Respiratory research · 2025
Dual-energy computed tomography derived pulmonary blood volume: association with pulmonary blood flow.
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Wittenstein Jakob, Apolle Rudi, Scharffenberg Martin, Rothmann Carolin, Müller Sabine, Hoffmann Ralf-Thorsten, Troost Esther G C, Koch Thea, Gama de Abreu Marcelo, Huhle Robert
Аннотация
BACKGROUND: Distribution of ventilation and pulmonary perfusion are the major determinants of pulmonary gas exchange. To study and compare strategies of mechanical ventilation in respiratory research accurate and high-resolution methods are needed to derive distribution of ventilation and perfusion with minimal additional intervention or radiation allowing repeated measurements. Dual-energy computed tomography (DECT) is an imaging technique allowing for the derivation of regional pulmonary perfused blood volume, as a surrogate for pulmonary perfusion (PPDECT). Here accuracy of PPDECT is evaluated in comparison to pulmonary blood flow measured with fluorescence-labeled microspheres (PPFLM). Its feasibility of repeated measurements is evaluated.
METHODS: Agreement between PPFLM and PPDECT was assessed by regression as well as Bland-Altman analysis in three anesthetized pigs using DECT and fluorescence labelled microspheres, respectively. Measurements were performed in two-lung and, after right sided thoracotomy, at one-lung ventilation with inhaled nitric oxide. PPFLM and PPDECT were assessed in three different regions of interest (ROI): the right (non-ventilated) and left (ventilated) upper and lower lung, yielding a total of 45 paired measurements over four hours. Persistent iodine accumulation was assessed by additional DECT scans before each contrast administration.
RESULTS: Regression analysis revealed a good overall association (R2 = 0.81) between PPFLM and PPDECT, with PPDECT substantially overestimating PPFLM up to 30%, with limits of agreement of -18 and 18%, Low PPFLM was underestimated, while high PPFLM was overestimated by PPDECT, indicating a higher sensitivity of the later. Changes of PPDECT and PPFLM had a concordance of 69.4% for all measurements. Agreement and concordance were highest in ventilated and lowest in non-ventilated ROIs. No persistent iodine enhancement was detected in the lung parenchyma after repetitive measurements per hour.
CONCLUSIONS: Dual-energy CT based measurement of pulmonary perfusion shows promising results indicating its feasibility in translational research on strategies of mechanical ventilation.
METHODS: Agreement between PPFLM and PPDECT was assessed by regression as well as Bland-Altman analysis in three anesthetized pigs using DECT and fluorescence labelled microspheres, respectively. Measurements were performed in two-lung and, after right sided thoracotomy, at one-lung ventilation with inhaled nitric oxide. PPFLM and PPDECT were assessed in three different regions of interest (ROI): the right (non-ventilated) and left (ventilated) upper and lower lung, yielding a total of 45 paired measurements over four hours. Persistent iodine accumulation was assessed by additional DECT scans before each contrast administration.
RESULTS: Regression analysis revealed a good overall association (R2 = 0.81) between PPFLM and PPDECT, with PPDECT substantially overestimating PPFLM up to 30%, with limits of agreement of -18 and 18%, Low PPFLM was underestimated, while high PPFLM was overestimated by PPDECT, indicating a higher sensitivity of the later. Changes of PPDECT and PPFLM had a concordance of 69.4% for all measurements. Agreement and concordance were highest in ventilated and lowest in non-ventilated ROIs. No persistent iodine enhancement was detected in the lung parenchyma after repetitive measurements per hour.
CONCLUSIONS: Dual-energy CT based measurement of pulmonary perfusion shows promising results indicating its feasibility in translational research on strategies of mechanical ventilation.