PERFUSION SCINTIGRAPHY IN THE EVALUATION FOR LUNG-VOLUME REDUCTION SURGERY - CORRELATION WITH CLINICAL OUTCOME

PURPOSE: To identify preoperative pulmonary perfusion scintigraphic fi ndings that might be associated with clinical outcome after lung volum e reduction surgery. MATERIALS AND METHODS: Preoperative perfusion sci ntigrams in 103 patients (56 men, 47 women; age range, 41-76 years; me an age, 61 years +/- 9) were reviewed and graded for emphysematous het erogeneity (from isolated areas to diffuse distribution), extent of ma ximally perfused lung, and lobar predominance (upper-lobe vs lower-lob e asymmetry). These findings were correlated with clinical outcome on the basis of pulmonary function, arterial blood gas levels, and exerci se test results before and 6 months after surgery. RESULTS: Among the 96 patients who survived surgery, there was an average improvement of 47% in the forced expiratory volume in 1 second (FEV1), of 20% in arte rial oxygen tension, and of 20% in the 6-minute walking distance. Scin tigraphic markers correlated best with FEV1 improvement. The strongest scintigraphic predictor of increase in FEV1 was upper-lobe predominan ce (r = .38, P < .001), which was followed by heterogeneity (r = .31, P = .002). The seven patients who died had a significantly lower perce ntage of maximally perfused lung than the survivors (25% vs 34%, P = . 004). CONCLUSION: Perfusion scintigraphy can provide modest prognostic information in patients who undergo evaluation for lung volume reduct ion surgery.