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Bailey DL, Roach PJ. A Brief History of Lung Ventilation and Perfusion Imaging Over the 50-Year Tenure of the Editors of Seminars in Nuclear Medicine. Semin Nucl Med 2019; 50:75-86. [PMID: 31843063 DOI: 10.1053/j.semnuclmed.2019.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The ventilation/perfusion lung scan has been in continuous use for approximately half a century, the same lifetime as Seminars in Nuclear Medicine. Remarkably, the founding Editors-in-Chief have continued to guide the journal over this entire period. In this Feschrift issue celebrating their enormous contribution, we review the history of the lung scan, its highs and lows, the transition from planar to SPECT/CT V/Q scans, and the future that is in store in this age of multimodality functional imaging. We concur with the published view of one of the retiring editors (LMF) that V/Q scintigraphy is indeed alive and well and has a definite future in clinical medicine.
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Affiliation(s)
- Dale L Bailey
- Royal North Shore Hospital, Department of Nuclear Medicine, Sydney, Australia; University of Sydney, Faculty of Medicine & Health, Sydney, Australia.
| | - Paul J Roach
- Royal North Shore Hospital, Department of Nuclear Medicine, Sydney, Australia; University of Sydney, Faculty of Medicine & Health, Sydney, Australia
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Cheimariotis GA, Al-Mashat M, Haris K, Aletras AH, Jögi J, Bajc M, Maglaveras N, Heiberg E. Automatic lung segmentation in functional SPECT images using active shape models trained on reference lung shapes from CT. Ann Nucl Med 2017; 32:94-104. [PMID: 29236220 PMCID: PMC5797204 DOI: 10.1007/s12149-017-1223-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 12/04/2017] [Indexed: 11/25/2022]
Abstract
Objective Image segmentation is an essential step in quantifying the extent of reduced or absent lung function. The aim of this study is to develop and validate a new tool for automatic segmentation of lungs in ventilation and perfusion SPECT images and compare automatic and manual SPECT lung segmentations with reference computed tomography (CT) volumes. Methods A total of 77 subjects (69 patients with obstructive lung disease, and 8 subjects without apparent perfusion of ventilation loss) performed low-dose CT followed by ventilation/perfusion (V/P) SPECT examination in a hybrid gamma camera system. In the training phase, lung shapes from the 57 anatomical low-dose CT images were used to construct two active shape models (right lung and left lung) which were then used for image segmentation. The algorithm was validated in 20 patients, comparing its results to reference delineation of corresponding CT images, and by comparing automatic segmentation to manual delineations in SPECT images. Results The Dice coefficient between automatic SPECT delineations and manual SPECT delineations were 0.83 ± 0.04% for the right and 0.82 ± 0.05% for the left lung. There was statistically significant difference between reference volumes from CT and automatic delineations for the right (R = 0.53, p = 0.02) and left lung (R = 0.69, p < 0.001) in SPECT. There were similar observations when comparing reference volumes from CT and manual delineations in SPECT images, left lung (bias was − 10 ± 491, R = 0.60, p = 0.005) right lung (bias 36 ± 524 ml, R = 0.62, p = 0.004). Conclusion Automated segmentation on SPECT images are on par with manual segmentation on SPECT images. Relative large volumetric differences between manual delineations of functional SPECT images and anatomical CT images confirms that lung segmentation of functional SPECT images is a challenging task. The current algorithm is a first step towards automatic quantification of wide range of measurements.
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Affiliation(s)
- Grigorios-Aris Cheimariotis
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mariam Al-Mashat
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Kostas Haris
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anthony H Aletras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jonas Jögi
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Marika Bajc
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Nicolaos Maglaveras
- Laboratory of Computing, Medical Informatics and Biomedical-Imaging Technologies, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Einar Heiberg
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund University, Lund, Sweden.
- Department of Biomedical Engineering, Faculty of Engineering, Lund University, Lund, Sweden.
- Department of Clinical Physiology, Lund University Hospital, 22185, Lund, Sweden.
