Application of V/P SPECT/CT in quantitative assessment of lung function in patients with asthma_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

PENG Qian ¹ , XIE Hangyu ² ,  LIU Chuntao ¹

1. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan 610041, P. R. China;
2. Department of Nuclear Medicine, West China Hospital, Sichuan University, Sichuan 610041, P. R. China;

Corresponding author：

LIU Chuntao, Email: taosen666@vip.163.com

Keywords：

Asthma; Ventilation; Perfusion; Single photon emission computed tomography

DOI：

10.7507/1671-6205.202101076

Video：

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Objective To explore the application of pulmonary ventilation and perfusion imaging (V/P SPECT/CT) in quantitative evaluation of ventilation and perfusion function and its potential value in guiding local treatment of lung in patients with asthma.Methods A total of 20 patients with asthma were included in this study. All patients underwent V/P SPECT/CT and pulmonary function test, and symptoms were assessed by the ACT questionnaire. Patients were graded for degree of airway obstruction according to V/ P SPECT/CT image visual scoring criteria. The comprehensive lung function (%) of the patients was quantitatively evaluated by combining the ventilation and perfusion defect of each lung segment in V/P imaging. The correlation between the degree of airway obstruction, comprehensive lung function, pulmonary function test and ACT score was analyzed.Results V/P SPECT/CT imaging can be used to grade the degree of airway obstruction in asthma patients (0-3 grade). Airway obstruction grading by V/P SPECT/CT visual score was associated with predictive forced expiratory volume in one second (FEV₁%pred) of patients (r=–0.74, P<0.001). V/P SPECT/CT can also comprehensively evaluate ventilation and perfusion function in patients with asthma, and comprehensive lung function measured by this method was also correlated with FEV₁%pred (r=0.629, P=0.003). V/P SPECT/CT can be used to quantitatively analyze the percentage of ventilation and perfusion function in each lung lobe. Compared with V/P SPECT/CT results, the CT volume overestimates the contribution in the upper lobes, and underestimates the lower lobes contribution to overall function.Conclusions V/P SPECT/CT can be used as a new method to directly reflect the degree of airway obstruction in patients with asthma. Moreover, it can comprehensively and quantitatively evaluate the ventilation and perfusion function of asthma patients. V/P SPECT/CT can also be used to evaluate lobe function in patients with asthma, helping to identify the heterogeneity of changes in pulmonary function in patients with asthma, and has potential value for future treatment targeting specific areas of the lung.

Citation： PENG Qian, XIE Hangyu, LIU Chuntao. Application of V/P SPECT/CT in quantitative assessment of lung function in patients with asthma. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(4): 247-253. doi: 10.7507/1671-6205.202101076 Copy

