Hidenobu Takagi1, Hideki Ota2, Koichiro Sugimura3, Katharina Otani4, Junya Tominaga5, Tatsuo Aoki6, Shunsuke Tatebe7, Masanobu Miura8, Saori Yamamoto9, Haruka Sato10, Nobuhiro Yaoita11, Hideaki Suzuki12, Hiroaki Shimokawa13, Kei Takase14. 1. Department of Diagnostic Radiology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: hdnb69tkg@gmail.com. 2. Department of Diagnostic Radiology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: h-ota@rad.med.tohoku.ac.jp. 3. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: ksugimura@cardio.med.tohoku.ac.jp. 4. Diagnostic Imaging Business Area, DI Research & Collaboration Department, Siemens Healthcare KK, Gate City Osaki West Tower, 1-11-1, Osaki, Shinagawa-ku, Tokyo, #141-8644, Japan. Electronic address: katharina.otani@siemens.com. 5. Department of Diagnostic Radiology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: jrtomi@jf6.so-net.ne.jp. 6. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: aokitatsuo@gmail.com. 7. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: shuntatebe@cardio.med.tohoku.ac.jp. 8. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: masa-miura@cardio.med.tohoku.ac.jp. 9. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: yamamoto@cardio.med.tohoku.ac.jp. 10. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: haruka.s@cardio.med.tohoku.ac.jp. 11. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: tohokuyaoita@cardio.med.tohoku.ac.jp. 12. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: hd.suzuki.1870031@cardio.med.tohoku.ac.jp. 13. Department of Cardiovascular Medicine, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: shimo@cardio.med.tohoku.ac.jp. 14. Department of Diagnostic Radiology, Tohoku University Hospital, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, #980-8574, Japan. Electronic address: ktakase@rad.med.tohoku.ac.jp.
Abstract
PURPOSE: To evaluate whether the extent of perfusion defects assessed by examining lung perfused blood volume (PBV) images is a stronger estimator of the clinical severity of chronic thromboembolic pulmonary hypertension (CTEPH) compared with other computed tomography (CT) findings and noninvasive parameters. MATERIALS AND METHODS: We analyzed 46 consecutive patients (10 men, 36 women) with CTEPH who underwent both dual-energy CT and right-heart catheter (RHC) examinations. Lung PBV images were acquired using a second-generation dual-source CT scanner. Two radiologists independently scored the extent of perfusion defects in each lung segment employing the following criteria: 0, no defect, 1, defect in <50% of a segment, 2, defect in ≥50% of a segment. Each lung PBV score was defined as the sum of the scores of 18 segments. In addition, all of the following were recorded: 6-min walk distance (6MWD), brain natriuretic peptide (BNP) level, and RHC hemodynamic parameters including pulmonary artery pressure (PAP), right ventricular pressure (RVP), cardiac output (CO), the cardiac index (CI), and pulmonary vascular resistance (PVR). Bootstrapped weighted kappa values with 95% confidence intervals (CIs) were calculated to evaluate the level of interobserver agreement. Correlations between lung PBV scores and other parameters were evaluated by calculating Spearman's rho correlation coefficients. Multivariable linear regression analyses (using a stepwise method) were employed to identify useful estimators of mean PAP and PVR among CT, BNP, and 6MWD parameters. A p value<0.05 was considered to reflect statistical significance. RESULTS: Interobserver agreement in terms of the scoring of perfusion defects was excellent (κ=0.88, 95% CIs: 0.85, 0.91). The lung PBV score was significantly correlated with the PAP (mean, rho=0.48; systolic, rho=0.47; diastolic, rho=0.39), PVR (rho=0.47), and RVP (rho=0.48) (all p values<0.01). Multivariable linear regression analyses showed that only the lung PBV score was significantly associated with both the mean PAP (coefficient, 0.84, p<0.01) and the PVR (coefficient, 28.83, p<0.01). CONCLUSION: The lung PBV score is a useful and noninvasive estimator of clinical CTEPH severity, especially in comparison with the mean PAP and PVR, which currently serve as the gold standards for the management of CTEPH .
PURPOSE: To evaluate whether the extent of perfusion defects assessed by examining lung perfused blood volume (PBV) images is a stronger estimator of the clinical severity of chronic thromboembolic pulmonary hypertension (CTEPH) compared with other computed tomography (CT) findings and noninvasive parameters. MATERIALS AND METHODS: We analyzed 46 consecutive patients (10 men, 36 women) with CTEPH who underwent both dual-energy CT and right-heart catheter (RHC) examinations. Lung PBV images were acquired using a second-generation dual-source CT scanner. Two radiologists independently scored the extent of perfusion defects in each lung segment employing the following criteria: 0, no defect, 1, defect in <50% of a segment, 2, defect in ≥50% of a segment. Each lung PBV score was defined as the sum of the scores of 18 segments. In addition, all of the following were recorded: 6-min walk distance (6MWD), brain natriuretic peptide (BNP) level, and RHC hemodynamic parameters including pulmonary artery pressure (PAP), right ventricular pressure (RVP), cardiac output (CO), the cardiac index (CI), and pulmonary vascular resistance (PVR). Bootstrapped weighted kappa values with 95% confidence intervals (CIs) were calculated to evaluate the level of interobserver agreement. Correlations between lung PBV scores and other parameters were evaluated by calculating Spearman's rho correlation coefficients. Multivariable linear regression analyses (using a stepwise method) were employed to identify useful estimators of mean PAP and PVR among CT, BNP, and 6MWD parameters. A p value<0.05 was considered to reflect statistical significance. RESULTS: Interobserver agreement in terms of the scoring of perfusion defects was excellent (κ=0.88, 95% CIs: 0.85, 0.91). The lung PBV score was significantly correlated with the PAP (mean, rho=0.48; systolic, rho=0.47; diastolic, rho=0.39), PVR (rho=0.47), and RVP (rho=0.48) (all p values<0.01). Multivariable linear regression analyses showed that only the lung PBV score was significantly associated with both the mean PAP (coefficient, 0.84, p<0.01) and the PVR (coefficient, 28.83, p<0.01). CONCLUSION: The lung PBV score is a useful and noninvasive estimator of clinical CTEPH severity, especially in comparison with the mean PAP and PVR, which currently serve as the gold standards for the management of CTEPH .
Authors: Jenny Louise Bacon; Brendan Patrick Madden; Conor Gissane; Charles Sayer; Sarah Sheard; Ioannis Vlahos Journal: Radiol Cardiothorac Imaging Date: 2020-12-17
Authors: Kiara Rezaei-Kalantari; Kaveh Samimi; Hamid Zomorodian; Hooman Bakhshandeh; Maryam Jafari; Ali Mohammad Farahmand; Taleb Pourseyedian; Maedeh Sharifian; Salah Dine Qanadli Journal: Front Cardiovasc Med Date: 2022-07-05
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