Evaluation of patients undergoing lung volume reduction surgery: Ancillaryinformation available from computed tomography

AIM: A number of imaging techniques have been used for the pre-operative as sessment of patients for lung volume reduction surgery (LVRS), We evaluated whether data currently acquired from perfusion scintigrams and cine MR of the diaphragm are obtainable from high resolution CT (HRCT) of the thorax. MATERIALS AND METHODS: Thirty patients taking part in a randomized controll ed trial of LVRS against maximal medical therapy were evaluated. HRCT exami nations (n = 30) were scored for (i) the extent and distribution of emphyse ma; (ii) the extent of normal pulmonary vasculature; and (iii) diaphragmati c contour, apparent defects and herniation, On scintigraphy, (n = 28), perf usion of the lower thirds of both lungs, as a proportion of total lung perf usion (LZ/T-PERF), was expressed as a percentage of predicted values (deriv ed from 10 normal control subjects). On cine MR (n = 25) hemidiaphragmatic excursion and coordination were recorded. RESULTS: Extensive emphysema was present on HRCT (60% +/- 13.2%), There was strong correlation between the extent of normal pulmonary vasculature on H RCT and on perfusion scanning (r(s) = 0,85, P < 0,00005), Hemidiaphragmatic incoordination on MR was weakly associated with hemidiaphragmatic eventrat ion on HRCT (P = 0,04). CONCLUSION: The strong correlation between lung perfusion assessed by HRCT and lung perfusion on scintigraphy suggests that perfusion scintigraphy is superfluous in the pre-operative evaluation of patients with emphysema for LVRS. (C) 2000 The Royal College of Radiologists.