Predicting the response to lung volume reduction surgery using scintigraphy.
ABSTRACT This study was conducted to evaluate the use of quantitative scintigraphy with a newly designed marker to assess and predict the efficacy of lung volume reduction surgery in treating emphysema. In a series of 50 patients with severe emphysema who underwent the operation, ventilation/perfusion scintigraphy was performed and 2 markers of area ratio and lung uniformity were measured before and 6 months after surgery. The markers were correlated with the results of pulmonary function tests. The histopathological subtype of emphysema was also determined in the resected specimen and related to improvement in the markers. The markers were closely related to improvement in forced expiratory volume in 1 second, with the highest correlation being the marker lung uniformity measured by perfusion scintigraphy. Improvement in this marker was significantly greater in centrilobular than in panlobular emphysema. This quantitative method of scintigraphy could provide an excellent reflection of surgical efficacy as well as predict the surgical outcome. Additionally, it provides a mechanistic explanation for the differential improvement between the histopathological subtypes of emphysema following surgery.