European Journal of Radiology 78 (2011) 266–271

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European Journal of Radiology

journal homepage: www.elsevier.com/locate/ejrad

Dual energy CT ventilation imaging after aerosol inhalation of iodinated contrast

medium in rabbits
Long-Jiang Zhang a , Zhen Jane Wang b , Li Lu a , Ke Zhu a , Xue Chai a , Yan E. Zhao a ,
Jin Peng a , Guang-Ming Lu a,∗
a
Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road,
Xuanwu District, Nanjing, Jiangsu 210002, China
b
Department of Radiology, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States

a r t i c l e i n f o a b s t r a c t

Article history: Purpose: To assess the feasibility of dual energy CT (DECT) after aerosol inhalation of iodinated contrast
Received 20 July 2010 medium for the evaluation of ventilation function in rabbits with airway obstruction.
Received in revised form 11 October 2010 Materials and methods: The study was approved by our institutional animal experimental committee
Accepted 20 October 2010
and performed according to animal care guidelines. Airway obstruction was created by injecting gelatin
sponge into the right bronchus of 6 New Zealand rabbits. One additional rabbit served as control with-
Keywords:
out airway obstruction. All 7 rabbits then underwent inhalation of aerosol iodinated contrast medium
Dual energy CT
for 5 min, followed by DECT of the lungs from which ventilation CT images were created. CT number
Airway obstruction
Ventilation imaging
and overlay value (calculated iodine enhancement on the ventilation images in hounsfield unit) of the
Aerosolised iodinated contrast media obstructed and non-obstructed lung lobes were measured at 80-kVp, 140-kVp, and weighted average
120-kVp. Immediately after DECT scan, the rabbits were sacrificed, the lungs were removed and detailed
pathological examination of the locations and parenchymal changes of the obstructed lung lobes were
performed and correlated with DECT ventilation imaging findings.
Results: Data from one rabbit with airway obstruction were excluded because of post-procedure
pneumatothorax. Seventeen normal lung lobes without airway obstruction proven by histopathology
had nearly homogeneous ventilation, while 13 abnormal lung lobes had ventilation defects on DECT
ventilation images. CT numbers and overlay values of the normal (CT number, −737.77 ± 71.46 HU,
−768.84 ± 73.86 HU, −731.86 ± 65.92 HU for 140-kVp, 80-kVp, and weighted average 120-kVp;
overlay value, 46.58 ± 19.49 HU) and abnormal lung lobes (CT number, −183.58 ± 173.37 HU,
−124.93 ± 242.23 HU, −166.07 ± 191.57 HU for 140-kVp, 80-kVp, and weighted average 120-kVp; overlay
value, 0.00 ± 0.00 HU) were significantly different at 80-kVp, 140-kVp, and weighted average 120-kVp
(P < 0.001 for all). Diffuse hemorrhage, inflammatory cell infiltration, and exudation were observed at
histopathology in the obstructed lung lobes.
Conclusions: It is feasible to study regional lung ventilation function using DECT after aerosol inhalation
of iodinated contrast medium in rabbit. The safety of inhalation of iodine contrast medium is unknown,
and has to be investigated further before use of this new method in humans.
© 2010 Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Evaluation of regional lung ventilation function is important in
localizing the areas of pathology in the lungs. However, current
methods for the evaluation of regional ventilation function are lim-
ited. The widely available pulmonary function tests provide global
measurements of airflow, lung volumes, and gas exchange, but can-
not directly measure regional changes in ventilation. Radionuclide
scintigraphy, oxygen-enhanced, 3 He, and 129 Xenon MR imaging are
∗ Corresponding author.
E-mail address: guangminglu66@yahoo.com.cn (G.-M. Lu).
used for pulmonary functional imaging, but they are limited by
their spatial resolution with poor morphological information [1,2].
Multidetector CT provides high resolution morphological informa-
tion and is the first-line choice for the evaluation of lung diseases.
Additionally, multidetector CT has the potential for assessing pul-
monary function. For example, several previous studies have shown
that xenon inhalation CT (xenon-enhanced CT) can be used to depict
lung ventilation both in animals and in human [3–10]. However,
xenon causes respiratory depression and is not widely available,
and therefore xenon-enhanced CT for ventilation imaging remains
a research tool.
