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Vogt JK, Vogt WK, Heinzel A, Mottaghy FM. Computational Decision Support for PE Diagnosis based on Ventilation Perfusion Ratio. Nuklearmedizin 2024. [PMID: 38593855 DOI: 10.1055/a-2287-2051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
AIM The aim of this study is to investigate whether computer-aided, semi-automated 3D lung lobe quantification can support decision-making on PE diagnosis based on the ventilation-perfusion ratio in clinical practice. METHODS A study cohort of 100 patients (39 male, 61 female, age 64.8±15.8 years) underwent ventilation/perfusion single photon emission computed tomography (V/Q-SPECT/CT) to exclude acute PE on SPECT/CT OPTIMA NM/CT 640 (GE Healthcare). Two 3D lung lobe quantification software tools (Q. Lung: Xeleris 4.0, GE Healthcare and LLQ: Hermes Hybrid 3D Lung Lobar Quantification, Hermes Medical Solutions) were used to evaluate the numerical lobar ventilation/perfusion ratio (VQR) and lobar volume/perfusion ratio (VPR). A test of linearity and equivalence of the two 3D software tools was performed using Pearson, Spearman, quadratic weighted kappa and the mean squared deviation for VPR/VQR. An algorithm was developed that identified PE candidates using ROC analysis. The agreement between the PE findings of an experienced nuclear medicine expert and the calculated PE candidates was represented by the magnitude of the YOUDEN index (J) and the size of the area under the receiver operating curve (AUC). RESULTS Both 3D software tools showed good comparability. The YOUDEN index for QLUNG(VPR/VQR)/LLQ(VPR/VQR) was in the range from 0.2 to 0.5. The mean AUC averaged over all lung lobes for QLUNG(VPR) was 0.66, CI95%: ±14.0%, for QLUNG(VQR) 0.66, CI95%: ±13.3%, for LLQ(VPR) 0.64, CI95%: ±14.7% and for LLQ(VQR) 0.65, CI95%: ±13.1%. CONCLUSION This study reveals that 3D software tools are feasible for numerical PE detection. The clinical decision can be supported by using a numerical algorithm based on ROC analysis.
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Affiliation(s)
- Julia Katharina Vogt
- GB Sicherheit und Compliance, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Nuclear Medicine, University Hospital Aachen, Aachen, Germany
| | - Wolfgang Kurt Vogt
- Faculty of Electrical Engineering & Information Technology, University of Applied Sciences, Düsseldorf, Germany
- Max-Planck-Institut für Eisenforschung GmbH, Düsseldorf, Germany
| | - Alexander Heinzel
- Nuclear Medicine, University Hospital Halle, Halle/Saale, Germany
- Institute of Neuroscience and Medicine (INM-4), Forschungszentrum Jülich GmbH, Jülich, Germany
| | - Felix M Mottaghy
- Nuclear Medicine, University Hospital Aachen, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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Mallaev M, Chirindel AF, Lardinois D, Tamm M, Vija AH, Cachovan M, Wild D, Stolz D, Nicolas GP. 3D-Quantitated Single Photon Emission Computed Tomography/Computed Tomography: Impact on intended Management Compared to Lung Perfusion Scan in Marginal Candidates for Pulmonary Resection. Clin Lung Cancer 2023; 24:621-630. [PMID: 37544842 DOI: 10.1016/j.cllc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Based on previous studies, single-photon emission computed tomography/computed tomography (SPECT/CT) has been proven more accurate and reproducible than planar lung perfusion scintigraphy to assess lobar perfusion. However, the impact of 3D-quantitated SPECT/CT on intended management in functionally marginal candidates for pulmonary resection is unknown. The evaluation of this impact was the main aim of this study. METHODS Consecutive candidates for lung resection underwent preoperative evaluation according to ERS/ESTS Algorithm and underwent preoperative lung perfusion imaging. The lobar contribution to the total lung perfusion was estimated using established planar scintigraphic methods and 3-dimensional quantitative SPECT/CT method (CT Pulmo3D and xSPECT-Quant, Siemens). The difference in estimated lobar perfusion with resulting changes in predicted postoperative (ppo) lung function and extent of lung resection were analyzed to reveal possible changes in operability. In-hospital outcome was assessed. RESULTS One hundred twenty patients (46 females) were enrolled. The mean age (±SD) of patients was 68 ± 9 years, target lesions were in upper lobes in 57.7% and in lower lobes in 33.5%. The median FEV1 (forced expiratory volume in 1 second) was 70.5% (IQR 52-84) and median DLCO (diffusion capacity of lung for carbon monoxide) was 56.6% [47.1-67.4]. The planar posterior oblique method, compared to 3D-quantitated SPECT/CT, underestimated the perfusion of upper lobes by a median difference of 5% (right [2-9], left [2.5-8]; P = <.0001), while it overestimated the perfusion of lower lobes (left by 4% [2-7], right by 6% [2-9]; P = <.0001). In contrast to planar scintigraphy-based evaluation, 4 patients (3.3%), all with upper lobe lesions, were classified as inoperable when 3D-quantitated SPECT/CT was used for calculation of the ppo lung function. CONCLUSIONS In selected patients with upper lobe lesions, 3D-quantitated SPECT/CT would have changed the treatment strategy from operable to inoperable. Importantly, postoperative mortality in this particular subgroup was disproportionally high. 3D-quantitated SPECT/CT shall be further evaluated as it might improve preoperative risk stratification in functionally marginal candidates.
