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New ¹³³Xe Gas Trapping Index for Quantifying Severe Emphysema Before Partial Lung Volume Reduction

¹ Nuclear Medicine, Department of Radiology, Temple University School of Medicine and Hospital, Philadelphia, Pennsylvania; ² Section of Pulmonary Medicine, Department of Medicine, Temple University School of Medicine and Hospital, Philadelphia, Pennsylvania; ³ Biostatistics Consulting Center, Temple University School of Medicine and Hospital, Philadelphia, Pennsylvania; and ⁴ Center for Cardiovascular and Pulmonary Research, Vancouver General Hospital, Vancouver, British Columbia, Canada

View larger version (134K): [in this window] [in a new window]   FIGURE 1.  (A) Selected transaxial CT images in upper, middle, and lower lung zones. These were graded with NETT scores of 4 for extensive emphysema involvement in bilateral upper and middle lung zones, with sparing of lung bases. (B) Coronal reformatted CT image with left and right inverted to match posterior 133Xe images in C. (C) 133Xe images illustrate washin phase (frames 1–4), equilibrium phase (frames 5–10), and washout phase (frames 11–16). Good agreement is seen in areas of gas trapping in washout images in right upper (GTI, 0.54) and middle (GTI, 0.40) lung zones, with areas of low density in CT coronal image. 133Xe study, however, showed more severe gas trapping in right than in left upper (GTI, 0.24) and left middle (GTI, 0.23) lung zones.

View larger version (148K): [in this window] [in a new window]   FIGURE 2.  (A) Selected transaxial CT images in upper, middle, and lower lung zones. These were graded with NETT scores of 4 for extensive emphysema involvement in bilateral upper and middle lung zones, with sparing of lung bases. (B) Coronal reformatted CT image with left and right inverted to match posterior 133Xe images in C. (C) 133Xe images illustrate washin phase (frames 1–4), equilibrium phase (frames 5–10), and washout phase (frames 11–16). Visual NETT CT scoring was 2 in all lung zones and interpreted as bilaterally symmetric. 133Xe washout images show, however, asymmetric gas trapping, which is focal in the left upper lung zone (GTI = 0.19) and the right middle (GTI = 0.20) and the right lower (GTI = 0.22) lung zones.