BACKGROUND: In patients being considered for lung-resection surgery, quantitative perfusion scintigraphy is used to predict postoperative lung function and guide the determination of lung-resection candidacy. Vibration-response imaging has been proposed as a noninvasive, radiation-free, and simpler method to predict postoperative lung function. We compared vibration-response imaging to quantitative perfusion scintigraphy for predicting postoperative FEV1 and diffusing capacity of the lung for carbon monoxide (D-LCO). METHODS: We enrolled 35 candidates for lung resection. Twenty-five patients had preoperative FEV1 and D-LCO measurements. RESULTS: The vibration-response-imaging measurements showed strong correlation with the quantitative-perfusion-scintigraphy measurements of predicted postoperative FEV1 % (r = 0.87, P < .001), predicted postoperative FEV1 (r = 0.90, P < .001), and predicted postoperative D-LCO% (r = 0.90, P < .001). There was a correlation between predicted postoperative FEV1 (To and L) measured via quantitative perfusion scintigraphy and the actual postoperative FEV1 (% and L) (r = 0.47, P = .048, r = 0.73, P < .001). There was no difference between the vibration-response-imaging measurements and the actual postoperative measurements of predicted postoperative FEV1 (% and L). There was a correlation between predicted postoperative FEV1 (% and L) measured via vibration-response imaging and actual postoperative FEV1 (% and L) (r = 0.52, P = .044, r = 0.79, P < .001). The mean differences between the predicted and actual postoperative FEY, values were 49 mL with vibration-response imaging, versus 230 mL with quantitative perfusion scintigraphy. Neither the vibration-response imaging nor the quantitative perfusion scintigraphy predicted postoperative D-LCO% values agreed with the actual postoperative D-LCO% values. CONCLUSIONS: Vibration-response imaging may be a good alternative to quantitative perfusion scintigraphy in evaluating lung-resection candidacy.