Posoperative Function Prediction

            Female patient: 28 year old, operated on osteosarcoma in the right femur 12 years ago. Subsequently on 2 occasions, pulmonary metastases in the right lung  were detected, also resected and treated with chemotherapy and good clinical response. A year ago a new left apical pulmonary metastasis was found on CT and resected. Recently  a 12 cm mass in the  left upper lung lobe was diagnosed. A lung perfusion scan was requested to estimate post-operative residual function and plan the surgery. Note a huge tumor in the left lung seen on anterior perfusion scintigraphy, chest x-ray and CT. Bottom, posterior view and total relative pulmonary perfusion with 69% in the right lung and 31% in the left. In addition, upper and lower right lung was 50%. The left upper half had 9% and the lower half 91%.

             This is a classical indication for perfusion lung scintigraphy. Although, the measurement is a relative one, which compares the whole right and left pulmonary field to the total of both, it can be combined with spirometry to make an absolute prediction. The calculation may also be performed in the halves or thirds of the lungs, comparing to the complete pulmonary right or left organ. The most common case is before lung cancer pulmonary surgery to estimate the residual function after lobectomy or pneumonectomy.

            There are other less frequent applications. Kharouf R et al studied patients following transcatheter patent ductus arteriosus (PDA) closure using the Amplatzer devices and concluded that  is associated with a relatively significant risk of decreased perfusion to the left lung, mostly mild abnormalities. In this work, 17% of patients had abnormally decreased left lung perfusion.

References:

1    Spies WG. Ventilation/Perfusion Scintigraphy and Royal HD Pulmonary Imaging for Nonthromboembolic Disease, in Henkin RE et al. Nuclear Medicine. Mosby St Louis 1996, p 1382 and 1440.

2    Kharouf R, Heitschmidt M, Hijazi ZM. Pulmonary perfusion scans following transcatheter patent ductus arteriosus closure using the Amplatzer devices. Catheter Cardiovasc Interv. 2011 Jan 4.

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