Skip to main content
SpringerLink
Log in

Evaluation of organized thrombus in distal pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension using cone-beam computed tomography

  • Original Article
  • Published:
Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

Balloon pulmonary angioplasty (BPA) is an emerging treatment for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) patients. However, the approach to use to identify distal thrombi suitable for BPA has not yet been established. The purpose of this work was therefore to evaluate distal chronic thromboembolic lesions for BPA using cone-beam computed tomography (CBCT).

Materials and methods

Thirty-two patients (men/women: 9/23) with CTEPH who underwent CBCT before BPA were enrolled. We assessed representative forms of chronic thromboembolic lesions in 94 segmental and/or 208 subsegmental branches according to CBCT and compared the results to the findings of selective angiography during BPA.

Results

We classified CTEPH lesions into five subtypes as follows: type 1a (11.1 %), webs; type 1b (14.4 %), web with severe narrowing of the subsegmental artery; type 2, (58.2 %) web and slits; type 3 (2.4 %), slits; and type 4 (13.9 %), pouch defect with incomplete obstruction of subsegmental branches or complete occlusion. In our study, 92.6 % of the CTEPH lesions diagnosed by CBCT were highly consistent with the findings of selective angiography during BPA.

Conclusion

CBCT clearly revealed and classified distal lesions in CTEPH patients. The CBCT findings for distal lesions were highly consistent with those of selective angiography during BPA. CBCT could be a useful modality to detect target lesions before BPA.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Hoeper MM, Mayer E, Simonneau G, Rubin LJ. Chronic thromboembolic pulmonary hypertension. Circulation. 2006;113:2011–20.

    Article  PubMed  Google Scholar 

  2. Mayer E, Jenkins D, Lindner J, D’Armini A, Kloek J, Meyns B, Ilkjaer LB, Klepetko W, Delcroix M, Lang I, Pepke-Zaba J, Simonneau G, Dartevelle P. Surgical management and outcome of patients with chronic thromboembolic pulmonary hypertension: results from an international prospective registry. J Thorac Cardiovasc Surg. 2011;141:702–10.

    Article  PubMed  Google Scholar 

  3. Mizoguchi H, Ogawa A, Munemasa M, Mikouchi H, Ito H, Matsubara H. Refined balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Circ Cardiovasc Interv. 2012;5:748–55.

    Article  PubMed  Google Scholar 

  4. Yamada N. Percutaneous transluminal pulmonary angioplasty for distal-type chronic thromboembolic pulmonary hypertension. Circ J. 2012;76:307–308.

  5. Feinstein JA, Goldhaber SZ, Lock JE, Ferndandes SM, Landzberg MJ. Balloon pulmonary angioplasty for treatment of chronic thromboembolic pulmonary hypertension. Circulation. 2001;103:10–3.

    Article  CAS  PubMed  Google Scholar 

  6. Fukui S, Ogo T, Morita Y, Tsuji A, Tateishi E, Ozaki K, Sanda Y, Fukuda T, Yasuda S, Ogawa H, Nakanishi N. Right ventricular reverse remodelling after balloon pulmonary angioplasty. Eur Respir J. 2014;43:1394–402.

    Article  PubMed  Google Scholar 

  7. Korn D, Gore I, Blenke A, Collins DP. Pulmonary arterial bands and webs: an unrecognized manifestation of organized pulmonary emboli. Am J Pathol. 1962;40:129–51.

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Sugiyama M, Fukuda T, Sanda Y, Morita Y, Higashi M, Ogo T, Tsuji A, Demachi J, Nakanishi N, Naito H. Organized thrombus in pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension; imaging with cone beam computed tomography. Jpn J Radiol. 2014;32:375–82.

    Article  PubMed  Google Scholar 

  9. Auger WR, Fedullo PF, Moser KM, Buchbinder M, Peterson KL. Chronic major-vessel thromboembolic pulmonary artery obstruction: appearance at angiography. Radiology. 1992;182:393–8.

    Article  CAS  PubMed  Google Scholar 

  10. Hinrichs JB, Marquardt S, von Falck C, Hoeper MM, Olsson KM, Wacker FK, Meyer BC. Comparison of C-arm computed tomography and digital subtraction angiography in patients with chronic thromboembolic pulmonary hypertension. Cardiovasc Intervent Radiol. 2016;39:53–63.

    Article  PubMed  Google Scholar 

  11. Reichelt A, Hoeper MM, Galanski M, Keberle M. Chronic thromboembolic pulmonary hypertension: evaluation with 64-detector row CT versus digital substraction angiography. Eur J Radiol. 2009;71:49–54.

    Article  PubMed  Google Scholar 

  12. Meyer BC, Frericks BB, Voges M, Borchert M, Martus P, Justiz J, Wolf KJ, Wacker FK. Visualization of hypervascular liver lesions during TACE: comparison of angiographic C-arm CT and MDCT. AJR Am J Roentgenol. 2008;190:W263–9.

    Article  PubMed  Google Scholar 

  13. Hinrichs JB, von Falck C, Hoeper MM, Olsson KM, Wacker FK, Meyer BC, Renne J. Pulmonary artery imaging in patients with chronic thromboembolic pulmonary hypertension: comparison of cone-beam CT and 64-row multidetector CT. J Vasc Interv Radiol. 2016;27:361–368.e2.

  14. Sugimura K, Fukumoto Y, Satoh K, Nochioka K, Miura Y, Aoki T, Tatebe S, Miyamichi-Yamamoto S, Shimokawa H. Percutaneous transluminal pulmonary angioplasty markedly improves pulmonary hemodynamics and long-term prognosis in patients with chronic thromboembolic pulmonary hypertension. Circ J 2011;76:485–488.

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Tetsuya Fukuda, Yoshihiro Sanda, Yoshiaki Morita, Munehiro Sugiyama & Hiroaki Naito

  2. Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan

    Takeshi Ogo, Norifumi Nakanishi, Jin Ueda, Shigefumi Fukui & Akihiro Tsuji

Authors
  1. Tetsuya Fukuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Ogo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Norifumi Nakanishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jin Ueda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshihiro Sanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yoshiaki Morita
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Munehiro Sugiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shigefumi Fukui
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akihiro Tsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroaki Naito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tetsuya Fukuda.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fukuda, T., Ogo, T., Nakanishi, N. et al. Evaluation of organized thrombus in distal pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension using cone-beam computed tomography. Jpn J Radiol 34, 423–431 (2016). https://doi.org/10.1007/s11604-016-0538-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11604-016-0538-2

Keywords

Search

Navigation