Chief Investigator
Dr David Hall
Dates
Sep-2016 to Aug-2017
Funding Stream
RCF Spring 2016
Amount
£11,427
Summary
Patients with emphysema, a serious lung disease often caused by
smoking, struggle to breathe because part of their lungs is not
working well. Clinicians at UH Bristol treat patients by sealing
off damaged parts of the lungs using one-way valves, allowing the
stronger parts of the lungs to work more effectively. This method
is very useful for some patients, but not all. It has been
introduced at a number of major centres in the UK, including the
Royal Brompton Hospital.
In order to select the best treatment for each patient, scans
are taken and discussed by the doctors. At UH Bristol, we use a
scan called a SPECT/CT to show the blood flow and ventilation of
the lungs. This gives information about how well each area of the
lungs is working, as well showing lung damage. This study is
intended to improve the use of these scans, in order to predict the
outcome of treatment better than with current techniques. This will
improve the ability of doctors to select the best treatment for
each patient. These scans would be available at any major centre
which could carry out this treatment.
This project will see whether numerical information obtained
from the SPECT/CT scans at UH Bristol relates to patient
post-treatment outcomes. Based on previous research using less
advanced scans we are likely to demonstrate a relationship, however
as we are using improved scan images we anticipate to obtain
improved results. If the pilot study is successful, this will lead
on to a prospective trial to assess patient impact of the SPECT/CT
scans.
Main findings
Visual score of ventilation and perfusion from SPECT/CT did not
correlate with pulmonary function testing (e.g. FEV1) at baseline.
This suggests that VQ SPECT/CT is giving different and
potentially complementary information to standard pulmonary
function testing..
There was an association between both a patients' target lobe
and non-target lobe ventilation and improvement in their FEV1.
Results suggested that patients with poorer ventilation in their
target lobe, and better ventilation in their non-target lobe, were
associated with greater improvement in their FEV1 after treatment.
Additionally, mismatch between ventilation-perfusion in the target
lobe was also found to be associated with improvement in FEV1. It
was also shown that improvement in a patients' FEV1 following
treatment may be able to be predicted by their TL and INL
ventilation values, as well as their TL VPR value, when compared to
a threshold.
The project results support the conclusions of the literature,
which state that patients identified as having mismatch in disease
distribution between their targeted lobe and the adjacent lobe are
associated with better clinical outcome. The project's analysis
demonstrated that it is in fact ventilation imaging that plays a
key role in this. However, in contrast to work by Thomsen et al,
the project found no statistically significant assocation between
perfusion and clinical outcome.
From these results, it can be argued that the project provides
preliminary evidence for the potential clinical utility of
ventilation imaging and suggests that the costs and patient
discomfort associated are not at this time unjustified.
However, the associations identified in the analysis were only weak
to moderate, and there are limitations in the collected data and
the statistical analysis methods, therefore definitive conclusions
on this area of research cannot be made until further work has been
carried out.
Impact
The project results support the conclusions of the literature,
which state that patients identified as having mismatch in disease
distribution between their targeted lobe and the adjacent lobe are
associated with better clinical outcome. The project's analysis
demonstrated that it is in fact ventilation imaging that plays a
key role in this. However, in contrast to work by Thomsen et al,
the project found no statistically significant assocation between
perfusion and clinical outcome.
From these results, it can be argued that the project provides
preliminary evidence for the potential clinical utility of
ventilation imaging and suggests that the costs and patient
discomfort associated are not at this time unjustified.
However, the associations identified in the analysis were only weak
to moderate, and there are limitations in the collected data and
the statistical analysis methods, therefore definitive conclusions
on this area of research cannot be made until further work has been
carried out.
Larger Grants
Planning an NIHR RfPB grant application in 2020.
Other project outcomes
Collaborations were established between radiology, medical
physics, and respiratory services at UHBristol.
Outputs
MSc project - Laura Burberry, 2019. Intending to write up for
publication Jan 2020.
page updated 06/12/2019