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Affiliation(s)
- Makhmudbek Mallaev
- Clinic of Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | | | - Didier Lardinois
- Clinic of Thoracic Surgery, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Clinic of Pulmonology, University Hospital Basel, Basel, Switzerland
| | | | - Michal Cachovan
- Siemens Healthcare GmbH, Molecular Imaging, Erlangen, Germany
| | - Damian Wild
- Division of Nuclear Medicine, University Hospital Basel, Basel, Switzerland
| | - Daiana Stolz
- Clinic of Pulmonology, University Hospital Basel, Basel, Switzerland; Clinic of Respiratory Medicine and Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
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Mathew B, Nag S, Agrawal A, Ranganathan P, Purandare NC, Shah S, Puranik A, Rangarajan V. Comparison of predicted postoperative forced expiratory volume in the first second (FEV1) using lung perfusion scintigraphy with observed forced expiratory volume in the first second (FEV1) post lung resection. World J Nucl Med 2020; 19:131-136. [PMID: 32939200 PMCID: PMC7478303 DOI: 10.4103/wjnm.wjnm_59_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/06/2019] [Indexed: 12/25/2022] Open
Abstract
Lung perfusion scintigraphy is done as a part of preoperative evaluation in lung cancer patients for the prediction of postoperative forced expiratory volume in the first second (FEV1). This study was performed to see the accuracy of prediction of postoperative FEV1 by perfusion scintigraphy for patients undergoing lobectomy/pneumonectomy by comparing it with actual postoperative FEV1 obtained by spirometry 4-6 months after surgery. We retrospectively reviewed 50 surgically resected lung cancer patients who underwent preoperative spirometry, lung perfusion study, and postoperative spirometry. Pearson's correlation coefficient was used to evaluate the relationship between predicted postoperative FEV1 (PPO FEV1) by lung perfusion scintigraphy and postoperative actual FEV1 measured by spirometry. Agreement between the two methods was analyzed with Bland-Altman method. The correlation between the PPO FEV1 and actual postoperative FEV1 was statistically significant (r = 0.847, P = 0.000). The correlation was better for pneumonectomy compared to lobectomy (r = 0.930 [P = 0.000] vs. 0.792 [P = 0.000]). The agreement analysis showed a mean difference of -0.0558 with a standard deviation (SD) of 0.284. The limits of agreement vary over a wide range from --0.625 to 0.513 L (mean ± 2 SD) for the entire group. For pneumonectomy, the mean difference was -0.0121 and SD 0.169 with limits of agreement varying between -0.30 L and 0.30 L. For lobectomy, the mean difference was -0.0826 and SD 0.336 with limits of agreement varying between -0.755 L and 0.590 L. Postoperative FEV1 predicted using lung perfusion scintigraphy shows good correlation with actual postoperative FEV1 and shows reasonably good agreement in patients undergoing pneumonectomy. The limits of agreement appear to be clinically unacceptable in patients undergoing lobectomy, where single-photon emission computed tomography (SPECT) or SPECT/CT techniques may improve prediction.
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Affiliation(s)
- Boon Mathew
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudipta Nag
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Archi Agrawal
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Priya Ranganathan
- Department of Anesthesiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nilendu C Purandare
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ameya Puranik
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine and Molecular Imaging, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Knollmann D, Avondo J, Schaefer WM. Is hybrid SPECT/CT necessary for pre-interventional 3D quantification of relative lobar lung function? Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-018-0036-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Genseke P, Wetz C, Wallbaum T, Kreissl MC, Ghazzawi S, Schreiber J, Amthauer H, Grosser OS. Pre-operative quantification of pulmonary function using hybrid-SPECT/low-dose-CT: A pilot study. Lung Cancer 2018; 118:155-160. [PMID: 29571995 DOI: 10.1016/j.lungcan.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/30/2018] [Accepted: 02/13/2018] [Indexed: 11/16/2022]
Abstract
RATIONALE Pre-operative lobar function is estimated by scintigraphy in patients with pulmonary malignancies and compromised function. This study compared the lobar perfusion determined by scintigraphy (PS) with data from SPECT/low-dose-CT (SPECT/ldCT) analyzed manually and semi-automatic. METHODS Retrospective analysis on 39 patients (m/f = 25/14; age: 72.5 [22-89] years) with indication for pulmonary perfusion scintigraphy. Imaging was performed using SPECT/ldCT. Data was analyzed manually and by semi-automatic software. Readers' confidence in 3D-segmentation was scored by two independent readers. Interrater agreement was calculated. In addition, Spearman's rank correlation and Wilcoxon's test were used. RESULTS Results from PS differed significantly from SPECT/ldCT processed manually or semi-automatically in 4/5 lobes (total difference ≤21.6%; rho ≥0.44) and in 3/5 (total difference 21.6%; rho ≥0.37), respectively. Readers' confidence in 3D-segmentation showed a perfect interrater agreement (κ = 0.98). CONCLUSION Quantification of lobar perfusion by SPECT/ldCT differs significantly from planar scintigraphy (e.g., with potential influence on therapy). The semi-automatic software analysis provides an applicable methodology.