Dual source CT, with two orthogonally mounted detectors and
tube arrays operating simultaneously and setting to different tube

0720-048X/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.ejrad.2010.10.029
 L.-J. Zhang et al. / European Journal of Radiology 78 (2011) 266–271
potentials, allows for dual energy CT (DECT) acquisitions with min-
imal patient motion registration artifact. One tube can be set at a
peak tube voltage of 80-kVp, and the other at 140-kVp, and the
resultant datasets can be reformatted using the dedicated Singo
Dual Energy software to extract maps of contrast material con-
tent. DECT opens new horizons for dual energy contrast-enhanced
applications. Iodine extraction technique with DECT has been used
to investigate pulmonary perfusion [11–15], myocardial ischemia
[16,17], vascular diseases [18,19], endoleak after endovascular
abdominal aortic aneurysm repair [20,21], and characterization of
solitary pulmonary nodules [22].
Iodine-enhanced CT ventilation imaging has been reported in
one healthy volunteer after inhalation of Isovist-300 in 1995, in
which the author found CT numbers of lung increased by 60–80 HU
5–6 min after inhalation of Isovist-300 [23]. However, this tech-
nique has not been widely used, to the best of our knowledge. We
hypothesize that the iodine extraction technique with dual energy
CT can potentially be used to depict iodine distribution in normal
and diseased lung tissues after aerosol inhalation of iodinated con-
trast medium to assess pulmonary ventilation. The purpose of this
study was to evaluate the feasibility of iodine-enhanced DECT to
assess ventilation following aerosol inhalation of iodinated con-
trast medium in rabbits with airway obstruction and to correlate
iodine-enhanced DECT ventilation imaging with histopathological
findings.
2. Materials and methods
All the authors who are not employees of Siemens Medical Solu-
tions (Forchheim, Germany) controlled the data in this manuscript.
2.1. Animal model
The study protocol was approved by our institutional animal
experimental committee and performed according to the local ani-
mal care guidelines. A total of 7 New Zealand white rabbits with
an average body weight of 2.5 kg were used in this study. Ani-
mals were anaesthetised with 44 mg/kg of ketamine hydrochloride
(Hengrui Medical, Inc., Nanjing, Jiangsu, China). Airway obstruc-
tion was created in 6 rabbits by injecting 1–2 gelatin sponge plugs
(size: 2 mm × 2 mm × 10 mm) into right bronchus via 4 or 3-French
catheter placed under fluoroscopic guidance (INNOVA 3100, GE
Healthcare, Waukesha, WI, USA) through tracheotomy site. In one
of the 6 rabbits, 2 ml of iodinated contrast medium was injected
via the trachea catheter to determine the location of the plugs; the
remaining 5 rabbits received 1–2 ml saline rather than iodinated
contrast medium injection to distend the gelatine sponges follow-
ing injection of sponge plugs into the right bronchus. Gelatin sponge
was chosen as an embolic material in this study because of their
wide availability, simple preparation, rapid distension resulting in
acute occlusion, and no beam-hardening artifacts. One additional
rabbit underwent tracheotomy but without injection of gelatin
sponge plugs into right bronchus, this rabbit served as a control. All
procedures were performed by one interventional radiologist (K.Z.,
with a two-year experience of small animal intervention), who was
not involved in CT and histopathological evaluation.
2.2. Imaging protocols
All CT examinations were performed using DSCT (Somatom
Definition, Siemens AG, Medical Solutions, Forchheim, Germany).
Baseline CT of the chest was first performed to exclude any pul-
monary lesions in the 7 rabbits. The following CT settings were
used for the baseline scan: detector collimation of 32 mm × 0.6 mm,
gantry rotation time of 0.33 s, pitch 1.4, tube current 6 mA s, peak
tube voltages of 120-kVp, and imaging time of 2–3 s. Weighted dose
267
index (CTDIvol × pitch) was 0.4–0.8 mGy. Airway obstruction was
then created in 6 of the 7 rabbits using gelatine plugs following tra-
cheotomy as described above. The rabbits were transferred to the
CT unit immediately upon completion of the gelatine plug injec-
tion. The rabbits were placed centrally in the scanner to ensure
that the entire thorax was covered by the field-of-view (FOV) of
both the larger and the smaller tube detector arrays. The size of
the FOV of the second tube detector array is 260 mm. Ultravist
(300 mg I/ml, Bayer Schering Pharma, Berlin, Germany) was pul-
verized by an ultrasonic nebulizer (402A, Shanghai Yuyue Medical
treatment facility Co., Ltd., Shanghai, China) as an inhaled contrast
medium with 1:1 ratio of Ultravist and saline to maintain enough
aerosol iodine contents. The particle size of aerosol iodinated con-
trast medium was about 0.5–5.0 ␮m. The rabbits’ tracheotomy site
was connected to the ultrasonic nebulizer via extension tubes.
