Comparison of 133Xenon Ventilation Equilibrium Scan (XV) and 99mTechnetium Transmission (TT) Scan for Use in Regional Lung Analysis by 2D Gamma Scintigraphy in Healthy and Cystic Fibrosis Lungs

Background: Quantification of particle deposition in the lung by gamma scintigraphy requires a reference image for location of regions of interest (ROIs) and normalization to lung thickness. In various laboratories, the reference image is made by a transmission scan (Co-57 or (99)mTc) or gas ventilation scan (Xe-133 or Kr-81). There has not been a direct comparison of measures from the two methods. Methods: We compared Tc-99m transmission scans to Xe-133 equilibrium ventilation scans as reference images for 38 healthy subjects and 14 cystic fibrosis (CF) patients for their effects on measures of regional particle deposition: the central-to-peripheral ratio of lung counts (C/P); and ROI area versus forced vital capacity. Whole right lung ROI was based on either an isocontour threshold of three times the soft tissue transmission (TT) or a threshold of 20% of peak xenon ventilation counts (XV). We used a central ROI drawn to 50% of height and of width of the whole right lung ROI and placed along the left lung margin and centered vertically. Results: In general, the correlation of normalized C/P (nC/P) between the two methods was strong. However, the value of nC/P was significantly smaller for the XV method than the TT method. Regression equations for the relationship of nC/P between the two methods were, for healthy subjects, y=0.75x + 0.61, R-2=0.64 using rectangular ROIs and y=0.76x + 0.45, R-2=0.66 using isocontour ROIs; and for CF patients, y=0.94x + 0.46, R-2=0.43 and y=0.85x + 0.42, R-2=0.41, respectively. Conclusions: (1) A transmission scan with an isocontour outline in combination with a rectangular central region to define the lung borders may be more useful than a ventilation scan. (2) Close correlation of nC/Ps measured by transmission or gas ventilation should allow confident comparison of values determined by the two methods.