A Study on the Correlation between Lung Ventilation Scan using Technegas and Pulmonary Function Test in Patients with COPD

Technegas를 이용한 폐환기 검사와 폐기능 검사의 상관관계에 관한 고찰

  • Kim, Sang-Gyu (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Kim, Jin-Gu (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Baek, Song-EE (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Kang, Chun-Koo (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System) ;
  • Kim, Jae-Sam (Department of Nuclear Medicine, Severance Hospital, Yonsei University Health System)
  • 김상규 (연세의료원, 세브란스병원, 핵의학과) ;
  • 김진구 (연세의료원, 세브란스병원, 핵의학과) ;
  • 백송이 (연세의료원, 세브란스병원, 핵의학과) ;
  • 강천구 (연세의료원, 세브란스병원, 핵의학과) ;
  • 김재삼 (연세의료원, 세브란스병원, 핵의학과)
  • Received : 2019.02.28
  • Accepted : 2019.03.02
  • Published : 2019.04.27

Abstract

Purpose Lung Ventilation Scan(LVS) images directly inhaled radiation gas to evaluate lung ventilation ability. Therefore, it is influenced by various factors related to inhalation, including number of breaths, respiratory duration, respiration rate, and breathing method. In actual LVS examinations, it is difficult for objectify the patient's ability to inhale, and there is currently no known index related to inhalation. Therefore, this study confirms the correlation between counts per second(cps) in LVS and the results of pulmonary function test(PFT) and evaluate its usefulness as an objective indicator of inhalation. Materials and Methods From October 2010 to September 2018, 36 Chronic Obstructive Pulmonary Disease(COPD) patients who had both LVS and PFT were classified by severity(Mild, Moderate, Severe). LVS was performed by creating Technegas with Vita Medical's Technegas Generator and inhaling it to the patient. LVS images were acquired with Philips's Forte equipment., and PFT used Carefusion's Vmax Encore 22. The correlation between the cps measured by setting the region of interest(ROI) of both lungs on the LVS and the forced vital capacity(FVC), forced expiratory volume in one second($FEV_1$), $FEV_1/FVC$ of the results of PFT was compared and analyzed. Results We analyzed the correlation between cps of LVS using Technegas and the results of PFT by classifying COPD patients according to severity. Correlation coefficient between $FEV_1/FVC$ and cps was Severe -0.773, Moderate -0.750, and Mild -0.437. The Severe and Modulate result values were statistically significant(P<0.05) and Mild was not significant(P=0.155). On the other hand, the correlation coefficient between FVC and cps was statistically significant only in Mild and it was 0.882(P<0.05). Conclusion According to the study, we were able to analyze correlation between cps of LVS using Technegas and the results of PFT in COPD Patients. Using this result, when performing a LVS, the results of PFT can be used as an index of inhaling capacity. In addition, it is thought that it will be more effective for the operation of the exam rooms.

폐 환기 검사는 직접 방사성 기체를 흡입한 후 이를 영상화 한다. 그러나 실제 폐 환기 검사 시 활용할 수 있는 흡입과 관련한 지표는 널리 알려진 바가 없다. 따라서 본 연구를 통해 흡입과 관련한 객관적인 지표로써 폐 환기 검사 계수율과 폐 기능검사 결과 값의 상관관계를 확인하고 그 유용성을 알아보고자 한다. 2010년 10월부터 2018년 9월까지 본원에서 폐 환기 검사와 폐 기능 검사를 모두 시행한 만성폐쇄성 폐질환 환자 36명을 대상으로 중증도(Mild, Moderate, Severe)별로 분류하였다. 폐 환기 검사는 Technegas Generator (Vita Medical Ltd, Australia)로 Technegas를 생성하여, 환자에게 흡입하게 하였다. 영상은 Forte (Philips Medical Systems, Netherlands) 장비를 사용하였으며, 폐 기능 검사는 Vmax Encore 22 (Carefusion Corporation, USA)를 사용하였다. 폐 환기 검사에서는 양측 폐에 관심 영역을 설정하여 계수율을 측정하였고, 이와 함께 폐 기능 검사의 결과 값 중 노력 폐활량(FVC), 1초 노력 호기량($FEV_1$), 일초율($FEV_1/FVC$) 사이의 상관관계를 비교 분석하였다. 만성폐쇄성폐질환 환자의 폐 환기 검사 계수율과 폐 기능 검사 결과 값의 상관관계를 분석한 결과, 중증도별 $FEV_1/FVC$와 계수율 사이의 상관계수는 Severe에서 -0.773, Moderate에서 -0.750, Mild에서 -0.437이였다. Severe, Moderate 결과 값은 통계적으로 유의하였으며(P<0.05), Mild는 유의하지 않았다(P=0.155). 반면에 FVC와 계수율 사이의 상관계수는 Mild에서만 0.882로 통계적으로 유의한 것을 확인하였다(P<0.05). 만성폐쇄성폐질환 환자를 대상으로 시행한 폐 환기 검사 시 계수율과 폐 기능 검사 결과 값의 상관관계를 확인할 수 있었다. 이를 통해 폐 환기 검사 시 호흡력에 대한 지표로써 폐 기능 검사 결과 값을 활용할 수 있을 것으로 생각된다.