Iodine-enhanced DECT ventilation imaging was performed 5 min
after the initiation of the aerosol inhalation of iodinated contrast
medium in both the 6 rabbits with airway obstruction and the
1 control rabbit. The aerosol iodinated contrast medium inhala-
tion lasted throughout the DECT ventilation scan. The following CT
parameters were used for the DECT ventilation scan: tube voltages
of 80-kVp and 140-kVp and tube currents of 213 mA and 51 mA for
the larger and smaller X-ray tubes, respectively; gantry rotation
time of 0.33 s, detector collimation of 14 mm × 1.2 mm, pitch 0.5,
field of view 260 mm, scan time was about 3–4 s. Weighted dose
index (CTDIvol × pitch) was 0.5–0.8 mGy.
2.3. Image reconstruction and analysis
From the raw spiral projection data of both detectors, images
were automatically reconstructed into three image datasets (80-
kVp, 140-kVp, and 120-kVp weighted images which were fused
images with 30% density information from the 80-kVp image and
70% from the 140-kVp image) with slice thickness of 0.75 mm and
intervals of 0.50 mm. Then, all images were transferred to a com-
mercially available workstation (Syngommvvp VE23A, Siemens AG,
Medical Solutions, Forchheim, Germany) to obtain multiplanar lung
CT images in the axial, coronal and sagittal planes with slice thick-
ness of 2 mm and interval of 1 mm to show any morphological
changes in the lungs. Ventilation images were obtained using a
modified prototype of the Lung PBV application class of Syngo
Dual Energy (Siemens Medical Solutions), which was based on the
material decomposition theory [24]. The material parameters were
adjusted as follows: −1000 HU for air at 80-kVp; −1000 HU for air
at 140-kVp; 60 HU for soft tissue at 80-kVp; 54 HU for soft tis-
sue at 140-kVp; 1.5 for relative contrast material enhancement;
minimum value, −960 HU; maximum value, −400 HU; and 4 for
range. Pixels with densities outside of this range (below −960 HU
and above −400 HU) are set to 0 HU at DECT ventilation images.
We used grey scale 16 bit and Hot body 16 bit to show pulmonary
DECT ventilation imaging, including 100% of ventilation images and
fused images (50% of CT anatomical images and 50% of ventilation
images).
All images were evaluated in consensus by two radiologists
(L.J.Z. and X.C., with 8 and 2 years of experience in chest CT inter-
pretation, respectively) who were unaware of the histopathological
findings. For each of the 7 rabbits, both the morphological changes
and the ventilation images were assessed for each of the 5 lung
lobes (right upper, middle and lower lobe, and left upper and lower
lobes). The locations and numbers of abnormal and normal lung
lobes on the ventilation and conventional CT images were recorded.
A radiologist (L.J.Z., with 8 years’ experience of chest CT interpre-
tation) placed circular region of interest (ROI) in the abnormal
and normal lung lobes demonstrated by histopathology. On two
different axial CT images obtained 5 min after aerosol inhalation
of iodinated contrast medium, CT numbers (HU) of the abnormal
268 L.-J. Zhang et al. / European Journal of Radiology 78 (2011) 266–271

Fig. 1. Dual energy CT ventilation images in one rabbit (rabbit #6) with airway obstruction. (a) Axial, (b) coronal, and (c) sagittal ventilation images show the ventilation
defects in the right upper and lower lobes and left upper lobes (arrows), corresponding lung window CT images (d–f) which demonstrated patchy opacity of the right
upper and lower lobes and left upper lobes (arrows). (g) Gross specimen shows the surface discolouration of right upper and lower lobes and left upper lobes (arrows). (h)
Pathological photo shows the sponge gelatin in the bronchus (arrow) and diffuse hemorrhage in the alveolus of obstructed lung lobe (H&E staining, 200×).