1.	Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J, 2008, 31(1): 143-178.
2.	King GG, Harris B, Mahadev S. V/Q SPECT: utility for investigation of pulmonary physiology. Semin Nucl Med, 2010, 40: 467-473.
3.	Farrow CE, Salome CM, Harris BE, et al. Peripheral ventilation heterogeneity determines the extent of bronchoconstriction in asthma. J Appl Physiol (1985), 2017, 123: 1188-1194.
4.	Harris RS, Fujii-Rios H, Winkler T, et al. Ventilation defect formation in healthy and asthma subjects is determined by lung inflation. PLoS One, 2012, 7: e53216.
5.	Kelly VJ, Hibbert KA, Kohli P, et al. Hypoxic pulmonary vasoconstriction does not explain all regional perfusion redistribution in asthma. Am J Respir Crit Care Med, 2017, 196: 834-844.
6.	Harris RS, Winkler T, Tgavalekos N, et al. Regional pulmonary perfusion, inflation, and ventilation defects in bronchoconstricted patients with asthma. Am J Respir Crit Care Med, 2006, 174: 245-253.
7.	Mann A, DiDea M, Fournier F, et al. The importance of quality in ventilation-perfusion imaging. J Nucl Med Technol, 2018, 46: 89-95.
8.	Roach PJ, Gradinscak DJ, Schembri GP, et al. SPECT/CT in V/Q scanning. Semin Nucl Med, 2010, 40: 455-466.
9.	Roach PJ, Bailey DL, Schembri GP, et al. Transition from planar to SPECT V/Q scintigraphy: rationale, practicalities, and challenges. Semin Nucl Med, 2010, 40: 397-407.
10.	Roach PJ, Schembri GP, Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med, 2013, 54: 1588-1596.
11.	Bajc M, Markstad H, Jarenbäck L, et al. Grading obstructive lung disease using tomographic pulmonary scintigraphy in patients with chronic obstructive pulmonary disease (COPD) and long-term smokers. Ann Nucl Med, 2015, 29: 91-99.
12.	Bajc M, Chen Y, Wang J, et al. Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1579-1587.
13.	Jögi J, Ekberg M, Jonson B, et al. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT. Eur J Nucl Med Mol Imaging, 2011, 38: 1344-1352.
14.	Bailey DL, Roach PJ, Bailey EA, et al. Development of a cost-effective modular SPECT/CT scanner. Eur J Nucl Med Mol Imaging, 2007, 34: 1415-1426.
15.	Elf JE, Jögi J, Bajc M. Home treatment of patients with small to medium sized acute pulmonary embolism. J Thromb Thrombolysis, 2015, 39: 166-172.
16.	Olsson CG, Bitzén U, Olsson B, et al. Outpatient tinzaparin therapy in pulmonary embolism quantified with ventilation/perfusion scintigraphy. Med Sci Monit, 2006, 12: Pi9-13.
17.	Bajc M, Schümichen C, Grüning T, et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging, 2019, 46: 2429-2451.
18.	Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J, 2005, 26: 319-338.
19.	Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol, 2004, 113: 59-65.
20.	Tulchinsky M, Fotos JS, Wechalekar K, et al. Applications of ventilation-perfusion scintigraphy in surgical management of chronic obstructive lung disease and cancer. Semin Nucl Med, 2017, 47: 671-679.
21.	Mortensen J, Berg RMG. Lung scintigraphy in COPD. Semin Nucl Med, 2019, 49: 16-21.
22.	Wechalekar K, Garner J, Gregg S. Pre-surgical evaluation of lung function. Semin Nucl Med, 2019, 49: 22-30.
23.	Elojeimy S, Cruite I, Bowen S, et al. Overview of the novel and improved pulmonary ventilation-perfusion imaging applications in the era of SPECT/CT. AJR Am J Roentgenol, 2016, 207: 1307-1315.
24.	Trivedi A, Hall C, Hoffman EA, et al. Using imaging as a biomarker for asthma. J Allergy Clin Immunol, 2017, 139: 1-10.
25.	Pellegrino R, Biggi A, Papaleo A, et al. Regional expiratory flow limitation studied with Technegas in asthma. J Appl Physiol (1985). 2001 Nov;91(5): 2190-2198.
26.	Downie SR, Salome CM, Verbanck S, et al. Ventilation heterogeneity is a major determinant of airway hyperresponsiveness in asthma, independent of airway inflammation. Thorax, 2007, 62: 684-689.
27.	Wagner PD, Hedenstierna G, Bylin G. Ventilation-perfusion inequality in chronic asthma. Am Rev Respir Dis, 1987, 136: 605-612.
28.	Melosini L, Dente FL, Bacci E, et al. Asthma control test (ACT): comparison with clinical, functional, and biological markers of asthma control. J Asthma, 2012, 49: 317-323.
29.	Shirai T, Furuhashi K, Suda T, et al. Relationship of the asthma control test with pulmonary function and exhaled nitric oxide. Ann Allergy Asthma Immunol, 2008, 101: 608-613.
30.	Guy HJ, Prisk GK, Elliott AR, et al. Inhomogeneity of pulmonary ventilation during sustained microgravity as determined by single-breath washouts. J Appl Physiol (1985), 1994, 76: 1719-1729.

1. Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J, 2008, 31(1): 143-178.
2. King GG, Harris B, Mahadev S. V/Q SPECT: utility for investigation of pulmonary physiology. Semin Nucl Med, 2010, 40: 467-473.
3. Farrow CE, Salome CM, Harris BE, et al. Peripheral ventilation heterogeneity determines the extent of bronchoconstriction in asthma. J Appl Physiol (1985), 2017, 123: 1188-1194.
4. Harris RS, Fujii-Rios H, Winkler T, et al. Ventilation defect formation in healthy and asthma subjects is determined by lung inflation. PLoS One, 2012, 7: e53216.
5. Kelly VJ, Hibbert KA, Kohli P, et al. Hypoxic pulmonary vasoconstriction does not explain all regional perfusion redistribution in asthma. Am J Respir Crit Care Med, 2017, 196: 834-844.
6. Harris RS, Winkler T, Tgavalekos N, et al. Regional pulmonary perfusion, inflation, and ventilation defects in bronchoconstricted patients with asthma. Am J Respir Crit Care Med, 2006, 174: 245-253.
7. Mann A, DiDea M, Fournier F, et al. The importance of quality in ventilation-perfusion imaging. J Nucl Med Technol, 2018, 46: 89-95.
8. Roach PJ, Gradinscak DJ, Schembri GP, et al. SPECT/CT in V/Q scanning. Semin Nucl Med, 2010, 40: 455-466.
9. Roach PJ, Bailey DL, Schembri GP, et al. Transition from planar to SPECT V/Q scintigraphy: rationale, practicalities, and challenges. Semin Nucl Med, 2010, 40: 397-407.
10. Roach PJ, Schembri GP, Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med, 2013, 54: 1588-1596.
11. Bajc M, Markstad H, Jarenbäck L, et al. Grading obstructive lung disease using tomographic pulmonary scintigraphy in patients with chronic obstructive pulmonary disease (COPD) and long-term smokers. Ann Nucl Med, 2015, 29: 91-99.
12. Bajc M, Chen Y, Wang J, et al. Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease. Int J Chron Obstruct Pulmon Dis, 2017, 12: 1579-1587.
13. Jögi J, Ekberg M, Jonson B, et al. Ventilation/perfusion SPECT in chronic obstructive pulmonary disease: an evaluation by reference to symptoms, spirometric lung function and emphysema, as assessed with HRCT. Eur J Nucl Med Mol Imaging, 2011, 38: 1344-1352.
14. Bailey DL, Roach PJ, Bailey EA, et al. Development of a cost-effective modular SPECT/CT scanner. Eur J Nucl Med Mol Imaging, 2007, 34: 1415-1426.
15. Elf JE, Jögi J, Bajc M. Home treatment of patients with small to medium sized acute pulmonary embolism. J Thromb Thrombolysis, 2015, 39: 166-172.
16. Olsson CG, Bitzén U, Olsson B, et al. Outpatient tinzaparin therapy in pulmonary embolism quantified with ventilation/perfusion scintigraphy. Med Sci Monit, 2006, 12: Pi9-13.
17. Bajc M, Schümichen C, Grüning T, et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging, 2019, 46: 2429-2451.
18. Miller MR, Hankinson J, Brusasco V, et al. Standardisation of spirometry. Eur Respir J, 2005, 26: 319-338.
19. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol, 2004, 113: 59-65.
20. Tulchinsky M, Fotos JS, Wechalekar K, et al. Applications of ventilation-perfusion scintigraphy in surgical management of chronic obstructive lung disease and cancer. Semin Nucl Med, 2017, 47: 671-679.
21. Mortensen J, Berg RMG. Lung scintigraphy in COPD. Semin Nucl Med, 2019, 49: 16-21.
22. Wechalekar K, Garner J, Gregg S. Pre-surgical evaluation of lung function. Semin Nucl Med, 2019, 49: 22-30.
23. Elojeimy S, Cruite I, Bowen S, et al. Overview of the novel and improved pulmonary ventilation-perfusion imaging applications in the era of SPECT/CT. AJR Am J Roentgenol, 2016, 207: 1307-1315.
24. Trivedi A, Hall C, Hoffman EA, et al. Using imaging as a biomarker for asthma. J Allergy Clin Immunol, 2017, 139: 1-10.
25. Pellegrino R, Biggi A, Papaleo A, et al. Regional expiratory flow limitation studied with Technegas in asthma. J Appl Physiol (1985). 2001 Nov;91(5): 2190-2198.
26. Downie SR, Salome CM, Verbanck S, et al. Ventilation heterogeneity is a major determinant of airway hyperresponsiveness in asthma, independent of airway inflammation. Thorax, 2007, 62: 684-689.
27. Wagner PD, Hedenstierna G, Bylin G. Ventilation-perfusion inequality in chronic asthma. Am Rev Respir Dis, 1987, 136: 605-612.
28. Melosini L, Dente FL, Bacci E, et al. Asthma control test (ACT): comparison with clinical, functional, and biological markers of asthma control. J Asthma, 2012, 49: 317-323.
29. Shirai T, Furuhashi K, Suda T, et al. Relationship of the asthma control test with pulmonary function and exhaled nitric oxide. Ann Allergy Asthma Immunol, 2008, 101: 608-613.
30. Guy HJ, Prisk GK, Elliott AR, et al. Inhomogeneity of pulmonary ventilation during sustained microgravity as determined by single-breath washouts. J Appl Physiol (1985), 1994, 76: 1719-1729.

Chinese Journal of Respiratory and Critical Care Medicine

Application of V/P SPECT/CT in quantitative assessment of lung function in patients with asthma

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