1
|
Gertz RJ, Gerhardt F, Pienn M, Lennartz S, Kröger JR, Caldeira L, Pennig L, Schömig TH, Hokamp NG, Maintz D, Rosenkranz S, Bunck AC. Dual-layer dual-energy CT-derived pulmonary perfusion for the differentiation of acute pulmonary embolism and chronic thromboembolic pulmonary hypertension. Eur Radiol 2024; 34:2944-2956. [PMID: 37921925 PMCID: PMC11126515 DOI: 10.1007/s00330-023-10337-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/18/2023] [Accepted: 10/03/2023] [Indexed: 11/05/2023]
Abstract
OBJECTIVES To evaluate dual-layer dual-energy computed tomography (dlDECT)-derived pulmonary perfusion maps for differentiation between acute pulmonary embolism (PE) and chronic thromboembolic pulmonary hypertension (CTEPH). METHODS This retrospective study included 131 patients (57 patients with acute PE, 52 CTEPH, 22 controls), who underwent CT pulmonary angiography on a dlDECT. Normal and malperfused areas of lung parenchyma were semiautomatically contoured using iodine density overlay (IDO) maps. First-order histogram features of normal and malperfused lung tissue were extracted. Iodine density (ID) was normalized to the mean pulmonary artery (MPA) and the left atrium (LA). Furthermore, morphological imaging features for both acute and chronic PE, as well as the combination of histogram and morphological imaging features, were evaluated. RESULTS In acute PE, normal perfused lung areas showed a higher mean and peak iodine uptake normalized to the MPA than in CTEPH (both p < 0.001). After normalizing mean ID in perfusion defects to the LA, patients with acute PE had a reduced average perfusion (IDmean,LA) compared to both CTEPH patients and controls (p < 0.001 for both). IDmean,LA allowed for a differentiation between acute PE and CTEPH with moderate accuracy (AUC: 0.72, sensitivity 74%, specificity 64%), resulting in a PPV and NPV for CTEPH of 64% and 70%. Combining IDmean,LA in the malperfused areas with the diameter of the MPA (MPAdia) significantly increased its ability to differentiate between acute PE and CTEPH (sole MPAdia: AUC: 0.76, 95%-CI: 0.68-0.85 vs. MPAdia + 256.3 * IDmean,LA - 40.0: AUC: 0.82, 95%-CI: 0.74-0.90, p = 0.04). CONCLUSION dlDECT enables quantification and characterization of pulmonary perfusion patterns in acute PE and CTEPH. Although these lack precision when used as a standalone criterion, when combined with morphological CT parameters, they hold potential to enhance differentiation between the two diseases. CLINICAL RELEVANCE STATEMENT Differentiating between acute PE and CTEPH based on morphological CT parameters is challenging, often leading to a delay in CTEPH diagnosis. By revealing distinct pulmonary perfusion patterns in both entities, dlDECT may facilitate timely diagnosis of CTEPH, ultimately improving clinical management. KEY POINTS • Morphological imaging parameters derived from CT pulmonary angiography to distinguish between acute pulmonary embolism and chronic thromboembolic pulmonary hypertension lack diagnostic accuracy. • Dual-layer dual-energy CT reveals different pulmonary perfusion patterns between acute pulmonary embolism and chronic thromboembolic pulmonary hypertension. • The identified parameters yield potential to enable more timely identification of patients with chronic thromboembolic pulmonary hypertension.