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Phillips J, Straiton J, Staff R. Planar and SPECT ventilation/perfusion imaging and computed tomography for the diagnosis of pulmonary embolism: A systematic review and meta-analysis of the literature, and cost and dose comparison. Eur J Radiol 2015; 84:1392-400. [DOI: 10.1016/j.ejrad.2015.03.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/05/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
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Milne S, King GG. Advanced imaging in COPD: insights into pulmonary pathophysiology. J Thorac Dis 2014; 6:1570-85. [PMID: 25478198 DOI: 10.3978/j.issn.2072-1439.2014.11.30] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/10/2014] [Indexed: 12/31/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) involves a complex interaction of structural and functional abnormalities. The two have long been studied in isolation. However, advanced imaging techniques allow us to simultaneously assess pathological processes and their physiological consequences. This review gives a comprehensive account of the various advanced imaging modalities used to study COPD, including computed tomography (CT), magnetic resonance imaging (MRI), and the nuclear medicine techniques positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Some more recent developments in imaging technology, including micro-CT, synchrotron imaging, optical coherence tomography (OCT) and electrical impedance tomography (EIT), are also described. The authors identify the pathophysiological insights gained from these techniques, and speculate on the future role of advanced imaging in both clinical and research settings.
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Affiliation(s)
- Stephen Milne
- 1 The Woolcock Institute of Medical Research, Glebe, Sydney NSW 2037, Australia ; 2 Northern Clinical School, University of Sydney, NSW 2006, Australia ; 3 Northern and Central Clinical Schools, University of Sydney, NSW 2006, Australia ; 4 Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Gregory G King
- 1 The Woolcock Institute of Medical Research, Glebe, Sydney NSW 2037, Australia ; 2 Northern Clinical School, University of Sydney, NSW 2006, Australia ; 3 Northern and Central Clinical Schools, University of Sydney, NSW 2006, Australia ; 4 Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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Abstract
Planar ventilation-perfusion (V/Q) scanning is often used to investigate pulmonary embolism; however, it has well-recognized limitations. SPECT overcomes many of these through its ability to generate 3-dimensional imaging data. V/Q SPECT has higher sensitivity, specificity, and accuracy than planar imaging and a lower indeterminate rate. SPECT allows for new ways to display and analyze data, such as parametric V/Q ratio images. Compared with CT pulmonary angiography, SPECT has higher sensitivity, a lower radiation dose, fewer technically suboptimal studies, and no contrast-related complications. Any nuclear medicine department equipped with a modern hybrid scanner can now perform combined V/Q SPECT with CT (using low-dose protocols) to further enhance diagnostic accuracy. V/Q SPECT (with or without CT) has application in other pulmonary conditions and in research.
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Affiliation(s)
- Paul J Roach
- Department of Nuclear Medicine, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia.
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Soler X, Hoh CK, Test VJ, Kerr KM, Marsh JJ, Morris TA. Single photon emission computed tomography in chronic thromboembolic pulmonary hypertension. Respirology 2011; 16:131-7. [PMID: 20920137 DOI: 10.1111/j.1440-1843.2010.01867.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE The management of chronic thromboembolic pulmonary hypertension (CTEPH) is largely dependent on the extent of obstruction in the pulmonary arteries. Planar perfusion scans are commonly used to quantify perfusion defects in CTEPH patients. However, planar scans typically under-represent the extent of vascular obstruction in CTEPH. We conducted this study to test the hypothesis that SPECT lung perfusion scans are more accurate than planar scans for determining the location and extent of perfusion defects in patients with CTEPH. METHODS Planar ventilation scans, planar and SPECT perfusion scans were performed preoperatively in patients undergoing pulmonary thromboendarterectomy for treatment of CTEPH. Two clinical experts independently documented the segmental anatomy of the vascular obstructions by reviewing clinical records, pulmonary and CT angiograms, and surgical specimens. A nuclear medicine expert documented the segmental anatomy of the perfusion defects observed by planar and SPECT scans independently. RESULTS Clinical/pathological evaluation disclosed 241 obstructed and 99 unobstructed lung segments in 17 patients. Sensitivity for detecting obstructed segments was significantly higher for SPECT than for planar scanning (63.5 ± 3.1% vs. 42.7 ± 3.2%, respectively; P < 0.01). Specificities of SPECT and planar scanning were not significantly different (62.6 ± 4.8% vs. 76.8 ± 4.2%, respectively; P = 0.092). CONCLUSIONS The SPECT is more sensitive than planar perfusion scanning for identifying obstructed segments in CTEPH. However, even SPECT under-represents the true extent of the vascular occlusions in CTEPH.
