A new approach to reproducible measurement of lung attenuation and structure by means of respiratory-gated computed tomography (CT) was developed. The patient breathes through a microcomputer-controlled pocket spirometer during the complete CT examination, starting with a measurement of the vital capacity. At a user-selected respiratory level, the CT scan is triggered and air flow is inhibited mechanically. To exclude operator-related reproducibility errors, evaluation is based on semiautomated algorithms that isolate lung parenchyma by fast contour tracing. In a study on one volunteer, measurement of lung attenuation changed by a factor of about 2.6 (-895 to -730 HU) as a function of inspirational status. Reproducibility on the order of 5% or better can be achieved only with tight spirometric control of respiration.

Institutional review board approval and informed consent were obtained for this study. The aim of the study was to prospectively assess, in patients with lung cancer, the reproducibility of a quantitative whole tumor perfusion computed tomographic (CT) technique. Paired CT studies were performed in 10 patients (eight men, two women; mean age, 66 years) with lung cancer. Whole tumor permeability and blood volume were measured, and reproducibility was evaluated by using Bland-Altman statistics. Coefficient of variation of 9.49% for permeability and 26.31% for blood volume and inter- and intraobserver variability ranging between 3.30% and 6.34% indicate reliable assessment with this whole tumor technique.

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Our results show that an improvement in tumor perfusion measurement reproducibility may be achieved with greater z-axis coverage.