Collateral ventilation in a canine model with bronchial obstruction: assessment with xenon-enhanced dual-energy CT.

PURPOSE: To determine the feasibility of the use of xenon-enhanced dynamic dual-energy computed tomography (CT) for visualization and quantitative assessment of collateral ventilation in a canine model with bronchial obstruction. MATERIALS AND METHODS: This study was approved by the institutional animal care and use committee. One segmental bronchus was occluded in nine dogs (weight range, 20-25 kg). Dynamic dual-energy CT scanning was performed by using dual-source CT during the wash-in-washout study of xenon inhalation via mechanical ventilation. Imaging parameters were 14 x 1.2-mm collimation, 40 mAs (effective) at 140 kV and 170 mAs (effective) at 80 kV, pitch of 0.45, and 0.33-second rotation time. By using dual-energy software, CT images and xenon maps were reconstructed. CT attenuation values were measured in the airways proximal to obstruction (AW(PROX)) and airways distal to obstruction (AW(DIST)) and at the parenchyma with patent airways (P(PATE)) and parenchyma with obstructed airways (P(OBST)). CT attenuation values on dynamic xenon maps were plotted with exponential function; ventilation parameters, including velocity of ventilation (K value), magnitude of ventilation (A value), and time of arrival (TOA), were calculated on the basis of the Kety model. RESULTS: In all animals, delayed and weaker xenon enhancement was identified at the airway and parenchyma distal to obstruction. For the A value, in the wash-in study, the differences between AW(PROX) and AW(DIST) and between P(PATE) and P(OBST) were significant (71.80 and 57.64, P = .05; 51.86 and 37.52 HU, P = .02). The K value of P(OBST) was lower than that of P(PATE) in the wash-in study (0.006 and 0 .010, P = .06). Mean and standard deviation for TOA were observed in the following increasing order: AW(PROX) ([3.50 +/- 7.70] x 10(-6) sec), P(PATE) (4.58 +/- 2.83), AW(DIST) (9.20 +/- 6.87), and P(OBST) (21.00 +/- 13.44). CONCLUSION: Collateral ventilation in a canine model with bronchial obstruction can be quantitatively assessed by using xenon-enhanced dynamic dual-energy CT.

Dual-energy CT for assessment of the severity of acute pulmonary embolism: pulmonary perfusion defect score compared with CT angiographic obstruction score and right ventricular/left ventricular diameter ratio.

OBJECTIVE: The purpose of this study was to prospectively evaluate the usefulness of scoring perfusion defects on perfusion images at dual-energy CT for assessment of the severity of pulmonary embolism. SUBJECTS AND METHODS: Thirty patients (13 men, 17 women; mean age, 55 +/- 15 [SD] years; range, 26-81 years) with pulmonary thromboembolism underwent dual-source CT at two voltages (140 and 80 kV). The weighted average image of two acquisitions was used for CT angiograms, and a color-coded iodine image was used for perfusion images. Two thoracic radiologists with 15 and 6 years of clinical experience independently assigned perfusion defect scores to perfusion images and both a CT angiographic (CTA) obstruction score and right ventricular-to-left ventricular (RV/LV) diameter ratio to CT angiograms. The CTA obstruction score was based on the Qanadli method. The perfusion defect score was defined as Sigma (n . d) / 40 x 100, where n is the number of segments and d is the degree of perfusion from 0 to 2. Correlations between perfusion defect score, CTA obstruction score, and RV/LV diameter ratio were evaluated. Agreement between perfusion defect score and CTA score was assessed per patient and per segment. Interobserver agreement regarding perfusion defect and CTA obstruction scores was analyzed. RESULTS: Perfusion defect and CTA obstruction scores had good correlation with RV/LV diameter ratio (r = 0.69, r = 0.66; all p < 0.001). Per patient, correlation between perfusion defect score and CTA obstruction score also was good (reader 1, r = 0.87; reader 2, r = 0.85; all p < 0.001). Per segment, moderate agreement was found between perfusion defect score and CTA obstruction score (reader 1, kappa = 0.56; reader 2, kappa = 0.51; all p < 0.05). Both readers were in strong agreement on perfusion defect score and CTA obstruction score. CONCLUSION: The proposed perfusion defect score had good correlation with RV/LV diameter ratio and CTA obstruction score. Therefore, acquisition of perfusion images at dual-energy CT may be helpful for assessing the severity of acute pulmonary embolism.