and normal lung lobes were measured using copy-and-paste func-
tion in order to maintain similar ROIs size at 80-kVp, 140-kVp,
and weighted average 120-kVp. For the iodine maps, the “overlay
value”, which is a DECT measure of iodine concentration on iodine
maps developed by Siemens, was measured three times to quan-
tify iodine contents in the normal and abnormal lung lobes using
similar size (0.1 cm2 ) ROIs as those on the conventional CT images.
The results were averaged as a final measurement of overlay value.
2.4. Pathological analysis
Pathological analysis served as the standard of reference in this
study. After DECT ventilation imaging, animals were sacrificed by
an overdose of pentobarbital via ear marginal vein. The lungs and
heart were subsequently removed en bloc and fixed in 10% for-
malin. Serial axial sectioning at 1 mm intervals was performed 2–5
days after fixation. Haematoxylin and eosin staining was performed
to confirm the presence of gelatin sponge within the bronchus.
Histopathological findings of the presence or absence of airway
obstruction were correlated with findings on the CT images used to
assess lung morphology and on the ventilation CT images. Corre-
sponding CT and histopathological images were analyzed on a per
lung lobe basis for each rabbit.
2.5. Statistical analysis
Statistical analysis was performed using software SPSS ver-
sion 11.5 (SPSS, Inc., Chicago, IL, USA). Quantitative variables were
expressed as mean ± SD and categorical variables as frequencies or
percentages. A two independent sample t test was used to analyze
the differences in CT number and overlay value between the abnor-
mal and normal lung regions at 80-kVp, 140-kVp, weighted average
120-kVp images used to assess lung morphology, and on the DECT
ventilation images. One-way ANOVA test was used to compare the
differences in CT numbers between the abnormal and normal lung
regions among three sets of different kilovoltage images. Box plots
were used to graphically compare the medians, upper extremes,
lower extremes, upper quartiles and lower quartiles of CT number
and overlay value between the abnormal and normal lung regions
at 80-kVp, 140-kVp, weighted average 120-kVp, and DECT ventila-
 L.-J. Zhang et al. / European Journal of Radiology 78 (2011) 266–271 269

Fig. 2. Dual energy CT ventilation images in one rabbit (rabbit #7) with airway obstruction. (a) Axial, (b) coronal, and (c) sagittal ventilation images overlaying on the anatomical
images and (d) axial, (e) coronal, and (f) sagittal ventilation functional images show the ventilation defects in the bilateral multiple lung lobes (arrows), corresponding to
findings on lung window CT images (g–i) showing patchy opacity of the right upper and lower lobes and left upper lobes (arrows).

tion images. P values less than 0.05 were regarded as statistically
significant.
3. Results
One rabbit that had gelatine sponge injection into the airway
was excluded from the data analysis because of post-procedure
pneumothorax. The histological specimen showed discolouration
of the lung surface in 13 obstructed abnormal lung lobes, while
17 normal lung lobes showed homogeneous pink colour on the
lung surface. Pathological photos showed the presence of gelatine
sponge in the bronchus, and diffuse hemorrhage, inflammatory cell
infiltration, and exudation in the obstructed lung lobes.
On the CT ventilation images following iodine inhalation, nor-
mal ventilation was defined as homogeneous iodine distribution
that is colour coded brown, while ventilation defects was defined
as lobar or segmental diminished or absent iodine distribution that
is colour-coded black. Seventeen normal lung lobes demonstrated
by histopathology showed nearly homogeneous ventilation, while
13 obstructed lung lobes showed ventilation defects on the DECT
ventilation images (Figs. 1 and 2). Three abnormal lung lobes with
patchy ventilation defects or opacities in the lungs without airway
obstruction were also observed on iodine-enhanced DECT venti-
lation imaging and thin section CT images. Findings on the DECT
ventilation images had a 100% concordance with the morphologi-
cal changes in the lung parenchyma on the thin-section CT images
and with histopathological findings (Figs. 1 and 2).
