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2014 ; 4
(1
): 39
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Does quantitative lung SPECT detect lung abnormalities earlier than lung function
tests? Results of a pilot study
#MMPMID26055938
Norberg P
; Persson HL
; Schmekel B
; Carlsson GA
; Wahlin K
; Sandborg M
; Gustafsson A
EJNMMI Res
2014[Dec]; 4
(1
): 39
PMID26055938
show ga
BACKGROUND: Heterogeneous ventilation in lungs of individuals with allergies,
cigarette smokers, asthmatics and chronic obstructive pulmonary disease (COPD)
patients has been demonstrated using imaging modalities such as positron emission
tomography (PET), magnetic resonance imaging (MRI) and single-photon emission
computed tomography (SPECT). These individuals suffer from narrow and/or closed
airways to various extents. By calculating regional heterogeneity in lung
ventilation SPECT images as the coefficient of variation (CV) in small elements
of the lung, heterogeneity maps and CV-density curves can be generated and used
to quantitatively measure heterogeneity. This work explores the potential to use
such measurements to detect mild ventilation heterogeneities in lung-healthy
subjects. METHOD: Fourteen healthy subjects without documented lung disease or
respiratory symptoms, and two patients with documented airway disease, inhaled on
average approximately 90 MBq (99m)Tc-Technegas immediately prior to the 20-min
SPECT acquisition. Variation in activity uptake between subjects was compensated
for in resulting CV values. The area under the compensated CV density curve
(AUC), for CV values greater than a threshold value CVT, AUC(CV?>?CVT), was used
as the measure of ventilation heterogeneity. RESULTS: Patients with lung function
abnormalities, according to lung function tests, generated higher AUC(CV?>?20%)
values compared to healthy subjects (p?=?0.006). Strong linear correlations with
the AUC(CV?>?20%) values were found for age (p?=?0.006) and height (p?=?0.001).
These demonstrated that ventilation heterogeneities increased with age and that
they depend on lung size. Strong linear correlations were found for the lung
function value related to indices of airway closure/air trapping, residual
volume/total lung capacity (RV/TLC; p?=?0.009), and diffusion capacity of the
lung for carbon monoxide adjusted for haemoglobin concentration in the blood
(DLCOc; p?=?0.009), a value partly related to supposed ventilation/perfusion
mismatch. These findings support the association between conventional lung
function tests and the AUC(CV?>?20%) value. CONCLUSIONS: Among the healthy
subjects, there is a group with increased AUC(CV?>?20%) values, but with normal
lung function tests, which implies that it might be possible to differentiate
ventilation heterogeneities earlier in a disease process than by lung function
tests.