Ventilation SPECT/CT-guided air leak management: improving precision in a long-standing surgical challenge

Objectives Prolonged air leak (PAL) remains a significant surgical challenge after pulmonary resections and secondary spontaneous pneumothorax. Ventilation single-photon emission computed tomography combined with computed tomography (vSPECT/CT) has emerged as a promising tool for air leak localization. This study evaluates the impact of preoperative vSPECT/CT on surgical management of PAL. Methods This single-center study compared a prospectively enrolled vSPECT/CT cohort (February 2021–December 2025) with retrospective historical controls (January 2015–January 2021). Propensity score matching generated two matched groups: with and without vSPECT/CT. Primary outcome was vSPECT/CT accuracy in detecting air leaks; secondary outcomes included chest tube duration, persistent PAL, reoperation rates, and hospital stay. Wilcoxon signed-rank and McNemar tests were used for comparisons. Results A total of 122 patients were included (52 vSPECT/CT; 70 non-vSPECT/CT). vSPECT/CT showed a 95.3% concordance with intraoperative air leak localization. After matching, 86 patients (43 per group) were analyzed. The vSPECT/CT group had shorter chest tube duration (median 2 vs. 4 days; P = 0.01) and hospital stay (median 3 vs. 5 days; P = 0.036). Rates of persistent PAL and reoperation were similar between groups ( P = 0.057 and P = 0.375, respectively). Conclusion In this prospectively enrolled cohort, preoperative vSPECT/CT reliably localizes PAL, enabling focused surgical intervention and supporting more efficient postoperative recovery. Its use is associated with shorter chest tube duration and hospital stay, highlighting its value as a preoperative tool in the management of PAL.