Quantitative analysis showed no significant difference in
CT numbers of normal lung tissue among three sets of kVp
images (−737.77 ± 71.46 HU [95% CI, −788.89 to −686.65; range,
−831.8 to −636.50 HU] for 140-kVp, −768.84 ± 73.86 HU [95% CI,
−821.68 to −716.00; range, −863.10 to −624.40 HU] for 80-kVp,
−731.86 ± 65.92 HU [95% CI, −779.01 to −684.71; range, −826.20
to −633.40 HU] for weighted average120 kVp, P > 0.05 for all). No
significant difference was found for CT numbers of abnormal
lung tissue among three sets of kVp images (−183.58 ± 173.37 HU
[95% CI, −307.60 to −59.56; range, −480.20–141.20 HU] for
80 kVp, −124.93 ± 242.23 HU [95% CI, −298.21 to −48.35; range,
−473.20–309.80 HU] for 140 kVp, −166.07 ± 191.57 HU [95% CI,
−303.11 to −29.02; range, −478.60–185.60 HU] for weighted aver-
age 120-kVp; P > 0.05 for all) (Fig. 3A). However, at any kVp,
significant difference was found for CT numbers between normal
270 L.-J. Zhang et al. / European Journal of Radiology 78 (2011) 266–271
Fig. 3. Quantitative analysis of CT number and overlay values in the abnormal and normal lung lobes. (a) There are no difference for CT numbers of the normal and abnormal
lung tissues at 140-kVp, 80-kVp, and weighted average 120-kVp; but CT numbers of the abnormal lung tissues were higher than those of the normal lung lobes. (b) Overlay
value of the normal lung tissue was higher than that of the abnormal lung tissue, which was zero when −400 HU maximum threshold value was used in the lung PBV software.
and abnormal lung tissue (all P < 0.001) (Fig. 3A). Normal lung tissue
had higher overlay values (46.58 ± 19.49 HU) than abnormal lung
tissue (0.00 ± 0.00 HU) (Fig. 3B) when a threshold of −400 HU was
used in the lung PBV software, indicating high iodine trapping in
airspace of the normal lung tissue.
4. Discussion
Our study demonstrated that it is feasible to study pulmonary
ventilation using DECT after aerosol inhalation of iodinated con-
trast medium in rabbit. Ventilation defects visualized on DECT
ventilation images matched well to the morphological findings on
thin-section CT images and to the histopathological findings. We
also showed quantitatively that the CT number and overlay value
were significantly different between the obstructed abnormal lung
lobes and the normal lung lobes. To the best of our knowledge, this
is the first study to investigate lung ventilation function using dual-
source DE CT technique with inhaled iodine as a contrast agent.
Xenon gas has been used to investigate lung ventilation with
single- and dual-source dual energy CT technique in previous stud-
ies [3–10]. The study by Chae and co-workers showed that xenon
component could be extracted without any influence from lung
volume with use of a DECT technique, and regional ventilation dis-
played at DECT exactly match to the thin-section CT images [9].
However, xenon-enhanced ventilation CT is limited by high radia-
tion dose to the patients and adverse effects including, respiratory
depression (prevalence of 3.5%), somnolence, headache, nausea,
lightheadedness, and labile emotion [9,10,25–27]. In addition, spe-
cial equipment is needed to transfer the xenon to the patients,
and xenon is not widely available in most hospitals. Thus, xenon
ventilation CT imaging is only used as a research tool.
Iodine, with similar high atomic numbers (Z = 53) as xenon
(Z = 54), is a readily available and easy to use contrast medium. Our
study demonstrated that iodine distribution in the lungs follow-
ing aerosol inhalation can be extracted with the DECT technique,
thereby allowing regional lung ventilation evaluation. Compared
to single source CT which cannot always detect low level con-
trast medium, DECT allows the depiction and quantification of
contrast medium at very low level via contrast agent absorptiomet-
ric characteristics [25]. With this technique, it is possible to detect
functional alterations in the absence of morphological abnormali-
ties on single-energy CT scans.
In this study, we observed patchy ventilation defects on the
ventilation images in three left lung lobes without airway obstruc-
tion. We speculate that this may be a result of saline refluxing into
the left bronchus when the gelatin sponge was injected into the
right bronchus. In addition, we noted gravity-induced lung venti-
lation in two rabbits with increased ventilation in the dependent
location, which can be associated with scan position. This is in
agreement with previous xenon-enhanced CT study which demon-
strated increased ventilation in the dependent location [6].
