Quantitative assessment of pre-operative lung perfusion predicts outcome of lung volume reduction surgery

Full text: Lung volume reduction surgery (LVRS) was reintroduced by Cooper in 1990 as a palliative measure to improve the mechanics of breathing in patients with severe heterogeneous emphysema. Between 1995 and mid-1998, 90 patients underwent bilateral upper zone LVRS at The Alfred Hospital. Qualitative assessment of preoperative perfusion study and CT scan was used routinely to assess heterogeneity in all patients. In the 41 patients (16 M, 25 F, age 41-75 years) who had pre-operative lung perfusion study performed in our department, a new quantitative method was applied. Geometric means of the count rates were calculated for both lungs and for upper zones. The combined left and right upper zone perfusion was given as percentage of the total lung perfusion (perfusion heterogeneity index). Clinical outcome was measured as percentage improvement in forced expiratory volume in 1 s (FEV1), 3 months post-operatively. Multivariate regression analysis was performed for the variables against change in FEV1 in 32 patients with complete pre- and post-operative data. The only significant independent predictor of outcome was the perfusion heterogeneity index. This simple, objective assessment of heterogeneity gives good prediction of postoperative outcome