Pre-surgical Evaluation of Lung Function.

Chronic obstructive pulmonary disease affects 400 million individuals worldwide and is predicted to be the third leading cause of death by 2020 with a projected economic cost of 4.8 trillion US dollars by 2030. Lung volume reduction surgery is an established means of targeting hyperinflation in patients with severe emphysema, optimizing ventilator mechanics, and reducing the work of breathing. Preoperative evaluation of regional lung function is essential to planning and predicting the outcomes of surgery. The traditional planar approach is inaccurate for lobar contribution since it is not based on anatomy. We developed a novel approach combining single photon emission tomography (SPECT) with CT, offering accurate quantitative characterization of ventilation and perfusion at a lobar level. The utility of this hybrid imaging technique has been demonstrated in preoperative disease profiling, surgical planning, and predicting of postoperative outcomes in patients undergoing Lung volume reduction surgery, affording superior results to conventional planar imaging modalities. In this article, we describe the methodological development of this technique with technical validation.