Assessment of Regional Xenon Ventilation, Perfusion, and Ventilation-Perfusion Mismatch Using Dual-Energy Computed Tomography in Chronic Obstructive Pulmonary Disease Patients

Objectives The aim of this study was to assess the feasibility of combined xenon-enhanced ventilation (V) and iodine-enhanced perfusion (Q) dual-energy computed tomography (DECT) to evaluate regional V and Q status in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods Combined V and Q DECT imaging was performed in 52 prospectively enrolled male COPD patients. Virtual noncontrast images, V maps, and Q maps were anatomically coregistered with deformable registration and evaluated using in-house software. After normalization of the V and Q values of each pixel, normalized V and Q, V/Qratio, and VQmin (ie, the smaller of the V and Q in each pixel) maps were generated. For visual analysis, the V/Qratio pattern was determined to be matched, mismatched, or reversed mismatched and compared with the regional disease patterns—emphysema with/without bronchial wall thickening, bronchial wall thickening, or normal parenchyma—in each segment. The mean V, Q, V/Qratio, and VQmin values and the standard deviation of the V/Qratio (V/QSD) of each patient were quantified and compared with pulmonary function test (PFT) parameters using the Pearson correlation test. Results Segments with normal parenchyma showed a matched V/Qratio pattern, whereas segments with bronchial wall thickening commonly showed a reversed mismatched V/Qratio pattern. In the emphysema areas, the matched, mismatched, and reversed mismatched patterns were mixed without a dominant pattern. In quantitative analysis, the mean V, Q, VQmin, and V/Qratio values were significantly and positively correlated with PFT parameters (r = 0.290–0.819; P < 0.05). The V/QSD was significantly and negatively correlated with PFT parameters (r = −0.439 to −0.736; P < 0.001). VQmin values showed the best correlation with PFT parameters (r = 0.483–0.819; P < 0.001). Conclusions Visual and quantitative assessment of the regional V, Q, V/Qratio, and VQmin is feasible with combined V and Q DECT imaging and significantly correlate with PFT results in COPD patients. Assessing disease patterns using conventional computed tomography images may not provide correct evaluation of regional V and Q in COPD patients with emphysema.