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

M Bajc, Y Chen, J Wang, X Y Li, W M Shen, C Z Wang, H Huang, A Lindqvist, X Y He, M Bajc, Y Chen, J Wang, X Y Li, W M Shen, C Z Wang, H Huang, A Lindqvist, X Y He

Abstract

Introduction: 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.

Methods: 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.

Results: 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 (r=0.63 and -0.60, respectively, P<0.0001). V/P SPECT identified pulmonary embolism in 30 patients (32%). A pattern typical for heart failure was present in 26 patients (28%). Parenchymal changes typical for pneumonia or lung tumor were present in several cases.

Conclusion: V/P SPECT, using Technegas as the functional ventilation imaging agent, is a new tool to diagnose COPD and to grade its severity. Additionally, it revealed heterogeneity of COPD caused by pulmonary comorbidities. The characteristics of these comorbidities suggest their significant impact in clarifying symptoms, and also their influence on the prognosis.

Keywords: COPD; Technegas; V/P SPECT; imaging interpretation criteria; pulmonary comorbidities.

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
V/P SPECT of a patient with a severe COPD (GOLD 3). Notes: On the frontal slice, uneven distribution of ventilation and absent ventilation are seen, as is perfusion in the upper lobe (blue arrows indicating emphysema). Hot spots represent changes in small airway disease (dotted blue arrow on sagittal slice). Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; V/P SPECT, ventilation/perfusion single-photon emission computed tomography.
Figure 2
Figure 2
Correlation between Vgrade and TPLF% and GOLD stages. Note: Pearson correlation coefficients and linear regression lines with best-fit values (continuous line) and 95% confidence intervals (dotted lines) are presented. Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; TPLF%, total preserved lung function; SPECT, single-photon emission computed tomography; Vgrade, penetration grade of Technegas in V SPECT.
Figure 3
Figure 3
Correlation between Vgrade and TPLF% and results of the technically accepted and reproducible pulmonary lung function tests. Note: Pearson’s correlation coefficients and linear regression lines with best-fit values (continuous line) and 95% confidence intervals (dotted lines) are presented. Abbreviations: FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; TPLF%, total preserved lung function; SPECT, single-photon emission computed tomography; Vgrade, penetration grade of Technegas in V SPECT.
Figure 4
Figure 4
Vgrade 1, 2, and 3 in relation to the technically accepted and reproducible lung function test results (n=75). Note: The plots of measurements with the mean and the 95% confidence intervals are shown. Abbreviations: FEV1, forced expiratory volume in 1 second; FVC, forced vital capacity; SPECT, single-photon emission computed tomography; Vgrade, penetration grade of Technegas in V SPECT.
Figure 5
Figure 5
V/P SPECT of a patient with a severe COPD (GOLD 3). Note: Uneven distribution of ventilation with hot spots (indicating obstructive small airways disease), area with absent ventilation and perfusion in the upper lobe (blue arrows indicating emphysema), as well as area with absent perfusion and preserved ventilation (mismatch – red arrows indicating pulmonary embolism). Abbreviations: GOLD, Global Initiative for Chronic Obstructive Lung Disease; V/P SPECT, ventilation/perfusion single-photon emission computed tomography.

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