Documento descargado de http://www.elsevier.es el 19/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato. 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: mayka@infomed.sld.cu (M.C. Guerrero Cancio). 2253-8089/$ – see front matter © 2011 Elsevier España, S.L. and SEMNIM. All rights reserved. Documento descargado de http://www.elsevier.es el 19/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato. 333 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: 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. Documento descargado de http://www.elsevier.es el 19/11/2016. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato. 334 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. References 1. Santos Luna F, Lama Martinez R. Trasplante pulmonar: Criterios de selección y evaluación de candidatos. NEUMOSUR. 2000;12:120–30. 2. Zophel K, Bacher-Stier C, Pinkert J, Kropp J. Ventilation/perfusion lung scintigraphy: what is still needed? A review considering technetium-99m-labeled macro-aggregates of albumin. Nucl Med. 2009;23:1–16. 3. Chavarria Martinez U, Posadas Valay R. Trasplante pulmonar. Neumol Cir Torax. 2006;65:11–23. 4. Borro JM. Actualización del trasplante pulmonar en España. Arch Bronconeumol. 2005;41:457–67. 5. Ponto JA. Radiopharmaceutical considerations for using 99m Tc-MAA in lung transplant patients. J Am Pharm Assoc. 2010;50:419–23. 6. Almadana Pacheco V, Sanchez Varilla JM. Medicina nuclear (I), Gammagrafía de ventilación/perfusión pulmonar. Suplemento NEUMOSUR. 2006:20–2. 7. Tsagkaropoulos S, Belmasns A, Verleden GM, Coosemans W, Decaluwe H, De Leyn P, et al. Single-lung transplantation: does side matter? Eur J Cardiothorac Surg. 2011;40:e83–92.