Briac Lefebvre1, Maeva Kyheng2,3, Jessica Giordano1, Nicolas Lamblin4,5, Pascal de Groote4,5, Marie Fertin4,5, Marie Delobelle4, Thierry Perez6,7, Jean-Baptiste Faivre1, Jacques Remy1, Alain Duhamel2,3, Martine Remy-Jardin8,9. 1. Univ Lille, CHU Lille, Department of Thoracic Imaging, Cardio-Pulmonary Institute, Boulevard Jules Leclercq, F-59000, Lille, France. 2. Department of Biostatistics, University Center of Lille, F-59000, Lille, France. 3. EA2694-Santé Publique: épidémiologie et qualité des soins, F-59000, Lille, France. 4. Univ Lille, CHU Lille, Department of Cardiology, Cardio-Pulmonary Institute, F-59000, Lille, France. 5. INSERM U1167, Institut Pasteur de Lille, F-59000, Lille, France. 6. Univ Lille, CHU Lille, Department of Pulmonary Function, Cardio-Pulmonary Institute, F-59000, Lille, France. 7. INSERM U1019 - CNRS UMR 8204, Institut Pasteur de Lille - CIIL - Center for Infection and Immunity of Lille, Lille, France. 8. Univ Lille, CHU Lille, Department of Thoracic Imaging, Cardio-Pulmonary Institute, Boulevard Jules Leclercq, F-59000, Lille, France. martine.remy@chru-lille.fr. 9. EA2694-Santé Publique: épidémiologie et qualité des soins, F-59000, Lille, France. martine.remy@chru-lille.fr.
Abstract
BACKGROUND: In the stratification of potential causes of PH, current guidelines recommend performing V/Q lung scintigraphy to screen for CTEPH. The recognition of CTEPH is based on the identification of lung segments or sub-segments without perfusion but preserved ventilation. The presence of mismatched perfusion defects has also been described in a small proportion of idiopathic pulmonary arterial hypertension (PAH) and pulmonary veno-occlusive disease and/or pulmonary capillary hemangiomatosis (PVOD/PCH). Dual-energy CT lung perfusion changes have not been specifically investigated in these two entities. PURPOSE: To compare dual-energy CT (DECT) perfusion characteristics in PAH and PVOD/PCH, with specific interest in PE-type perfusion defects. MATERIALS AND METHODS: Sixty-three patients with idiopathic or heritable PAH (group A; n = 51) and PVOD/PCH (group B; n = 12) were investigated with DECT angiography with reconstruction of morphologic and perfusion images. RESULTS: The number of patients with abnormal perfusion did not differ between group A (35/51; 68.6%) and group B (6/12; 50%) (p = 0.31) nor did the mean number of segments with abnormal perfusion per patient (group A: 17.9 ± 4.9; group B: 18.3 ± 4.1; p = 0.91). The most frequent finding was the presence of patchy defects in group A (15/35; 42.9%) and a variable association of perfusion abnormalities in group B (4/6; 66.7%). The median percentage of segments with PE-type defects per patient was significantly higher in group B than in group A (p = 0.041). Two types of PE-type defects were depicted in 8 patients (group A: 5/51; 9.8%; group B: 3/12; 25%), superimposed on PH-related lung abnormalities (7/8) or normal lung (1/8). The iodine concentration was significantly lower in patients with abnormal perfusion (p < 0.001) but did not differ between groups. CONCLUSION: Perfusion abnormalities did not differ between the two groups at the exception of a higher median percentage of segments with PE-type defects in patients with PVOD/PCH. KEY POINTS: • Patchy perfusion defect was the most frequent pattern in PAH. • A variable association of perfusion abnormalities was seen in PVOD/PCH. • Lobular and PE-type perfusion defects larger than a sub-segment were depicted in both PAH and PVOD/PCH patients.
BACKGROUND: In the stratification of potential causes of PH, current guidelines recommend performing V/Q lung scintigraphy to screen for CTEPH. The recognition of CTEPH is based on the identification of lung segments or sub-segments without perfusion but preserved ventilation. The presence of mismatched perfusion defects has also been described in a small proportion of idiopathic pulmonary arterial hypertension (PAH) and pulmonary veno-occlusive disease and/or pulmonary capillary hemangiomatosis (PVOD/PCH). Dual-energy CT lung perfusion changes have not been specifically investigated in these two entities. PURPOSE: To compare dual-energy CT (DECT) perfusion characteristics in PAH and PVOD/PCH, with specific interest in PE-type perfusion defects. MATERIALS AND METHODS: Sixty-three patients with idiopathic or heritable PAH (group A; n = 51) and PVOD/PCH (group B; n = 12) were investigated with DECT angiography with reconstruction of morphologic and perfusion images. RESULTS: The number of patients with abnormal perfusion did not differ between group A (35/51; 68.6%) and group B (6/12; 50%) (p = 0.31) nor did the mean number of segments with abnormal perfusion per patient (group A: 17.9 ± 4.9; group B: 18.3 ± 4.1; p = 0.91). The most frequent finding was the presence of patchy defects in group A (15/35; 42.9%) and a variable association of perfusion abnormalities in group B (4/6; 66.7%). The median percentage of segments with PE-type defects per patient was significantly higher in group B than in group A (p = 0.041). Two types of PE-type defects were depicted in 8 patients (group A: 5/51; 9.8%; group B: 3/12; 25%), superimposed on PH-related lung abnormalities (7/8) or normal lung (1/8). The iodine concentration was significantly lower in patients with abnormal perfusion (p < 0.001) but did not differ between groups. CONCLUSION: Perfusion abnormalities did not differ between the two groups at the exception of a higher median percentage of segments with PE-type defects in patients with PVOD/PCH. KEY POINTS: • Patchy perfusion defect was the most frequent pattern in PAH. • A variable association of perfusion abnormalities was seen in PVOD/PCH. • Lobular and PE-type perfusion defects larger than a sub-segment were depicted in both PAH and PVOD/PCH patients.
Authors: S Carmona; M J Loureiro; J Santos; A Oliveira; R Camacho; A I Santos Journal: Rev Esp Med Nucl Imagen Mol Date: 2012-09-12 Impact factor: 1.359
Authors: Matthew K Fuld; Ahmed F Halaweish; Susan E Haynes; Abhay A Divekar; Junfeng Guo; Eric A Hoffman Journal: Radiology Date: 2012-11-28 Impact factor: 11.105