Validation of 4D Computed Tomography (4D-CT) to Evaluate Fractional Regional Ventilation Against the Clinical Gold-Standard Scintigraphy V/Q
T Diwanji*, S Feigenberg, W D'Souza, N Mistry, University of Maryland School of Medicine, Baltimore, MDTH-E-217BCD-11 Thursday 1:00:00 PM - 2:50:00 PM Room: 217BCD
Purpose: To validate the use of 4D-Computed Tomography (4D-CT) for pre-treatment evaluation of fractional regional ventilation in patients with lung cancer by benchmarking its performance against scintigraphy V/Q imaging, the current gold-standard. The second aim is to further corroborate the results of 4D-CT estimation of lung aeration against the results of Pulmonary Function Testing.
Methods: Scintigraphy V/Q and 4D-CT studies were acquired in four lung cancer patients prior to treatment with radiation therapy. PFTs were acquired in 3 out of the 4 patients. 4D-CT images were used to create 3D fractional regional ventilation maps by applying a 'mass correction' and subtracting the spatially matched end-exhale and end-inhale images. Ventilation maps were then collapsed in the anterior-posterior dimension to create a coronal 2D projection image consistent with the scintigraphy V/Q images. The left and right lung fields were isolated on the projection image and divided into 3 sections of equal height. Summation of the signal intensity in each of the sections was carried out on the maps analogous to the analysis performed on V/Q scans and statistically compared using the Kendall's tau rank correlation.
Results: The non-parametric Kendall's tau estimate ranged between 0.87-0.95 for N=4, with corresponding p-values ranging between 0.005-0.0002. Mean functional residual capacities (FRC) from the PFTs (N=3) versus calculated FRCs was 2.7 +/- 0.6 L and 2.4 +/- 0.7 L, and the null hypothesis could not be rejected (p = 0.61). The mean fractional regional ventilation versus the ratio of tidal-volume/FRC was 0.24 +/- 0.11 and 0.22 +/- 0.08, and the null hypothesis could not be rejected (p=0.73).
Conclusions: There was a strong correlation between 4D-CT and scintigraphy V/Q. The similarity between the calculated and measured FRCs further validates the utility of 4D-CT and supports its use in evaluating lung ventilation in patients with pulmonary neoplasms.