Jessica Giordano1, Suonita Khung1, Alain Duhamel2, Claude Hossein-Foucher3, Dimitri Bellèvre3, Nicolas Lamblin4, Jacques Remy1, Martine Remy-Jardin5. 1. Department of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Université de Lille 2 Nord de France, 59000, Lille, France. 2. Department of Biostatistics, University Lille, CHU Lille, EA 2694, 59000, Lille, France. 3. Department of Nuclear Medicine, Hospital Salengro, University Lille, CHU Lille, 59000, Lille, France. 4. Department of Cardiology, Cardiology Hospital, University Lille, CHU Lille, 59000, Lille, France. 5. Department of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Université de Lille 2 Nord de France, 59000, Lille, France. martine.remy@chru-lille.fr.
Abstract
PURPOSE: To compare lung perfusion in PAH and pCTEPH on dual-energy CT (DECT) examinations. MATERIALS AND METHODS: Thirty-one patients with PAH (group 1; n = 19) and pCTEPH (group 2; n = 12) underwent a dual-energy chest CTA with reconstruction of diagnostic and perfusion images. Perfusion alterations were analysed at a segmental level. V/Q scintigraphy was available in 22 patients (group 1: 13/19; group 2: 9/12). RESULTS: CT perfusion was abnormal in 52.6 % of group 1 patients and in 100 % of group 2 patients (p = 0.0051). The patterns of perfusion alteration significantly differed between the two groups (p < 0.0001): (1) in group 1, 96.6 % of segments with abnormal perfusion showed patchy defects; (2) in group 2, the most frequent abnormalities consisted of patchy (58.5 %) and PE-type (37.5 %) defects. Paired comparison of CT perfusion and scintigraphy showed concordant findings in 76.9 % of group 1 (10/13) and 100 % of group 2 (9/9) patients, with a predominant or an exclusive patchy pattern in group 1 and a mixed pattern of abnormalities in group 2. CONCLUSION: Lung perfusion alterations at DECT are less frequent and more homogeneous in PAH than in pCTEPH, with a high level of concordant findings with V/Q scintigraphy. KEY POINTS: • Depiction of chronic pulmonary embolism exclusively located on peripheral arteries is difficult. • The main differential diagnosis of pCTEPH is PAH. • The pattern of DECT perfusion changes can help differentiate PAH and pCETPH. • In PAH, almost all segments with abnormal perfusion showed patchy defects. • In pCTEPH, patchy and PE-type defects were the most frequent abnormalities.
PURPOSE: To compare lung perfusion in PAH and pCTEPH on dual-energy CT (DECT) examinations. MATERIALS AND METHODS: Thirty-one patients with PAH (group 1; n = 19) and pCTEPH (group 2; n = 12) underwent a dual-energy chest CTA with reconstruction of diagnostic and perfusion images. Perfusion alterations were analysed at a segmental level. V/Q scintigraphy was available in 22 patients (group 1: 13/19; group 2: 9/12). RESULTS:CT perfusion was abnormal in 52.6 % of group 1 patients and in 100 % of group 2 patients (p = 0.0051). The patterns of perfusion alteration significantly differed between the two groups (p < 0.0001): (1) in group 1, 96.6 % of segments with abnormal perfusion showed patchy defects; (2) in group 2, the most frequent abnormalities consisted of patchy (58.5 %) and PE-type (37.5 %) defects. Paired comparison of CT perfusion and scintigraphy showed concordant findings in 76.9 % of group 1 (10/13) and 100 % of group 2 (9/9) patients, with a predominant or an exclusive patchy pattern in group 1 and a mixed pattern of abnormalities in group 2. CONCLUSION: Lung perfusion alterations at DECT are less frequent and more homogeneous in PAH than in pCTEPH, with a high level of concordant findings with V/Q scintigraphy. KEY POINTS: • Depiction of chronic pulmonary embolism exclusively located on peripheral arteries is difficult. • The main differential diagnosis of pCTEPH is PAH. • The pattern of DECT perfusion changes can help differentiate PAH and pCETPH. • In PAH, almost all segments with abnormal perfusion showed patchy defects. • In pCTEPH, patchy and PE-type defects were the most frequent abnormalities.
Authors: Michael M Madani; William R Auger; Victor Pretorius; Naohide Sakakibara; Kim M Kerr; Nick H Kim; Peter F Fedullo; Stuart W Jamieson Journal: Ann Thorac Surg Date: 2012-05-23 Impact factor: 4.330
Authors: Edward T D Hoey; Saeed Mirsadraee; Joanna Pepke-Zaba; David P Jenkins; Deepa Gopalan; Nicholas J Screaton Journal: AJR Am J Roentgenol Date: 2011-03 Impact factor: 3.959
Authors: Irene M Lang; Christina Plank; Roela Sadushi-Kolici; Johannes Jakowitsch; Walter Klepetko; Gerald Maurer Journal: JACC Cardiovasc Imaging Date: 2010-12
Authors: Nazzareno Galiè; Marc Humbert; Jean-Luc Vachiery; Simon Gibbs; Irene Lang; Adam Torbicki; Gérald Simonneau; Andrew Peacock; Anton Vonk Noordegraaf; Maurice Beghetti; Ardeschir Ghofrani; Miguel Angel Gomez Sanchez; Georg Hansmann; Walter Klepetko; Patrizio Lancellotti; Marco Matucci; Theresa McDonagh; Luc A Pierard; Pedro T Trindade; Maurizio Zompatori; Marius Hoeper Journal: Eur Heart J Date: 2015-08-29 Impact factor: 29.983
Authors: Ioannis Vlahos; Megan C Jacobsen; Myrna C Godoy; Konstantinos Stefanidis; Rick R Layman Journal: Br J Radiol Date: 2021-09-24 Impact factor: 3.039
Authors: Fawaz Alenezi; Taylor A Covington; Monica Mukherjee; Stephen C Mathai; Paul B Yu; Sudarshan Rajagopal Journal: Circ Res Date: 2022-04-28 Impact factor: 23.213
Authors: Rahul D Renapurkar; Michael A Bolen; Sankaran Shrikanthan; Jennifer Bullen; Wadih Karim; Andrew Primak; Gustavo A Heresi Journal: Cardiovasc Diagn Ther Date: 2018-08
Authors: Jan Robert Kroeger; Jakob Zöllner; Felix Gerhardt; Stephan Rosenkranz; Roman Johannes Gertz; Shir Kerszenblat; Gregor Pahn; David Maintz; Alexander C Bunck Journal: Quant Imaging Med Surg Date: 2022-02
Authors: Susan R Hopkins; Rui C Sá; G Kim Prisk; Ann R Elliott; Nick H Kim; Beni J Pazar; Beth F Printz; Howaida G El-Said; Christopher K Davis; Rebecca J Theilmann Journal: J Physiol Date: 2020-10-27 Impact factor: 5.182