Iodine-enhanced DECT ventilation imaging has multiple poten-
tial advantages. These include wide availability of CT which is
commonly used for evaluation of lung disease [3–8], simultaneous
visualization of high spatial resolution anatomical and ventilation
information provided by DECT compared with ventilation scintig-
raphy [13] and MR ventilation imaging [1,2], lower costs compared
with xenon-enhanced CT ventilation imaging and 129 Xe or 3 He
ventilation MR imaging, and ease of performing iodine-enhanced
DECT ventilation imaging compared with other ventilation imaging
modalities. However, these above-mentioned advantages and the
safety of aerosol inhalation of iodinated contrast medium needs to
be validated in human subjects in future studies.
Our study has some limitations. First, because 1–2 ml saline is
necessary to deliver the gelatin sponge into right bronchus, it is
possible that this may cause alveolar damages in the correspond-
ing lung lobes. Although airway obstruction created by inflating
a balloon catheter into the bronchus will be ideal [28]; it will
cause significant artifacts at CT. Second, we did not investigate any
dynamic changes in ventilation during the course of aerosol inhala-
tion of iodinated contrast medium in rabbits. However, the purpose
of this study was to demonstrate the feasibility of iodine-enhanced
DECT ventilation imaging in rabbits. Third, our results are limited by
small size, thus, sensitivity and specificity of iodine-enhanced DECT
ventilation imaging in rabbits were not calculated. Fourth, we did
not investigate the potential adverse effects of aerosol inhalation
of iodinated contrast medium on bronchial mucosa. To establish
the safety of aerosol inhalation of iodinated contrast medium and
to validate the histological analysis of normal lung for any damage
of iodine inhalation, further experiment of late influence of iodine
inhalation was needed.
Notwithstanding these limitations, our pilot experimental study
demonstrates the feasibility of quantitatively assessing regional
lung ventilation function with dual energy CT technique after
 L.-J. Zhang et al. / European Journal of Radiology 78 (2011) 266–271
aerosol inhalation of iodinated contrast medium in rabbits with air-
way obstruction. Ventilation defects visualized using dual energy
CT ventilation imaging match well with the morphological changes
on thin-section CT and histopathological findings in the pulmonary
parenchyma. The safety of inhalation of iodine contrast medium is
unknown, and has to be investigated further before use of this new
method in humans.
Conflict of interest
All authors have no conflict of interest.
Acknowledgements
We would like to express our gratitude for the grant from Jinling
Hospital, Nanjing, China (Q2008062 for Long-Jiang Zhang) and the
grant from Natural Science Foundation of Jiangsu Province, China
(BK2009316 for Guang-Ming Lu).
References
[1] Matsuoka S, Patz S, Albert MS, et al. Hyperpolarized gas MR Imaging of the lung:
current status as a research tool. J Thorac Imaging 2009;24:181–8.
[2] Driehuys B, Möller HE, Cleveland ZI, Pollaro J, Hedlund LW. Pulmonary perfu-
sion and xenon gas exchange in rats: MR imaging with intravenous injection
of hyperpolarized 129Xe. Radiology 2009;252:386–93.
[3] Mulreany DG, Simon BA, Murphy KJ, Easley RB. Volumetric xenon-CT imag-
ing of conventional and high-frequency oscillatory ventilation. Acad Radiol
2009;16:718–25.
[4] Chon D, Simon BA, Beck KC, et al. Differences in regional wash-in and wash-
out time constants for xenon-CT ventilation studies. Respir Physiol Neurobiol
2005;148:65–83.
[5] Kreck TC, Krueger MA, Altemeier WA, et al. Determination of regional ventila-
tion and perfusion in the lung using xenon and computed tomography. J Appl
Physiol 2001;91:1741–9.
[6] Marcucci C, Nyhan D, Simon BA. Distribution of pulmonary ventilation using
Xe-enhanced computed tomography in prone and supine dogs. J Appl Physiol
2001;90:421–30.
[7] Robertson HT, Kreck TC, Krueger MA. The spatial and temporal heterogeneity
of regional ventilation: comparison of measurements by two high-resolution
methods. Respir Physiol Neurobiol 2005;148:85–95.
[8] Tajik JK, Chon D, Won C, Tran BQ, Hoffman EA. Subsecond multisection CT of
regional pulmonary ventilation. Acad Radiol 2002;9:130–46.
