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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 (PP\n                      <jats:sub>DECT<\/jats:sub>\n                      ).\n                    <\/jats:p>\n                    <jats:p>\n                      Here accuracy of PP\n                      <jats:sub>DECT<\/jats:sub>\n                      is evaluated in comparison to pulmonary blood flow measured with fluorescence-labeled microspheres (PP\n                      <jats:sub>FLM<\/jats:sub>\n                      ). Its feasibility of repeated measurements is evaluated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Agreement between PP\n                      <jats:sub>FLM<\/jats:sub>\n                      and PP\n                      <jats:sub>DECT<\/jats:sub>\n                      was assessed by regression as well as Bland\u2013Altman 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. PP\n                      <jats:sub>FLM<\/jats:sub>\n                      and PP\n                      <jats:sub>DECT<\/jats:sub>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Regression analysis revealed a good overall association (R2\u2009=\u20090.81) between PP\n                      <jats:sub>FLM<\/jats:sub>\n                      and PP\n                      <jats:sub>DECT<\/jats:sub>\n                      , with PP\n                      <jats:sub>DECT<\/jats:sub>\n                      substantially overestimating PP\n                      <jats:sub>FLM<\/jats:sub>\n                      up to 30%, with limits of agreement of -18 and 18%, Low PP\n                      <jats:sub>FLM<\/jats:sub>\n                      was underestimated, while high PP\n                      <jats:sub>FLM<\/jats:sub>\n                      was overestimated by PP\n                      <jats:sub>DECT<\/jats:sub>\n                      , indicating a higher sensitivity of the later. Changes of PP\n                      <jats:sub>DECT<\/jats:sub>\n                      and PP\n                      <jats:sub>FLM<\/jats:sub>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dual-energy CT based measurement of pulmonary perfusion shows promising results indicating its feasibility in translational research on strategies of mechanical ventilation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12931-025-03374-8","type":"journal-article","created":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T11:52:40Z","timestamp":1761133960000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Dual-energy computed tomography derived pulmonary blood volume: association with pulmonary blood flow"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4397-1467","authenticated-orcid":false,"given":"Jakob","family":"Wittenstein","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1375-0498","authenticated-orcid":false,"given":"Rudi","family":"Apolle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Scharffenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carolin","family":"Rothmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf-Thorsten","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther G. 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The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.The other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"293"}}