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Rev Esp Med Nucl Imagen Mol. 2012;31(6):332–334
Clinical note
Importance of lung perfusion scintigraphy in single lung transplantation夽
N.V. Rodríguez Mesa, M.C. Guerrero Cancio ∗ , M.D. Cordero Jiménez, I.K. Álvarez Velázquez
Departamento de Medicina Nuclear y Oncología, Centro de Investigaciones Médico Quirúrgicas, La Habana, Cuba
a r t i c l e
i n f o
Article history:
Received 29 April 2011
Accepted 5 July 2011
Keywords:
Lung perfusion scintigraphy
Albumin aggregated
Lung transplantation
a b s t r a c t
Lung perfusion scintigraphy (LPS) with 99m Tc-MAA gives valuable information about patients who will
undergo a single lung transplantation. This technique makes it possible to evaluate and quantify the
relative function of both lungs to select the organ to be transplanted. Once the surgery has been performed,
the LPS represents a diagnostic method to study the status of the transplanted organ. Two patients who
underwent single lung transplantation were studied in our hospital. In both cases, a pre-operative LPS
was performed before surgery for selection of the organ to be transplanted and the scintigraphy study
was performed a few months after transplantation to establish the perfusion function of the transplanted
lung.
© 2011 Elsevier España, S.L. and SEMNIM. All rights reserved.
Importancia de la gammagrafía de perfusión pulmonar en el trasplante de
pulmón único
r e s u m e n
Palabras clave:
Gammagrafía de perfusión pulmonar
Macroagregados de albumina
Trasplante de pulmón
La gammagrafía de perfusión pulmonar con 99m Tc-MAA ofrece una valiosa información de los pacientes que van a someterse a trasplante de pulmón único. El empleo de esta técnica nos permite evaluar y
cuantificar la función relativa de ambos pulmones para seleccionar el órgano a trasplantar. Una vez que
se ha realizado la cirugía, la gammagrafía de perfusión pulmonar representa un método diagnóstico para
evaluar la evolución del órgano trasplantado. Dos pacientes que fueron sometidos a este procedimiento
quirúrgico fueron estudiados en nuestro hospital. En ambos se realizó gammagrafía de perfusión pulmonar preoperatoria para la selección del órgano a trasplantar, y meses después de la cirugía se realizó el
estudio gammagráfico para la evaluación de la función de perfusión del órgano trasplantado.
© 2011 Elsevier España, S.L. y SEMNIM. Todos los derechos reservados.
Introduction
Case presentation
Lung perfusion scintigraphy (LPS) with 99m Tc-MAA is one of the
studies indicated in patients undergoing lung transplantation1,2
since this study evaluates and quantifies relative pulmonary
function thereby facilitating the selection of the organ to be
transplanted. We present two patients with emphysema who
underwent single lung transplantation, which is one of the treatment alternatives for this type of non-infectious disease.3,4 The
patients underwent pretransplant perfusion scintigraphy with the
aim of qualitatively and quantitatively evaluating relative pulmonary perfusion and decide the lung to be selected for surgery.
Several months after surgery post-transplant LPS was requested
for both patients by the attending pneumologists with the aim of
evaluating the pulmonary perfusion of the transplanted organ.
Pretransplant LPS was performed with the administration of
111 MBq (3 mCi) of 99m Tc-MAA, which is the appropriate quantity
to obtain high quality diagnostic images and minimize the exposure of adult lung transplant patients to ionizing radiation.5 Five
hundred thousand particles were injected. The anterior and posterior static images (matrix 128 × 128, 1,000,000 counts per images)
were immediately acquired after intravenous administration of the
radiotacer with the patient in a supine position6 in a double detector DST-Xli gamma camera.
The first case was a 44-year-old woman showing a relation of
relative function of 49% in the left lung and 51% in the right lung on
pretransplant LPS, detecting diminished perfusion in the left lung
which was the organ to undergo transplantation. Four months after
surgery a new LPS was performed obtaining a relation of relative
function of 70% for the transplanted organ and 30% for the right
lung (Fig. 1).
