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SPECT ‐based functional lung imaging for the prediction of radiation pneumonitis: A clinical and dosimetric correlation
Author(s) -
Hoover Douglas A.,
Reid Robert H.,
Wong Eugene,
Stitt Larry,
Sabondjian Eric,
Rodrigues George B.,
Jaswal Jasbir K.,
Yaremko Brian P.
Publication year - 2014
Publication title -
journal of medical imaging and radiation oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.31
H-Index - 43
eISSN - 1754-9485
pISSN - 1754-9477
DOI - 10.1111/1754-9485.12145
Subject(s) - medicine , nuclear medicine , perfusion , radiation therapy , ventilation (architecture) , lung cancer , receiver operating characteristic , radiation pneumonitis , homogeneous , lung , single photon emission computed tomography , pneumonitis , lung volumes , radiology , mathematics , mechanical engineering , combinatorics , engineering
When we irradiate lung cancer, the radiation dose that can be delivered safely is limited by the risk of radiation pneumonitis ( RP ) in the surrounding normal lung. This risk is dose‐dependent and is commonly predicted using metrics such as the V 20, which are usually formulated assuming homogeneous pulmonary function. Because in vivo pulmonary function is not homogeneous, if highly functioning lung can be identified beforehand and preferentially avoided during treatment, it might be possible to reduce the risk of RP , suggesting the utility of function‐based prediction metrics. Methods We retrospectively identified 26 patients who received ventilation and perfusion single photon emission computed tomography ( SPECT‐CT ) immediately prior to curative‐intent radiation therapy. Patients were separated into non‐ RP and RP groups. As‐treated dose‐volume histogram ( DVH ), perfusion‐ SPECT ‐based and ventilation‐ SPECT ‐based dose‐function histogram ( DFH ) parameters were defined for each group and were tested for differences. The relative utilities of ventilation‐based and perfusion‐based DFH metrics were assessed using receiver operating characteristic ( ROC ) analysis. Results The standard mean lung dose ( MLD ) was significantly higher in the RP group; the standard V 20 and V 30 were higher in the RP group but not significantly. Perfusion‐weighted and ventilation‐weighted values of the MLD , V 20 and V 30 were all significantly higher in the RP group. ROC analysis suggested that SPECT ‐based DFH parameters outperformed standard DVH parameters as predictors of RP . Conclusions SPECT ‐based DFH parameters appear to be useful as predictors of RP .