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Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy

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Abstract

Objectives

To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy.

Methods

Forty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated.

Results

Fourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively.

Conclusions

Both DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities.

Key Points

• Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially treatable by surgery.

• Dual-energy computed tomography (DECT) allows angiography and perfusion using a single acquisition.

• Both DECT perfusion and angiography showed satisfactory diagnostic performance in CTEPH.

• DECT perfusion was more accurate than angiography in identifying segmental abnormalities.

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Authors and Affiliations

  1. CHU Bordeaux, Department of Medical Imaging, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France

    Gaël Dournes, Damien Verdier, Michel Montaudon, Olivier Corneloup, François Laurent & Mathieu Lederlin

  2. University Bordeaux Segalen, 146 rue Léo Saignat, 33076, Bordeaux Cedex, France

    Gaël Dournes, Damien Verdier, Michel Montaudon, François Laurent & Mathieu Lederlin

  3. CHU Bordeaux, Department of Nuclear Medicine, Hôpital Haut-Lévêque, 33600, Pessac, France

    Eric Bullier & Annalisa Rivière

  4. CHU Bordeaux, Department of Respiratory Diseases, Hôpital Haut-Lévêque, 33600, Pessac, France

    Claire Dromer

  5. CHU Bordeaux, Department of Cardiology, Hôpital Haut-Lévêque, 33600, Pessac, France

    François Picard

  6. CHU Bordeaux, Department of Cardiac Surgery, Hôpital Haut-Lévêque, 33600, Pessac, France

    Marc-Alain Billes

Authors
  1. Gaël Dournes
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  2. Damien Verdier
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  3. Michel Montaudon
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  4. Eric Bullier
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  5. Annalisa Rivière
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  6. Claire Dromer
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  7. François Picard
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  8. Marc-Alain Billes
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  9. Olivier Corneloup
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  10. François Laurent
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  11. Mathieu Lederlin
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Corresponding author

Correspondence to Mathieu Lederlin.

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Dournes, G., Verdier, D., Montaudon, M. et al. Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy. Eur Radiol 24, 42–51 (2014). https://doi.org/10.1007/s00330-013-2975-y

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  • DOI: https://doi.org/10.1007/s00330-013-2975-y

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