title: Chronic thromboembolic pulmonary hypertension: Comparison of dual-energy computed tomography and single photon emission computed tomography in canines.
abstract: OBJECTIVE
  To compare diagnostic accuracy between dual-energy CT lung perfused blood volume (Lung PBV) imaging and single photon emission computed tomography (SPECT) in detecting chronic thromboembolic pulmonary hypertension (CTEPH) with histopathological results as reference standard in a canine model.
  
  
  METHODS
  Eighteen CTEPH canines were included into this experimental study. All procedures including paracentesis, embolization, scanning, pressure measurement and feeding medicine were repeated each two weeks, until systolic/diastolic pressure in canines was ≥ 30/15 mm Hg or mean pulmonary artery pressure ≥ 20 mm Hg, and then sacrificed for histopathology examination. Two radiologists (readers 1 and 2) and two nuclear radiologists (readers 3 and 4) analyzed images of conventional CT pulmonary angiography in dual-energy CT mode, Lung PBV imaging and SPECT, respectively. The presence, numbers, and locations of pulmonary emboli (PE) were recorded on a per-lobe basis. Pathological examination was served as reference standard. Sensitivity, specificity and accuracy of Lung PBV and SPECT were calculated. Kappa statistics were used to quantify inter-reader agreement.
  
  
  RESULTS
  With histopathological results as reference standard, the sensitivities of 72.2%, 78.8%, 81.2%, specificities of 75.9%, 87.5%, 84.8%, accuracies of 73.8%, 83.1%, 83.1%, for readers 1, 2 and both with Lung PBV, respectively. Readers 3, 4 and both had sensitivities of 14.3%, 25.7%, 33.3%, specificities of 90.0%, 86.7%, 93.3%, accuracies of 49.2%, 53.8%, 60.0% with SPECT for detecting CTEPH. Inter-reader agreements were good for dual-energy CT (kappa=0.662) and SPECT (k=0.706) for detecting CTEPH.
  
  
  CONCLUSIONS
  Dual-energy CT had a higher accuracy to detect CTEPH than SPECT in this canine model study.
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Chun Xiang
authors.initials: CX
authors.lastname: Tang
authors.affiliation: Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Gui Fen
authors.initials: GF
authors.lastname: Yang
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China; Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29401, USA.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Department of Interventional Radiology, Changzhou First People's Hospital, Changzhou, Jiangsu 213003, China.
authors.forename: Zong Hong
authors.initials: ZH
authors.lastname: Han
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Li
authors.initials: L
authors.lastname: Qi
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Yan E
authors.initials: YE
authors.lastname: Zhao
authors.affiliation: Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Jiang
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Chang Sheng
authors.initials: CS
authors.lastname: Zhou
authors.affiliation: Department of Nuclear Medicine, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Zhu
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29401, USA.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Stubenrauch
authors.affiliation: Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29401, USA.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Mangold
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China. Electronic address: kevinzhlj@163.com.
authors.forename: Long Jiang
authors.initials: LJ
authors.lastname: Zhang
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu 210002, China. Electronic address: cjr.luguangming@vip.163.com.
authors.forename: Guang Ming
authors.initials: GM
authors.lastname: Lu
mesh_terms: D000818:Animals; D001810:Blood Volume; D002908:Chronic Disease; D004195:Disease Models, Animal; D004285:Dogs; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D015900:Radiography, Dual-Energy Scanned Projection / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013599:Systole; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*
keywords: Animal model; Chronic thromboembolic pulmonary hypertension; Dual-energy CT; Lung perfused blood volume; SPECT