Three-Dimensional Pulmonary Lobar Quantification to Guide Surgical Management

Purpose: To illustrate the benefits of using three-dimensional pulmonary lobar quantification and describe the technical details around a semi-automated lobar segmentation technique.

Background: Nuclear medicine lung ventilation and perfusion scans with planar two-dimensional analysis is a method to quantify a patient’s functional lung volumes in order to guide various procedures such as lung reduction surgery and endobronchial value placement for severe emphysema. SPECT/CT of the lungs allows for three-dimensional quantification of individual lobes of the lungs. Three-dimensional lobar quantification of the lungs has shown to provide more accurate results, as well as better estimation of residual pulmonary function post-surgery (1-5). However, manually segmenting each lobe of the lung is time consuming and a limiting factor in offering this analysis within clinical practice. A semi-automated workflow is described which can rapidly segment the lung lobes, making this analysis practical clinically.

Methods: Using clinically available software provided by MIM (MIM Software Inc., Cleveland Ohio, USA), a workflow employing semi-automated segmentation tools creates three-dimensional regions of interest around each pulmonary lobe by utilizing the fissures as seen on the CT component of the SPECT/CT images. These 3D regions of interest are then superimposed into the SPECT component of the exam for volumetric functional analysis.

Results: This presentation describes the value in providing three-dimensional pulmonary lobar ventilation and perfusion quantification, while illustrating how it can be performed in a rapid semi-automated manner.

Conclusions: At the end of this educational presentation, our audience will understand the value of utilizing three-dimensional pulmonary lobar quantification to evaluate patients prior to lung reducing procedures. In addition, we provide a step-by-step guide to utilization of a semi-automated pulmonary lobar segmentation technique.