Highlights
- •Spectral detector CT is valuable tool in the diagnostic work-up of PH.
- •Spectral detector CT differentiates CTEPH from PH of other causes.
- •SDCT/DECT has the potential to make V/Q-Scintigraphy obsolete for diagnosis of CTEPH.
Abstract
Objectives
To evaluate the value of spectral-detector CT (SDCT) in the diagnosis of chronic thromboembolic
pulmonary hypertension (CTEPH), its differentiation against other etiologies of pulmonary
hypertension (PH) and in the prediction of disease severity.
Materials and methods
60 patients with suspected PH underwent SDCT. Additional diagnostic tests in accordance
with the ESC guidelines including right heart catherization and VQ-SPECT were performed.
After full diagnostic work-up patients were classified as: 21 precapillary PH, 5 postcapillary
PH, 6 combined pre- and postcapillary PH, 19 CTEPH, 9 no PH. SDCT examinations were
analyzed by two blinded readers deciding on the diagnosis of CTEPH and scoring the
extent of perfusion abnormalities on iodine density images. An additional reading
was performed using conventional CTPA images only.
Results
With access to SDCT data, both readers reached a sensitivity of 100% for the diagnosis
of CTEPH with a specificity of 95.1% and 87.8%. On analysis of conventional CTPA images
alone, specificity and diagnostic confidence decreased for both readers (Specificity
90.2 and 85.3%) while sensitivity dropped for the less experienced reader only (Sensitivity
78.9%). Patients with PH showed significantly more perfusion abnormalities than patients
without PH (16.6 ± 8.4 vs. 9.5 ± 8.9 p < 0.001) and the extent of perfusion abnormalities
correlated with the mean pulmonary artery pressure (r = 0.37 p = 0.008).
Conclusions
SDCT offers confident identification of patients with CTEPH and enables a comprehensive
analysis of pulmonary vasculature, pulmonary perfusion and the lung parenchyma in
a single examination for patients with suspected PH.
Abbreviations:
PH (pulmonary hypertension), CTEPH (chronic thromboembolic pulmonary hypertension), CT (computed tomography), SDCT (spectral detector computed tomography), V/Q (ventilation/perfusion), RHC (right heart catheterization), mPAP (main pulmonary artery pressure), CTPA (CT pulmonary angiography), DECT (dual energy CT), IDI (iodine density image), AA (ascending aorta), MPA/RPA/LPA (main/right/left pulmonary artery), RV/LV (right/left ventricle), cpc-PH (combined pre- and postcapillary PH)Keywords
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Article info
Publication history
Published online: March 13, 2019
Accepted:
March 11,
2019
Received in revised form:
February 4,
2019
Received:
October 2,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
