Comparison of xenon-enhanced area-detector CT and krypton ventilation SPECT/CT for assessment of pulmonary functional loss and disease severity in smokers

OBJECTIVE. The objective of this study was to compare the capability of xenon-enhanced area-detector CT (ADCT) performed with a subtraction technique and coregistered 81mKr-ventilation SPECT/CT for the assessment of pulmonary functional loss and disease severity in smokers. SUBJECTS AND METHODS. Forty-six consecutive smokers (32 men and 14 women; mean age, 67.0 years) underwent prospective unenhanced and xenon-enhanced ADCT, 81mKr-ventilation SPECT/CT, and pulmonary function tests. Disease severity was evaluated according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classifcation. CT-based functional lung volume (FLV), the percentage of wall area to total airway area (WA%), and ventilated FLV on xenon-enhanced ADCT and SPECT/CT were calculated for each smoker. All indexes were correlated with percentage of forced expiratory volume in 1 second (%FEV1) using step-wise regression analyses, and univariate and multivariate logistic regression analyses were performed. In addition, the diagnostic accuracy of the proposed model was compared with that of each radiologic index by means of McNemar analysis. RESULTS. Multivariate logistic regression showed that %FEV1 was signifcantly affected (r = 0.77, r2 = 0.59) by two factors: the frst factor, ventilated FLV on xenon-enhanced ADCT (p < 0.0001); and the second factor, WA% (p = 0.004). Univariate logistic regression analyses indicated that all indexes signifcantly affected GOLD classifcation (p < 0.05). Multivariate logistic regression analyses revealed that ventilated FLV on xenon-enhanced ADCT and CTbased FLV signifcantly influenced GOLD classifcation (p < 0.0001). The diagnostic accuracy of the proposed model was signifcantly higher than that of ventilated FLV on SPECT/CT (p = 0.03) and WA% (p = 0.008). CONCLUSION. Xenon-enhanced ADCT is more effective than 81mKr-ventilation SPECT/CT for the assessment of pulmonary functional loss and disease severity.