Collapse
Affiliation(s)
- Roman Johannes Gertz
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Felix Gerhardt
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Michael Pienn
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Simon Lennartz
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Robert Kröger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Ruhr University Bochum, Johannes Wesling University Hospital, Bochum, Germany
| | - Liliana Caldeira
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lenhard Pennig
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thomas Henning Schömig
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nils Große Hokamp
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Rosenkranz
- Department of Cardiology, Heart Center, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Alexander Christian Bunck
- Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
2
|
Renapurkar RD, Bullen J, Rizk A, Abozeed M, Karim W, Bin Saeedan M, Tong MZ, Heresi GA. A Novel Dual Energy Computed Tomography Score Correlates With Postoperative Outcomes in Chronic Thromboembolic Pulmonary Hypertension. J Thorac Imaging 2024; 39:178-184. [PMID: 37423613 DOI: 10.1097/rti.0000000000000724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
PURPOSE To compare dual-energy computed tomography (DECT) based qualitative and quantitative parameters in chronic thromboembolic pulmonary hypertension with various postoperative primary and secondary endpoints. MATERIALS AND METHODS This was a retrospective analysis of 64 patients with chronic thromboembolic pulmonary hypertension who underwent DECT. First, a clot score was calculated by assigning the following score: pulmonary trunk-5, each main pulmonary artery-4, each lobar-3, each segmental-2, and subsegmental-1 per lobe; the sum total was then calculated. The perfusion defect (PD) score was calculated by assigning 1 point to each segmental PD. The combined score was calculated by adding clot and PD scores. For quantitative evaluation, we calculated perfused blood volume (PBV) (%) of each lung and the sum of both lungs. Primary endpoints included testing association between combined score and total PBV with change in mean pulmonary arterial pressure ([mPAP], change calculated as preop minus postop values). Secondary endpoints included explorative analysis of the correlation between combined score and PBV with change in preoperative and postoperative pulmonary vascular resistance, change in preoperative 6-minute walk distance (6MWD), and immediate postoperative complications such as reperfusion edema, ECMO placement, stroke, death and mechanical ventilation for more than 48 hours, all within 1 month of surgery. RESULTS Higher combined scores were associated with larger decreases in mPAP ( =0.27, P =0.036). On average, the decrease in mPAP (pre mPAP-post mPAP) increased by 2.2 mm Hg (95% CI: -0.6, 5.0) with each 10 unit increase in combined score. The correlation between total PBV and change in mPAP was small and not statistically significant. During an exploratory analysis, higher combined scores were associated with larger increases in 6MWD at 6 months postprocedure ( =0.55, P =0.002). CONCLUSION Calculation of DECT-based combined score offers potential in the evaluation of hemodynamic response to surgery. This response can also be objectively quantified.
Collapse
Affiliation(s)
| | | | - Alain Rizk
- Section of Thoracic Imaging, Imaging Institute
| | | | - Wadih Karim
- Section of Thoracic Imaging, Imaging Institute
| | | | | | - Gustavo A Heresi
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
3
|
Bird E, Hasenstab K, Kim N, Madani M, Malhotra A, Hahn L, Kligerman S, Hsiao A, Contijoch F. Mapping the Spatial Extent of Hypoperfusion in Chronic Thromboembolic Pulmonary Hypertension Using Multienergy CT. Radiol Cardiothorac Imaging 2023; 5:e220221. [PMID: 37693197 PMCID: PMC10483250 DOI: 10.1148/ryct.220221] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 06/05/2023] [Accepted: 07/03/2023] [Indexed: 09/12/2023]
Abstract
Purpose To assess if a novel automated method to spatially delineate and quantify the extent of hypoperfusion on multienergy CT angiograms can aid the evaluation of chronic thromboembolic pulmonary hypertension (CTEPH) disease severity. Materials and Methods Multienergy CT angiograms obtained between January 2018 and December 2020 in 51 patients with CTEPH (mean age, 47 years ± 17 [SD]; 27 women) were retrospectively compared with those in 110 controls with no imaging findings suggestive of pulmonary vascular abnormalities (mean age, 51 years ± 16; 81 women). Parenchymal iodine values were automatically isolated using deep learning lobar lung segmentations. Low iodine concentration was used to delineate areas of hypoperfusion and calculate hypoperfused lung volume (HLV). Receiver operating characteristic curves, correlations with preoperative and postoperative changes in invasive hemodynamics, and comparison with visual assessment of lobar hypoperfusion by two expert readers were evaluated. Results Global HLV correctly separated patients with CTEPH from controls (area under the receiver operating characteristic curve = 0.84; 10% HLV cutoff: 90% sensitivity, 72% accuracy, and 64% specificity) and correlated moderately with hemodynamic severity at time of imaging (pulmonary vascular resistance [PVR], ρ = 0.67; P < .001) and change after surgical treatment (∆PVR, ρ = -0.61; P < .001). In patients surgically classified as having segmental disease, global HLV correlated with preoperative PVR (ρ = 0.81) and postoperative ∆PVR (ρ = -0.70). Lobar HLV correlated moderately with expert reader lobar assessment (ρHLV = 0.71 for reader 1; ρHLV = 0.67 for reader 2). Conclusion Automated quantification of hypoperfused areas in patients with CTEPH can be performed from clinical multienergy CT examinations and may aid clinical evaluation, particularly in patients with segmental-level disease.Keywords: CT-Spectral Imaging (Multienergy), Pulmonary, Pulmonary Arteries, Embolism/Thrombosis, Chronic Thromboembolic Pulmonary Hypertension, Multienergy CT, Hypoperfusion© RSNA, 2023.
