Role of lung perfusion scintigraphy in relation to chest computed tomography and pulmonary function in the evaluation of candidates for lung volume reduction surgery

Lung perfusion scintigraphy is employed to evaluate patients with severe em physema who are candidates for lung volume reduction surgery (LVRS). Our pu rpose was to investigate the role of scintigraphy in relation to chest comp uted tomography (CT) and lung function in this setting. Six observers blind ed to clinical data retrospectively scored preoperative scintigrams of 70 p atients undergoing bilateral video-assisted LVRS according to the distribut ion of lung perfusion as homogeneous, intermediately heterogeneous, or mark edly heterogeneous. Heterogeneity of emphysema distribution was also assess ed by chest CT. Dyspnea and pulmonary function were measured preoperatively and 3 mo postoperatively. In 42 patients with markedly heterogeneous, in 1 8 with intermediately heterogeneous, and in 10 with homogeneous perfusion, mean (+/- SE) FEV1 increased by 57 +/- 8% (p < 0.0001), 38 +/- 9% (p < 0.00 1), and 23 +/- 9% (p = NS) (p = NS for intergroup comparisons). In a multip le regression analysis, functional improvement after LVRS was more closely correlated with preoperative hyperinflation and the degree of emphysema het erogeneity estimated by chest CT than with the degree of perfusion heteroge neity assessed by scintigraphy. In 16 of 22 patients with homogeneous emphy sema distribution in the chest CT scintigraphy revealed intermediately or m arkedly heterogeneous perfusion. We conclude that lung perfusion scintigrap hy has a limited role in prediction of outcome, but it may help to identify target areas for resection in LVRS candidates with homogeneous CT morpholo gy.