Keywords

References

  1. M. Bajc, J. B. Neilly, M. Miniati, C. Schuemichen, M. Meignan, B. Jonson. EANM guidelines for ventilation/ perfusion scintigraphy. Eur J Nucl Med Mol Imaging. 2009;36:1356-1370. https://doi.org/10.1007/s00259-009-1170-5
  2. Mills NL, Amin N, Robinson SD, Anand A, Davies J, Patel D, et al. Do Inhaled Carbon Nanoparticles Translocate Directly into Circulation in humans? Am J Respir Crit Care Med. 2006;173:426-431. https://doi.org/10.1164/rccm.200506-865OC
  3. Sinzinger H, Rodrigues M, Kummer F. Ventilation/perfusion lung scintigraphy. Multiple applications besides pulmonary embolism. Hell J Nucl Med. 2013;16(1):50-55. https://doi.org/10.1967/s002449910072
  4. Jogi J, Jonson B, Ekberg M, Bajc M. Ventilation-Perfusion SPECT with 99mTc-DTPA Versus Technegas: A Head-to-Head Study in Obstructive and Nonobstructive Disease. J Nucl Med. 2010;51:735-741. https://doi.org/10.2967/jnumed.109.073957
  5. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007;176:532-555. https://doi.org/10.1164/rccm.200703-456SO
  6. Choi JK, Paek D, Lee JO. Normal predictive values of spirometry in Korean population. Tuberc Respir Dis 2005;58:230-242. https://doi.org/10.4046/trd.2005.58.3.230
  7. Morris JF, Koski A, johnson LC. Spirometric standards for healthy nonsmoking adults. Am Rev Respir Dis 1971; 103:57-67.
  8. The BTS COPD consortium. Spirometry in practice. A practical guide to using spirometry in primary care. Available at: https://www.brit-thoracic.org.uk/document-library/ deliveryof- respiratory-care/spirometry/spirometry-in-practice; Accessed December 6, 2017.
  9. Gold WM, Koth LL. In: Murray JF, editor. Murray and Nadel's Textbook of Respiratory Medicine saunders, Elsevier; 2010.
  10. American Thoracic Society. Lung function testing: selection of reference values and interpretative strategies. Am Rev Respir Dis 1991;144:1202-1218. https://doi.org/10.1164/ajrccm/144.5.1202
  11. Swanney MP, Ruppel G, Enright PL, Pederson OF, Crapo RO, Miller MR, et al. Using the lower limit of normal for the FEV1/FVC ratio reduces the misclassification of airway obstruction. Thorax 2008;63:1046-1051. https://doi.org/10.1136/thx.2008.098483
  12. Cerveri I, Corsico AG, Acoordini S, Niniano R, Ansaldo E, Anto JM, et al. Underestimation of airflow obstruction among young adults using FEV1/FVC <70% as a fixed cut-off: a longitudinal evaluation of clinical and functional outcomes. Thorax 2008;63:1040-1045. https://doi.org/10.1136/thx.2008.095554