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Affiliation(s)
- Xavier Soler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, UCSD Medical Center, San Diego, California 92103-8377, USA.
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Tusman G, Suarez-Sipmann F, Bohm SH, Borges JB, Hedenstierna G. Capnography reflects ventilation/perfusion distribution in a model of acute lung injury. Acta Anaesthesiol Scand 2011; 55:597-606. [PMID: 21342153 DOI: 10.1111/j.1399-6576.2011.02404.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Changes in the shape of the capnogram may reflect changes in lung physiology. We studied the effect of different ventilation/perfusion ratios (V/Q) induced by positive end-expiratory pressures (PEEP) and lung recruitment on phase III slope (S(III)) of volumetric capnograms. METHODS Seven lung-lavaged pigs received volume control ventilation at tidal volumes of 6 ml/kg. After a lung recruitment maneuver, open-lung PEEP (OL-PEEP) was defined at 2 cmH(2)O above the PEEP at the onset of lung collapse as identified by the maximum respiratory compliance during a decremental PEEP trial. Thereafter, six distinct PEEP levels either at OL-PEEP, 4 cmH(2)O above or below this level were applied in a random order, either with or without a prior lung recruitment maneuver. Ventilation-perfusion distribution (using multiple inert gas elimination technique), hemodynamics, blood gases and volumetric capnography data were recorded at the end of each condition (minute 40). RESULTS S (III) showed the lowest value whenever lung recruitment and OL-PEEP were jointly applied and was associated with the lowest dispersion of ventilation and perfusion (Disp(R-E)), the lowest ratio of alveolar dead space to alveolar tidal volume (VD(alv)/VT(alv)) and the lowest difference between arterial and end-tidal pCO(2) (Pa-ETCO(2)). Spearman's rank correlations between S(III) and Disp(R-E) showed a ρ=0.85 with 95% CI for ρ (Fisher's Z-transformation) of 0.74-0.91, P<0.0001. CONCLUSION In this experimental model of lung injury, changes in the phase III slope of the capnograms were directly correlated with the degree of ventilation/perfusion dispersion.
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Affiliation(s)
- G Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
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Tusman G, Bohm SH, Suarez-Sipmann F, Scandurra A, Hedenstierna G. Lung recruitment and positive end-expiratory pressure have different effects on CO2 elimination in healthy and sick lungs. Anesth Analg 2010; 111:968-77. [PMID: 20705790 DOI: 10.1213/ane.0b013e3181f0c2da] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We studied the effects that the lung recruitment maneuver (RM) and positive end-expiratory pressure (PEEP) have on the elimination of CO(2) per breath (Vtco(2,br)). METHODS In 7 healthy and 7 lung-lavaged pigs at constant ventilation, PEEP was increased from 0 to 18 cm H(2)O and then decreased to 0 in steps of 6 cm H(2)O every 10 minutes. Cycling RMs with plateau pressure/PEEP of 40/20 (healthy) and 50/25 (lavaged) cm H(2)O were applied for 2 minutes between 18-PEEP steps. Volumetric capnography, respiratory mechanics, blood gas, and hemodynamic data were recorded. RESULTS In healthy lungs before the RM, Vtco(2,br) was inversely proportional to PEEP decreasing from 4.0 (3.6-4.4) mL (median and interquartile range) at 0-PEEP to 3.1 (2.8-3.4) mL at 18-PEEP (P < 0.05). After the RM, Vtco(2,br) increased from 3.3 (3-3.6) mL at 18-PEEP to 4.0 (3.5-4.5) mL at 0-PEEP (P < 0.05). In lavaged lungs before the RM, Vtco(2,br) increased initially from 2.0 (1.7-2.3) mL at 0-PEEP to 2.6 (2.2-3) mL at 12-PEEP (P < 0.05) but then decreased to 2.4 (2-2.8) mL when PEEP was increased further to 18 cm H(2)O (P < 0.05). After the RM, the highest Vtco(2,br) of 2.9 (2.1-3.7) mL was observed at 12-PEEP and then decreased to 2.5 (1.9-3.1) mL at 0-PEEP (P < 0.05). Vtco(2,br) was directly related to changes in lung perfusion, the area of gas exchange, and alveolar ventilation but inversely related to changes in dead space. CONCLUSIONS CO(2) elimination by the lungs was dependent on PEEP and recruitment and showed major differences between healthy and lavaged lungs.
