Mariaelena Occhipinti MD, Presenter: Nothing to Disclose

Ersilia Devicienti, Abstract Co-Author: Nothing to Disclose

Anna Rita Larici MD, Abstract Co-Author: Nothing to Disclose

Riccardo Inchingolo, Abstract Co-Author: Nothing to Disclose

Maria Rosaria Calve, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

To evaluate the reliability of multidetector computed tomography (MDCT)-virtual lobectomy in predicting post-operative forced expiratory volume in one second (poFEV1).

Before surgical lobectomy, 31 patients with non-small cell lung cancer (15/31 with chronic obstructive pulmonary disease) underwent both clinical assessment of lung volumes by pulmonary function tests and radiological evaluation by MDCT scan. All MDCT scans (obtained at full inspiration) were examined by using a software that allows semi-automated lobar segmentation and quantitative analyses of lung volumes. After manual tracing of virtual cutting planes, excluding voxels outside the identified lobe, the software automatically calculates the total volume of the lobe/lobes to be resected and the relative volume of emphysema, by applying specific density thresholds. We estimated the predicted post-operative FEV1 (ppoFEV1) considering pre-operative FEV1 (preFEV1), the number of resected lobes, resected lung volumes (RLV) and total lung volumes (TLV) calculated at MDCT. CT volumes were also adjusted according to the extent of emphysema (RLVe, TLVe). To calculate ppoFEV1 we adopted the following anatomic formula: ppoFEV1= preFEV1 x [1-(resected segments/total segments)], and we also adjusted this formula using lung volumes obtained by MDCT volumetry: ppoFEV1= preFEV1 x [1-(resected volume/total volume)]. Predicted values of both methods were correlated with post-operative measured values (poFEV1). 

Linear regression analysis of poFEV1 showed a statistically significant relationship with ppoFEV1, estimated by the anatomic method (R2:0.73) and by different radiological approaches considering: RLVe and TLVe (R2:0.75); RLVe and TLV (R2:0.76); RLV and TLV (R2:0.79). This correlation is even better including also the eventual presence of airflow obstruction (FEV1/FVC < 70%) and the number of days occurring between surgery and the first post-resection functional evaluation (VISITIME).

Anatomic and radiological methods to estimate poFEV1 show similar results, therefore quantitative MDCT is a valuable tool in predicting poFEV1.

MDCT-virtual lobectomy could be a useful tool for predicting post-resection lung function and may play a role in the clinical management of patients undergoing surgical lobectomy. 

Occhipinti, M, Devicienti, E, Larici, A, Inchingolo, R, Calve, M, Bonomo, L, Role of MDCT-virtual Lobectomy in the Prediction of Post-operative Lung Function in Patients Undergoing Surgical Lobectomy.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13028076.html