanning (99mTc). A predicted postoperative value of some variables was calculated by the formula: postop value = preop value x % function of regions of lung not resected. The correlation coefficient between the predicted (pred) and postoperatively observed (observ) values VC = vital capacity, FEV1 = forced expiratory volume in 1 second) is: VC pred/VC observ r = 0.83 p less than 0.001 FEV1 pred/FEV1 observ r = 0.82 p less than 0.001. The authors' results agree with earlier reports and show that the method used can accurately predict the postoperative respiratory function in patients undergoing lung resection (pneumonectomy or lobectomy). A predicted FEV1 of 0.8 L does not permit a surgical program, because, below this level, carbon dioxide retention becomes more frequent and exercise intolerance is increasingly severe (poor quality of life). The method proposed to predict the postoperative respiratory function is simple and routinely useful. The authors choose a perfusion instead of ventilation scan, because the former provides similar predicted postoperative data, and can be done routinely.

Prediction of postoperative pulmonary function in lung cancer patient using corrected lateral lung scan image

Prediction of postoperative pulmonary function in lung cancer patient using corrected lateral lung scan image

Prediction of postoperative pulmonary function following thoracic operations: Value of ventilation-perfusion scanning

Surgical resection of lung cancer is frequently required in patients with severely impaired lung function resulting from chronic obstructive pulmonary disease. Twenty patients with obstructive lung disease and cancer (mean preoperative forced expiratory volume in 1 second [FEV1] = 1.73 L) were studied preoperatively and postoperatively by spirometry and radionuclide perfusion, single-breath ventilation, and washout techniques to test the ability of these methods to predict preoperatively the partial loss of lung function by the resection. Postoperative FEV1 and forced vital capacity (FVC) were accurately predicted by the formula: postoperative FEV1 (or FVC) = preoperative FEV1 X percent function of regions of lung not to be resected (r = 0.88 and 0.95, respectively). Ventilation and perfusion scans are equally effective in prediction. Washout data add to the sophistication of the method by permitting the qualitative evaluation of ventilation during tidal breathing. Criteria for patients requiring the study are suggested.

Prediction of Postoperative Pulmonary Function with the Lateral Position Test: A Prospective Study

Ten patients undergoing pneumonectomy were evaluated with the lateral position test (LPT) in addition to routine pulmonary function tests (PFTs). On the basis of the percentage of ventilation estimated to be contributed by each lung on LPT, predictions were made for expected values for each patient's post-pneumonectomy PFTs. One to three months after surgery patients were again evaluated with complete pulmonary function studies. Results were found to agree closely with preoperative predictions in most patients. We conclude that the easily performed LPT, previously found to yield values which correlate with those found on bronchospirometry and macroaggregate lung scanning, does indeed yield acceptable results clinically and is deserving of more widespread application, especially in the large number of institutions without nuclear medicine capabilities.