[9] Goo HW, Chae EJ, Seo JB, Hong SJ. Xenon ventilation CT using a dual-source dual-
energy technique: dynamic ventilation abnormality in a child with bronchial
atresia. Pediatr Radiol 2008;38:1113–6.
271
[10] Chae EJ, Seo JB, Goo HW, et al. Xenon ventilation CT with a dual-energy tech-
nique of dual-source CT: initial experience. Radiology 2008;248:615–24.
[11] Thieme SF, Johnson TR, Lee C, et al. Dual-energy CT for the assessment of con-
trast material distribution in the pulmonary parenchyma. AJR Am J Roentgenol
2009;193:144–9.
[12] Zhang LJ, Zhao YE, Wu SY, et al. Pulmonary embolism detection with
dual-energy CT: experimental study of dual-source CT in rabbits. Radiology
2009;252:61–70.
[13] Zhang LJ, Chai X, Wu SY, et al. Detection of pulmonary embolism by dual energy
CT: correlation with perfusion scintigraphy and histopathological findings in
rabbits. Eur Radiol 2009;19:1844–54.
[14] Zhang LJ, Yang GF, Zhao YE, Zhou CS, Lu GM. Detection of pulmonary embolism
using dual-energy computed tomography and correlation with cardiovascular
measurements: a preliminary study. Acta Radiol 2009;50:892–901.
[15] Chae EJ, Seo JB, Jang YM, et al. 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. AJR Am J Roentgenol 2010;194:604–10.
[16] Zhang LJ, Peng J, Wu SY, Yeh BM, Zhou CS, Lu GM. Dual source dual energy CT
of acute myocardial infarction: correlation with histopathological findings in a
canine model. Invest Radiol 2010;45:290–7.
[17] Ruzsics B, Lee H, Zwerner PL, Gebregziabher M, Costello P, Schoepf UJ. Dual-
energy CT of the heart for diagnosing coronary artery stenosis and myocardial
ischemia-initial experience. Eur Radiol 2008;18:2414–24.
[18] Zhang LJ, Wu SY, Niu JB, et al. Dual-energy CT angiography in the evalua-
tion of intracranial aneurysms: image quality, radiation dose, and comparison
with 3D rotational digital subtraction angiography. AJR Am J Roentgenol
2010;194:23–30.
[19] Watanabe Y, Uotani K, Nakazawa T, et al. Dual-energy direct bone removal
CT angiography for evaluation of intracranial aneurysm or stenosis: com-
parison with conventional digital subtraction angiography. Eur Radiol
2009;19:1019–24.
[20] Stolzmann P, Frauenfelder T, Pfammatter T, et al. Endoleaks after endovascular
abdominal aortic aneurysm repair: detection with dual-energy dual-source CT.
Radiology 2008;249:682–91.
[21] Chandarana H, Godoy MC, Vlahos I, et al. Abdominal aorta: evaluation
with dual-source dual-energy multidetector CT after endovascular repair of
aneurysms—initial observations. Radiology 2008;249:692–700.
[22] Chae EJ, Song JW, Seo JB, Krauss B, Jang YM, Song KS. Clinical utility of dual-
energy CT in the evaluation of solitary pulmonary nodules: initial experience.
Radiology 2008;249:671–81.
[23] Kloppel JTR. Computertomographische messung der lungen ventilation durch
inhalation von isovist-300. Rontgenpraxis 1995;48:259–60 [in Germany].
[24] Johnson TR, Krauss B, Sedlmair M, et al. Material differentiation by dual energy
CT: initial experience. Eur Radiol 2007;17:1510–7.
[25] Remy-Jardin M, Faivre JB, Pontana F, et al. Thoracic applications of dual energy.
Radiol Clin North Am 2010;48:193–205.
[26] Latchaw RE, Yonas H, Pentheny SL, Gur D. Adverse reactions to xenon-enhanced
CT cerebral blood flow determination. Radiology 1987;163:251–4.
[27] Simon BA. Regional ventilation and lung mechanics using X-ray CT. Acad Radiol
2005;12:1414–22.
[28] Chen Q, Levin DL, Kim D, et al. Pulmonary disorders: ventilation-perfusion MR
imaging with animal models. Radiology 1999;213:871–9.