The second case involved a 52-year-old man in whom LPS
demonstrated a relation of relative function of 23% for the left lung
and 77% for the right lung, which, together with the qualitative
analysis of the images, concluded that the left lung should be transplanted. One year after surgery the LPS was repeated, obtaining a
relation of relative function of 51% for the transplanted organ and
夽 Please cite this article as: Rodríguez Mesa NV, et al. Importancia de la gammagrafía de perfusión pulmonar en el trasplante de pulmón único. Rev Esp Med Nucl.
2012;31(6):332–4.
∗ Corresponding author.
E-mail address: [email protected] (M.C. Guerrero Cancio).
2253-8089/$ – see front matter © 2011 Elsevier España, S.L. and SEMNIM. All rights reserved.
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333
N.V. Rodríguez Mesa et al. / Rev Esp Med Nucl Imagen Mol. 2012;31(6):332–334
Pretransplant
Scintigraphy
Post‐transplant
Scintigraphy
R
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t
L
e
f
t
R
i
g
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t
L
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Post Perf.
R
i
g
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t
Post Perf.
L
e
f
t
R
i
g
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t
L
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Pre‐perf.
Pre‐perf.
Relative function
Left lung: 49 %
Right lung: 51 %
Relative function
Left lung: 70 %
Right lung: 30 %
Fig. 1. Pre- and post-transplant images. Patient 1.
49% for the right lung. In this case excellent response to the lung
graft was also observed (Fig. 2).
Discussion
Single lung transplantation is considered a therapeutic option
in the case of non-infectious diseases. LPS with 99m Tc-MAA plays
an important role in the quantitative and qualitative evaluation of
relative perfusion function in both the selection of the organ to
be transplanted and in the postoperative follow-up of the patient.
Analysis of the results of the two patients studied in our hospital indicates that the preoperative scintigraphy in the first case
obtained a homogeneous relative function for both lungs (49–51%),
but the visual analysis concluded that the absolute function of the
right lung, albeit better than the left, was very diminished. This was
confirmed in the post-transplant study on observing that the relative function of the transplanted lung increased to 70% while that
of the native organ fell to 30%, taking into account that the graft
had better perfusion. In the second case, the right lung had a relative function of 77% in the preoperative study, which diminished
to 49% after the transplant. This is because the right lung had better absolute function than that of the first case, being confirmed in
the visual analysis of the image. In the post-transplant study, the
function of the right lung was reduced because it compared regionally with that of the graft, achieving a relative perfusion of 51–49%.
These results indicate that in both cases the lung function of the
transplanted organ improved. Previous studies by Zophel et al.2
demonstrated that LPS with 99m Tc-MAA was the method of choice
in the quantification of lung perfusion in the preoperative context.
Tsagkaropoulos et al.7 demonstrated that although the choice of
the organ (left or right) in single lung transplants does not influence patient survival, the selection of the lung to be transplanted
is always based on the results of a quantitative perfusion study. On
the other hand, LPS with 99m Tc-MAA is a follow-up method which
allows qualitative and quantitative evaluation of the quality of the
lung transplant over time.
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N.V. Rodríguez Mesa et al. / Rev Esp Med Nucl Imagen Mol. 2012;31(6):332–334
Pretransplant
Scintigraphy
Post‐transplant
Scintigraphy
R
i
g
h
t
L
e
f
t
R
i
g
h
t
L
e
f
t
Post Perf.
R
i
g
h
t
Post Perf.
L
e
f
t
R
i
g
h
t
L
e
f
t
Pre‐perf.
Pre‐perf.
Relative function
Left lung: 23 %
Right lung: 70 %
Relative function
Left lung: 51 %
Right lung: 49 %
Fig. 2. Pre- and post-transplant images. Patient 2.
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