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Affiliation(s)
- Philipp Genseke
- Department for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany.
| | - Christoph Wetz
- Department for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany; Department of Nuclear Medicine, Charité University Hospital Berlin, Berlin, Germany
| | - Thekla Wallbaum
- Department for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Michael C Kreissl
- Department for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Sammy Ghazzawi
- Department for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
| | - Jens Schreiber
- Department for Pneumology, University Hospital Magdeburg, Magdeburg, Germany
| | - Holger Amthauer
- Department of Nuclear Medicine, Charité University Hospital Berlin, Berlin, Germany
| | - Oliver S Grosser
- Department for Radiology and Nuclear Medicine, University Hospital Magdeburg, Magdeburg, Germany
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Tulchinsky M, Fotos JS, Wechalekar K, Dadparvar S. Applications of Ventilation-Perfusion Scintigraphy in Surgical Management of Chronic Obstructive Lung Disease and Cancer. Semin Nucl Med 2017; 47:671-679. [DOI: 10.1053/j.semnuclmed.2017.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Provost K, Leblond A, Gauthier-Lemire A, Filion É, Bahig H, Lord M. Reproducibility of Lobar Perfusion and Ventilation Quantification Using SPECT/CT Segmentation Software in Lung Cancer Patients. J Nucl Med Technol 2017; 45:185-192. [PMID: 28408698 DOI: 10.2967/jnmt.117.191056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022] Open
Abstract
Planar perfusion scintigraphy with 99mTc-labeled macroaggregated albumin is often used for pretherapy quantification of regional lung perfusion in lung cancer patients, particularly those with poor respiratory function. However, subdividing lung parenchyma into rectangular regions of interest, as done on planar images, is a poor reflection of true lobar anatomy. New tridimensional methods using SPECT and SPECT/CT have been introduced, including semiautomatic lung segmentation software. The present study evaluated inter- and intraobserver agreement on quantification using SPECT/CT software and compared the results for regional lung contribution obtained with SPECT/CT and planar scintigraphy. Methods: Thirty lung cancer patients underwent ventilation-perfusion scintigraphy with 99mTc-macroaggregated albumin and 99mTc-Technegas. The regional lung contribution to perfusion and ventilation was measured on both planar scintigraphy and SPECT/CT using semiautomatic lung segmentation software by 2 observers. Interobserver and intraobserver agreement for the SPECT/CT software was assessed using the intraclass correlation coefficient, Bland-Altman plots, and absolute differences in measurements. Measurements from planar and tridimensional methods were compared using the paired-sample t test and mean absolute differences. Results: Intraclass correlation coefficients were in the excellent range (above 0.9) for both interobserver and intraobserver agreement using the SPECT/CT software. Bland-Altman analyses showed very narrow limits of agreement. Absolute differences were below 2.0% in 96% of both interobserver and intraobserver measurements. There was a statistically significant difference between planar and SPECT/CT methods (P < 0.001) for quantification of perfusion and ventilation for all right lung lobes, with a maximal mean absolute difference of 20.7% for the right middle lobe. There was no statistically significant difference in quantification of perfusion and ventilation for the left lung lobes using either method; however, absolute differences reached 12.0%. The total right and left lung contributions were similar for the two methods, with a mean difference of 1.2% for perfusion and 2.0% for ventilation. Conclusion: Quantification of regional lung perfusion and ventilation using SPECT/CT-based lung segmentation software is highly reproducible. This tridimensional method yields statistically significant differences in measurements for right lung lobes when compared with planar scintigraphy. We recommend that SPECT/CT-based quantification be used for all lung cancer patients undergoing pretherapy evaluation of regional lung function.
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Affiliation(s)
- Karine Provost
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
| | - Antoine Leblond
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
| | - Annie Gauthier-Lemire
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
| | - Édith Filion
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada
| | - Martin Lord
- Department of Nuclear Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, Quebec, Canada; and
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