Collapse
Affiliation(s)
- Elizabeth Bird
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Kyle Hasenstab
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Nick Kim
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Michael Madani
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Atul Malhotra
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Lewis Hahn
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Seth Kligerman
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Albert Hsiao
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| | - Francisco Contijoch
- From the Department of Bioengineering (E.B., A.H., F.C.), Department
of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of
Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of
Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La
Jolla, CA 92093
| |
Collapse
|
4
|
Sirajuddin A, Mirmomen SM, Henry TS, Kandathil A, Kelly AM, King CS, Kuzniewski CT, Lai AR, Lee E, Martin MD, Mehta P, Morris MF, Raptis CA, Roberge EA, Sandler KL, Donnelly EF. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update. J Am Coll Radiol 2022; 19:S502-S512. [PMID: 36436973 DOI: 10.1016/j.jacr.2022.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations may be helpful in diagnosing and determining the etiology of pulmonary hypertension. Imaging examinations discussed in this document include chest radiography, ultrasound echocardiography, ventilation/perfusion scintigraphy, CT, MRI, right heart catheterization, and pulmonary angiography. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
| | | | - Travis S Henry
- Panel Chair, University of California San Francisco, San Francisco, California; Co-Director, ACR Education Center High Resolution CT of the Chest Course; Division Chief of Cardiothoracic Imaging, Duke University
| | - Asha Kandathil
- University of Texas Southwestern Medical Center, Dallas, Texas; Associate Program Director, Cardiothoracic Radiology Fellowship, The University of Texas Southwestern Medical Center
| | - Aine Marie Kelly
- Emory University Hospital, Atlanta, Georgia; Assistant Program Director Radiology Residency
| | - Christopher S King
- Inova Fairfax Hospital, Falls Church, Virginia; American College of Chest Physicians; Associate Medical Director, Advanced Lung Disease and Transplant Program; Associate Medical Director, Pulmonary Hypertension Program; System Director, Respiratory Therapy; Pulmonary Fibrosis Foundation
| | | | - Andrew R Lai
- University of California San Francisco, San Francisco, California; Primary care physician; former Director of the University of California San Francisco Hospitalist Procedure Service; former Director of the University of California San Francisco Division of Hospital Medicine's Case Review Committee, and former Director of procedures/quality improvement rotation for for the UCSF Internal Medicince residency
| | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan; Director M1Radiology Education University of Michigan Medical School, Associated Program Director Diagnostic Radiology Michigan Medicine, Director of Residency Education Cardiothoracic Division Michigan
| | - Maria D Martin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Director Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health
| | - Parth Mehta
- University of Illinois at Chicago College of Medicine, Chicago, Illinois; American College of Physicians
| | - Michael F Morris
- University of Arizona College of Medicine, Phoenix, Arizona; Director of Cardiac CT and MRI
| | | | - Eric A Roberge
- Uniformed Services University of the Health Sciences-Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Kim L Sandler
- Vanderbilt University Medical Center, Nashville, Tennessee; Imaging Chair Thoracic Committee ECOG-ACRIN; Co-Chair Lung Screening 2.0 Steering Committee; Co-Director Vanderbilt Lung Screening Program