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Affiliation(s)
- Gerardo Tusman
- Department of Anesthesiology, Hospital Privado de Comunidad, Mar del Plata, Argentina.
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Suga K, Kawakami Y, Koike H, Iwanaga H, Tokuda O, Okada M, Matsunaga N. Lung ventilation–perfusion imbalance in pulmonary emphysema: assessment with automated V/Q quotient SPECT. Ann Nucl Med 2010; 24:269-77. [DOI: 10.1007/s12149-010-0369-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2009] [Accepted: 01/17/2010] [Indexed: 11/27/2022]
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Characteristic crescentic subpleural lung zones with high ventilation (V)/perfusion (Q) ratios in interstitial pneumonia on V/Q quotient SPECT. Nucl Med Commun 2009; 30:881-9. [DOI: 10.1097/mnm.0b013e328330571d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roach PJ, Bailey DL, Schembri GP. Reinventing ventilation/perfusion lung scanning with SPECT. Nucl Med Commun 2008; 29:1023-5. [DOI: 10.1097/mnm.0b013e328315efa1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roach PJ, Bailey DL, Harris BE. Enhancing Lung Scintigraphy With Single-Photon Emission Computed Tomography. Semin Nucl Med 2008; 38:441-9. [DOI: 10.1053/j.semnuclmed.2008.06.002] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Thieme SF, Becker CR, Hacker M, Nikolaou K, Reiser MF, Johnson TRC. Dual energy CT for the assessment of lung perfusion--correlation to scintigraphy. Eur J Radiol 2008; 68:369-74. [PMID: 18775618 DOI: 10.1016/j.ejrad.2008.07.031] [Citation(s) in RCA: 224] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 07/29/2008] [Indexed: 11/30/2022]
Abstract
Purpose of this study was to determine the diagnostic value of dual energy CT in the assessment of pulmonary perfusion with reference to pulmonary perfusion scintigraphy. Thirteen patients received both dual energy CT (DECT) angiography (Somatom Definition, Siemens) and ventilation/perfusion scintigraphy. Median time between scans was 3 days (range, 0-90). DECT perfusion maps were generated based on the spectral properties of iodine. Two blinded observes assessed DECT angiograms, perfusion maps and scintigrams for presence and location of perfusion defects. The results were compared by patient and by segment, and diagnostic accuracy of DECT perfusion imaging was calculated regarding scintigraphy as standard of reference. Diagnostic accuracy per patient showed 75% sensitivity, 80% specificity and a negative predictive value of 66%. Sensitivity per segment amounted to 83% with 99% specificity, with 93% negative predictive value. Peripheral parts of the lungs were not completely covered by the 80 kVp detector in 85% of patients. CTA identified corresponding emboli in 66% of patients with concordant perfusion defects in DECT and scintigraphy. Dual energy CT perfusion imaging is able to display pulmonary perfusion defects with good agreement to scintigraphic findings. DECT can provide a pulmonary CT angiogram, high-resolution morphology of the lung parenchyma and perfusion information in one single exam.
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Affiliation(s)
- Sven F Thieme
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich, Germany
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