Cardiac complications after CRT are more common in esophageal than lung cancer patients but the difference is not statistically significant. MPI abnormalities are frequently seen after CRT but are not predictive of future cardiac complications. A history of arrhythmia or CHF is significantly associated with cardiac complications after CRT.
Introduction
We investigated the value of lung perfusion imaging in predicting the risk of developing pulmonary complications after chemoradiation (CRT) or RT for lung cancer.
Methods
Fifty patients who underwent lung perfusion imaging prior to RT for lung cancer were included. Planar and SPECT/CT images of the lungs were obtained. Lung perfusion score (LPS) was developed to visually grade localized perfusion defect per lung on a scale of 0-4 and perfusion pattern in the remaining lungs on a scale of 1-4. The LPS is the sum of the score for the localized perfusion defect in each lung plus the score for the remaining lungs perfusion. LPSs were correlated with pulmonary function tests (PFT) and the patients were followed for 8 months after therapy to determine the incidence of grade 2 to 5 symptomatic therapy related pulmonary complications according to the common terminology criteria for adverse events (CTCAE 3.0).
Results
Thirty four patients underwent CRT and 16 underwent RT. The mean total radiation dose delivered was 56.1 ± 10.4 Gy. Eighteen patients (36%) suffered from pulmonary complications at a mean interval of 3.4 months after therapy. Nine patients had grade 2, 7 had grade 3, 1 had grade 4 and 1 had grade 5 pulmonary complications. The mean LPS was 4.9 in patients who developed pulmonary complications versus 3.5 in patients who did not (p=0.01). There were no significant difference between PFTs in the patients with pulmonary complications and the patient without. Additionally, there were no significant differences between the mean lung radiation dose, the volume of lung irradiated or the percentage of lung receiving greater than 20 Gy between the two groups.
Conclusions
LPS using lung perfusion imaging is useful for predicting possible pulmonary complications after CRT or RT in lung cancer patients.
The temporary total artificial heart (TAH-t) has been valuable as a bridge to transplantation in patients with biventricular failure. However, the challenges of accurately assessing pulmonary vascular resistance after TAH-t implantation can preclude these patients from heart transplantation, especially those with pre-existing pulmonary hypertension. The CardioMEMS Heart Failure System (St. Jude's Medical, Little Canada, MN) comprises a wireless pressure sensor that is implanted percutaneously in the pulmonary artery and transmits real-time measurements of pulmonary artery pressures. Systolic and diastolic pulmonary artery (PA) pressures measurements have been well correlated between the CardioMEMS PA Sensor and traditional Swan-Ganz catheter and between the CardioMEMS PA Sensor and standard echocardiography. Here, we report the use of the CardioMEMS device in a patient with severe pulmonary hypertension supported with a SynCardia TAH-t (Tucson, AZ) during assessment for candidacy for transplantation.
The impact of iterative reconstruction (IR) on myocardial perfusion imaging (MPI) interpretation and functional results is under investigated. We evaluated the effect of IR on the interpretation and functional results of MPI compared with filtered back-projection (FBP). Material and Methods: Sixty patients with previously acquired MPI were randomly selected. Studies were processed using FBP and 2D ordered-subsets expectation-maximization (OSEM). Two physicians interpreted the images after IR and FBP processing. Results were confirmed by coronary angiography and/or clinical course. Left ventricular ejection fraction (LVEF), end-diastolic volume (EDV) and end-systolic volume (ESV) were calculated with IR and FBP. Results: The sensitivity, specificity, positive and negative predictive values and accuracy of physician 1 were 95%, 87%, 80%, 97%, and 90% with FBP and 100%, 80%, 72%, 100%, and 87% with IR. For physician 2, they were 95%, 95%, 91%, 97%, and 95% with FBP and 81%, 95%, 90%, 90%, and 90% with IR. There were no statistically significant differences between physicians' interpretations (P=0.71 for FBP and 0.09 for IR). There was good correlation between IR and FBP calculated LVEF (r=0.98), EDV (r=0.99), and ESV (r=0.99) but significant difference per patient (P=0.02, 0.03 and 0.02, respectively). Conclusion: There is no statistically significant difference in interpretation of MPI with IR versus FBP but there were statistically significant differences in functional results.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.