| | - Edwin F Donnelly
- Specialty Chair, The Ohio State University Wexner Medical Center, Columbus, Ohio; Ohio State University Medical Center: Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology
| |
Collapse
|
5
|
Abozeed M, Conic S, Bullen J, Rizk A, Saeedan MB, Karim W, Heresi GA, Renapurkar RD. Dual energy CT based scoring in chronic thromboembolic pulmonary hypertension and correlation with clinical and hemodynamic parameters: a retrospective cross-sectional study. Cardiovasc Diagn Ther 2022; 12:305-313. [PMID: 35800352 PMCID: PMC9253168 DOI: 10.21037/cdt-21-686] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 04/02/2022] [Indexed: 06/14/2024]
Abstract
BACKGROUND We used a dual energy computed tomography (DECT) based scoring system in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and correlated it with functional and hemodynamic parameters. METHODS This was a retrospective study on 78 patients with CTEPH who underwent DECT. First, clot burden score was calculated by assigning a following score: pulmonary trunk-5, each main pulmonary artery-4, each lobar-3, each segmental-2, and subsegmental-1 per lobe; sum total was then calculated. Perfusion defect (PD) score was calculated by assigning 1 point to each segmental PD. Combined score was calculated by adding the clot burden and PD score. All three scores were correlated with clinical and hemodynamic parameters that included New York Heart Association (NYHA) functional class, 6-minute walk distance (6MWT) in feet, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), pulmonary arterial pressure (PAP) [systolic PAP (sPAP), diastolic PAP (dPAP) and mean PAP (mPAP)], pulmonary vascular resistance (PVR), right atrial pressure, cardiac output, and cardiac index. RESULTS Clot burden score, PD score, and combined score all positively correlated with sPAP (0.25, 0.34, 0.34), PVR (0.27, 0.30, 0.34), and mPAP (0.28, 0.31, 0.36). There was no statistically significant correlation of clot burden score, PD score and combined score with 6MWT, % predicted 6MWT, FEV1, FEV1%, FVC, FVC%, DLCO% and NYHA functional class. CONCLUSIONS DECT based scoring in CTEPH is feasible and correlates positively with sPAP, mPAP and PVR. Combined score has the highest magnitude of correlation.
Collapse
Affiliation(s)
- Mostafa Abozeed
- Sections of Thoracic and Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, OH, USA
| | - Sofija Conic
- Sections of Thoracic and Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, OH, USA
| | | | - Alain Rizk
- Sections of Thoracic and Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, OH, USA
| | - Mnahi Bin Saeedan
- Sections of Thoracic and Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, OH, USA
| | - Wadih Karim
- Sections of Thoracic and Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, OH, USA
| | - Gustavo A. Heresi
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, OH, USA
| | - Rahul D. Renapurkar
- Sections of Thoracic and Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, OH, USA
| |
Collapse
|
6
|
Pulmonary Embolism Versus Mimics on Dual-energy Spectral Computed Tomography: An Algorithmic Approach. J Comput Assist Tomogr 2020; 44:833-840. [PMID: 33196595 DOI: 10.1097/rct.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pulmonary embolism is a commonly encountered diagnosis that is traditionally identified on conventional computed tomography angiography. Dual-energy computed tomography (DECT) is a new technology that may aid the initial identification and differential diagnosis of pulmonary embolism. In this review, we present an algorithmic approach for assessing pulmonary embolism on DECT, including acute versus chronic pulmonary embolism, relationship to conventional computed tomography angiography, surrogate for likelihood of hemodynamic significance, and alternative diagnoses for DECT perfusion defects.
