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

• Published in: International journal of chronic obstructive pulmonary disease 2017-01, Vol.12, p.1579-1587
• Main Authors: Bajc, M, Chen, Y, Wang, J, Li, X Y, Shen, W M, Wang, C Z, Huang, H, Lindqvist, A, He, X Y
• Format: Article
• Language: English
• Subjects: Adult; Aerosols; Aged; Aged, 80 and over; Airway management; Biomass energy; Care and treatment; China - epidemiology; Chronic obstructive lung disease; Chronic obstructive pulmonary disease; Clinical medicine; Comorbidity; Complications and side effects; COPD; Diagnosis; Ethics; Female; Forced Expiratory Volume; Hospitals; Humans; Imaging interpretation criteria; Lung - diagnostic imaging; Lung - physiopathology; Lung diseases; Lungs; Male; Middle Aged; Mortality; Nuclear medicine; Original Research; Pathophysiology; Patients; Perfusion Imaging - methods; Predictive Value of Tests; Prognosis; pulmonary co-morbidities; Pulmonary Disease, Chronic Obstructive - diagnostic imaging; Pulmonary Disease, Chronic Obstructive - epidemiology; Pulmonary Disease, Chronic Obstructive - physiopathology; Pulmonary Ventilation; Radiopharmaceuticals - administration & dosage; Risk Factors; Severity of Illness Index; Single photon emission computed tomography; Sodium Pertechnetate Tc 99m - administration & dosage; Spirometry; Technegas; Tomography; Tomography, Emission-Computed, Single-Photon - methods; V/P SPECT; Vital Capacity
• ISSN: 1178-2005; 1176-9106; 1178-2005
• DOI: 10.2147/COPD.S131847

Airway obstruction and possible concomitant pulmonary diseases in COPD cannot be identified conventionally with any single diagnostic tool. We aimed to diagnose and grade COPD severity and identify pulmonary comorbidities associated with COPD with ventilation/perfusion single-photon emission computed tomography (V/P SPECT) using Technegas as the functional ventilation imaging agent. 94 COPD patients (aged 43-86 years, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I-IV) were examined with V/P SPECT and spirometry. Ventilation and perfusion defects were analyzed blindly according to the European guidelines. Penetration grade of Technegas in V SPECT measured the degree of obstructive small airways disease. Total preserved lung function and penetration grade of Technegas in V SPECT were assessed by V/P SPECT and compared to GOLD stages and spirometry. Signs of small airway obstruction in the ventilation SPECT images were found in 92 patients. Emphysema was identified in 81 patients. Two patients had no signs of COPD, but both of them had a pulmonary embolism, and in one of them we also suspected a lung tumor. The penetration grade of Technegas in V SPECT and total preserved lung function correlated significantly to GOLD stages ( =0.63 and -0.60, respectively,