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Semi-quantitation of pulmonary perfusion heterogeneity on respiratory-gated inspiratory and expiratory perfusion SPECT in patients with pulmonary emphysema

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Abstract

Objective

Pulmonary perfusion heterogeneity (PPH) in pulmonary emphysema (PE) was semi-quantified by functional lung volume rate (FLVR) curves obtained from respiratory-gated inspiratory and expiratory single-photon emission computed tomography (SPECT).

Methods

Gated and ungated SPECT were obtained in 36 PE patients [25 with stage IIA and 11 with stage IIB for global initiative for chronic obstructive lung disease (GOLD) stage classification] and 12 controls, using a triple-head SPECT system and a respiratory tracking device. On gated SPECT, the voxel numbers calculated at the 10% cutoff threshold for the maximum lung radioactivity were assumed to be the functional lung volume of the lung (V). FLVR (%) was calculated as FLV divided by V at every additional 10% thresholds, yielding inspiratory and expiratory FLVR curves. The dissociations between these curves (ΔFLVRinsp − exsp) and the total difference (D index) of these curves from the normal standard curve (averaged inspiratory and expiratory curve in controls) were calculated. D index and the extent of low attenuation area (%LAA) on CT were correlated with the transfer coefficient for carbon monoxide (K CO) in PE patients.

Results

Although gated and ungated SPECT showed fairly uniform perfusion in controls, gated SPECT-enhanced PPH compared with ungated SPECT in PE patients, with significantly higher dissociation (ΔFLVRinsp − exsp) than that in controls (24.9% ± 9.5% vs. 4.5% ± 1.3%; P < 0.0001). ΔFLVRinsp − exsp was significantly higher even in stage IIA patients (P < 0.0001). Expiratory D index was significantly higher than the inspiratory one in PE patients (P < 0.01). This index was significantly higher in stage IIB patients than in stage IIA patients (44.1% ± 19.0% vs. 29.4% ± 13.7%; P < 0.05), and was significantly correlated with K CO (R = 0.642, P < 0.0001) in all PE patients, although %LAA was not correlated with K CO.

Conclusions

FLVR curve analysis on gated SPECT appears useful for semi-quantitation of respiratory change of PPH in PE. Expiratory D index may better reflect the lung pathophysiology of PE than morphologic CT.

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Authors and Affiliations

  1. Department of Radiology, Semui Cancer Screening and Radiotherapy Site, St. Hill Hospital, 1462-3 Nishikiwa, Ube, 755-0151, Japan

    Yasuhiko Kawakami & Kazuyoshi Suga

  2. Department of Radiology, Yamaguchi University School of Medicine, Ube, Japan

    Mohammed Zaki, Hideyuki Iwanaga, Tomio Yamashita, Noriko Hayashi & Naofumi Matsunaga

Authors
  1. Yasuhiko Kawakami
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  2. Kazuyoshi Suga
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  3. Mohammed Zaki
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  4. Hideyuki Iwanaga
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  5. Tomio Yamashita
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  6. Noriko Hayashi
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  7. Naofumi Matsunaga
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Correspondence to Kazuyoshi Suga.

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Kawakami, Y., Suga, K., Zaki, M. et al. Semi-quantitation of pulmonary perfusion heterogeneity on respiratory-gated inspiratory and expiratory perfusion SPECT in patients with pulmonary emphysema. Ann Nucl Med 21, 577–584 (2007). https://doi.org/10.1007/s12149-007-0071-6

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  • DOI: https://doi.org/10.1007/s12149-007-0071-6

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