Development of Quantitative Norms for Normal Lung Uptake Based on Three-Dimensional Gallium-67 Single Photon Emission Computed Tomography/Computed Tomography

Abstract Purpose Gallium-67 (Ga-67) lung scans assess alveolitis and interstitial lung disease, with Ga-67 accumulation correlating with inflammation intensity as seen in lung biopsy sections. Both semi-quantitative and quantitative methods have been used, with the latter providing an inflammatory activity index linked to lung lavage and histopathological scores. However, differing reference points result in varying outcomes. This study aimed to establish standard Ga-67 index parameters using semi-quantitative analysis and a linear regression model based on planar and SPECT/CT images. Methods Twenty subjects without lung disease received a 5–6 mCi Ga-67 injection via the ankle. Both planar and SPECT/CT images were analyzed, with semi-quantitative values assessed using GraphPad Prism 9.5.1. Results Compared to planar images, SPECT/CT acquisitions for the lung-to-arm uptake ratio proved the most reliable indicator for assessing lung inflammation. Increased lung Ga-67 uptake was defined as greater than 2 standard deviations from the average Ga-67 uptake for healthy subjects. The normal range was 0.065 ± 0.049 for the right side and 0.076 ± 0.070 for the left side. Conclusion Lung-to-arm ratios in SPECT/CT images are more accurate than those in planar images. This method should be adopted as a standard clinical practice, providing more reliable diagnostic information and improving patient management. Future studies should compare patients without lung disease to those with lung disease to determine the diagnostic benefit of these norms.