Localization of Persistent Air Leaks Using Technetium-99m Technegas SPECT/CT

Area of Science:

• Nuclear Medicine
• Thoracic Surgery
• Diagnostic Imaging

Background:

• Persistent air leaks (PAL) pose a challenge in thoracic surgery.
• Accurate localization of PAL is crucial for effective management.
• The intraoperative water submersion test (iWST) is the current standard but has limitations.

Purpose of the Study:

• To evaluate the utility of technetium-99m Technegas ventilation SPECT/CT (vSPECT) for localizing PAL.
• To assess the accuracy of vSPECT in identifying the site of air leaks.

Main Methods:

• A case series of 20 patients with suspected PAL underwent vSPECT.
• Technegas was administered using a specialized generator.
• SPECT/CT imaging was performed, and results were correlated with intraoperative findings and clinical course.

Main Results:

• vSPECT successfully located PAL in 10/20 cases, confirmed by iWST.
• In 4/20 cases, vSPECT-identified PALs were treated surgically with success, despite lack of iWST confirmation.
• In 4/20 cases, vSPECT-identified PALs were managed conservatively.
• vSPECT correctly identified alternative causes or absence of PAL in 2/20 cases.

Conclusions:

• Technegas vSPECT is a valuable tool for assessing patients with suspected PAL.
• The modality demonstrates high accuracy in localizing air leaks.
• vSPECT aids in guiding both surgical and conservative management strategies.