Nuclear Medicine Techniques in Pre- and Post-Procedural Evaluation of Lung Volume Reduction Interventions and of Single Pulmonary Nodule

Chronic obstructive pulmonary disease (COPD) remains a challenging condition in modern medicine, particularly in severe cases with significant morbidity and mortality. Lung volume reduction surgery (LVRS) has been a longstanding approach for severe emphysema, demonstrating effectiveness in improving survival and respiratory function. However, the less invasive option of bronchoscopic lung volume reduction (BLVR) has gained attention, offering lower morbidity and mortality. This chapter explores the crucial role of nuclear medicine techniques, primarily single-photon emission computed tomography/computed tomography (SPECT/CT), in the pre-procedural planning, patient selection, and monitoring of outcomes for both LVRS and BLVR. SPECT/CT provides a fully quantitative analysis of lung perfusion, aiding in precise evaluation of lobar lung function. The utility of SPECT/CT in LVRS planning is highlighted, demonstrating its superiority over planar techniques and multidetector-row CT. Furthermore, the role of quantitative lobar SPECT/CT extends to the realm of pulmonary nodule and mass resection, particularly in patients with concomitant COPD and lung cancer. The chapter discusses how SPECT/CT aids in treatment planning, assessing lung perfusion, and predicting post-operative pulmonary function in this challenging patient population. In the context of BLVR, the chapter details the advantages of this less invasive therapy and underscores the pivotal role of SPECT/CT in pre-procedural planning. SPECT/CT enables precise lobar assessment, guiding the selection of target lobes for valve placement, particularly in those with diffusely homogenous emphysema. The chapter discusses the impact of BLVR on ventilation and perfusion shifts, providing insights into physiological responses post-procedure. The evolving landscape of BLVR prompts a discussion on future aims, anticipating the continued integration of nuclear medicine techniques, especially SPECT/CT, in refining patient selection criteria and optimizing outcomes. The chapter concludes by highlighting the ongoing research and the potential of SPECT/CT in identifying patients who stand to gain the most from BLVR, ultimately contributing to the advancement of personalized and effective treatment strategies for severe COPD.