Collapse
|
7
|
Morphologic and Functional Dual-Energy CT Parameters in Patients With Chronic Thromboembolic Pulmonary Hypertension and Chronic Thromboembolic Disease. AJR Am J Roentgenol 2020; 215:1335-1341. [PMID: 32991219 DOI: 10.2214/ajr.19.22743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The objective of our study was to compare morphologic and functional dual-energy CT (DECT) parameters in patients with chronic thromboembolic disease (CTED) and chronic thromboembolic pulmonary hypertension (CTEPH). MATERIALS AND METHODS. Using the local CTEPH registry, we identified 28 patients with CTED and 72 patients with CTEPH. On each DECT examination, a clot burden score was calculated by assigning the following scores for chronic changes by location: pulmonary trunk, 5; each main pulmonary artery (MPA), 4; each lobar branch, 3; each segmental branch, 2; and each subsegmental branch, 1. The total clot burden score was calculated by adding the individual scores from both lungs. Functional parameters were assessed using perfused blood volume (PBV) maps and included lung enhancement (in Hounsfield units), percentage of PBV, MPA peak enhancement (in Hounsfield units), maximum enhancement corresponding to 100, and the ratio of MPA peak enhancement to lung enhancement. A perfusion defect (PD) score was calculated by assigning 1 point to each segmental PD. Patients with CTED and patients with CTEPH were matched using propensity score matching to account for potential confounders. RESULTS. After matching, the CTEPH group showed a higher PD score than the CTED group and unilateral disease was more common in the CTED group than in the CTEPH group. In the unmatched sample, patients with CTED showed increased percentages of PBV for both lungs (PBV total) and for the right lung as compared with the CTEPH group (adjusted p = 0.040 and 0.028, respectively); after adjustment for clot burden, the difference between groups was still noted but was not statistically significant. No statistically significant differences were noted in the various functional DECT parameters after propensity score matching. CONCLUSION. Patients with CTED show anatomic and functional changes in the pulmonary vasculature and lung parenchyma similar to those seen in patients with CTEPH. Functional DECT parameters support the observation that CTED is an intermediate clinical phenotype in the population with chronic pulmonary embolism.
Collapse
|
8
|
Singh R, Nie RZ, Homayounieh F, Schmidt B, Flohr T, Kalra MK. Quantitative lobar pulmonary perfusion assessment on dual-energy CT pulmonary angiography: applications in pulmonary embolism. Eur Radiol 2020; 30:2535-2542. [DOI: 10.1007/s00330-019-06607-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/25/2019] [Accepted: 12/04/2019] [Indexed: 11/25/2022]
|
9
|
Rajiah P, Tanabe Y, Partovi S, Moore A. State of the art: utility of multi-energy CT in the evaluation of pulmonary vasculature. Int J Cardiovasc Imaging 2019; 35:1509-1524. [PMID: 31049753 DOI: 10.1007/s10554-019-01615-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/25/2019] [Indexed: 12/14/2022]
Abstract
Multi-energy computed tomography (MECT) refers to acquisition of CT data at multiple energy levels (typically two levels) using different technologies such as dual-source, dual-layer and rapid tube voltage switching. In addition to conventional/routine diagnostic images, MECT provides additional image sets including iodine maps, virtual non-contrast images, and virtual monoenergetic images. These image sets provide tissue/material characterization beyond what is possible with conventional CT. MECT provides invaluable additional information in the evaluation of pulmonary vasculature, primarily by the assessment of pulmonary perfusion. This functional information provided by the MECT is complementary to the morphological information from a conventional CT angiography. In this article, we review the technique and applications of MECT in the evaluation of pulmonary vasculature.
Collapse
Affiliation(s)
- Prabhakar Rajiah
- Cardiothoracic Imaging Division, Department of Radiology, University of Texas Southwestern Medical Center, E6.122G, 5323 Harry Hines Boulevard, Mail Code 9316, Dallas, TX, 75390-8896, USA.
| | - Yuki Tanabe
- Cardiothoracic Imaging Division, Department of Radiology, University of Texas Southwestern Medical Center, E6.122G, 5323 Harry Hines Boulevard, Mail Code 9316, Dallas, TX, 75390-8896, USA
- Ehime University Graduate School of Medicine, Ehime, Japan
| | - Sasan Partovi
- Interventional Radiology Section, Imaging Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Alastair Moore
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
| |
Collapse
|