Skip to main content
SpringerLink
Log in

Impact of CT perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience in 62 patients

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the impact of CT perfusion imaging on the detection of peripheral chronic pulmonary embolisms (CPE).

Materials and methods

62 patients underwent a dual-energy chest CT angiographic examination with (a) reconstruction of diagnostic and perfusion images; (b) enabling depiction of vascular features of peripheral CPE on diagnostic images and perfusion defects (20 segments/patient; total: 1240 segments examined). The interpretation of diagnostic images was of two types: (a) standard (i.e., based on cross-sectional images alone) or (b) detailed (i.e., based on cross-sectional images and MIPs).

Results

The segment-based analysis showed (a) 1179 segments analyzable on both imaging modalities and 61 segments rated as nonanalyzable on perfusion images; (b) the percentage of diseased segments was increased by 7.2 % when perfusion imaging was compared to the detailed reading of diagnostic images, and by 26.6 % when compared to the standard reading of images.

At a patient level, the extent of peripheral CPE was higher on perfusion imaging, with a greater impact when compared to the standard reading of diagnostic images (number of patients with a greater number of diseased segments: n = 45; 72.6 % of the study population).

Conclusion

Perfusion imaging allows recognition of a greater extent of peripheral CPE compared to diagnostic imaging.

Key Points

• Dual-energy computed tomography generates standard diagnostic imaging and lung perfusion analysis.

• Depiction of CPE on central arteries relies on standard diagnostic imaging.

• Detection of peripheral CPE is improved by perfusion imaging.

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.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Lang I, Madani M (2014) Update on chronic thromboembolic pulmonary hypertension. Circulation 130:508–518

    Article  PubMed  Google Scholar 

  2. Auger WR, Fedullo PF, Moser KM et al (1992) Chronic major-vessel thromboembolic pulmonary artery obstruction: appearance at angiography. Radiology 182:393–398

    Article  CAS  PubMed  Google Scholar 

  3. Jamieson SW, Kapelanski DP, Sakakibara N et al (2003) Pulmonary endarterectomy : experience and lessons learned in 1,500 cases. Ann Thorac Surg 76:1457–1462

    Article  PubMed  Google Scholar 

  4. Thistlethwaite PA, Mo M, Madani MM et al (2002) Operative classicifcation of thromboembolic disease determines outcome after pulmonary endarterectomy. J Thorac Cardiovasc Surg 124:1203–1211

    Article  PubMed  Google Scholar 

  5. Madani MM, Auger WR, Pretorius V et al (2012) Pulmonary endarterectomy: recent changes in a single institution’s experience of more than 2,700 patients. Ann Thorac Surg 94:97–103

    Article  PubMed  Google Scholar 

  6. Stein PD, Kayali F, Hull RD (2007) Spiral computed tomography for the diagnosis of acute pulmonary embolism. J Thromb Haemost 98:713–720

    CAS  Google Scholar 

  7. Strashun AM (2007) A reduced role of V/Q scintigraphy in the diagnosis of acute pulmonary embolism. J Nucl Med 48:1405–1407

    Article  PubMed  Google Scholar 

  8. Roach PJ, Thomas P, Bajc et al (2008) Merits of V/Q SPECT scintigraphy compared with CTPA in imaging of pulmonary embolism. J Nucl Med 49:167–168

    Article  PubMed  Google Scholar 

  9. Ley S, Ley-Zaporozhan J, Pitton MB et al (2012) Diagnostic performance of state-of-the art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol 22:607–616

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  11. Kim BH, Seo JB, Chae EJ et al (2012) Analysis of perfusion defects by causes other than acute pulmonary thromboembolism on contrast-enhanced dual-energy CT in consecutive 537 patients. Eur J Radiol 81:e647–e652

    Article  PubMed  Google Scholar 

  12. Sugiura T, Tanabe N, Matsuura Y et al (2013) Role of 320-slice CT imaging in the diagnostic workup of patients with chronic thromboembolic pulmonary hypertension. Chest 143:1070–1077

    Article  PubMed  Google Scholar 

  13. Galiè N, Kim NHS (2006) Pulmonary microvascular disease in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc 3:571–576

    Article  PubMed  Google Scholar 

  14. Hoey ETD, Mirsadraee S, Pepke-Zaba J et al (2011) Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: Initial experience. AJR 196:524–532

    Article  PubMed  Google Scholar 

  15. Oikonomou A, Dennie CJ, Muller NL et al (2004) Chronic thromboembolic pulmonary arterial hypertension : correlation of postoperative results of thromboendarterectomy with preoperative helical contrast-enhanced computed tomography. J Thorac Imaging 19:67–73

    Article  PubMed  Google Scholar 

  16. Rubens F, Wells P, Beneze S et al (2000) Surgical treatment of chronic thromboembolic pulmonary hypertension. Can Respir J 7:49–57

    Article  CAS  PubMed  Google Scholar 

  17. Fedullo PF, Auger RW, Charnick RN et al (2001) Chronic thromboembolic pulmonary hypertension. Clin Chest Med 22:561–568

    Article  CAS  PubMed  Google Scholar 

  18. Heinrich M, Uder M, Tscholl D et al (2005) CT scan findings in chronic thromboembolic pulmonary hypertension. Predictors of hemodynamic improvement after pulmonary thromboendarterectomy. Chest 127:1606–1613

    Article  PubMed  Google Scholar 

  19. Auger WR, Kim NH, Trow TK (2010) Chronic thromboembolic pulmonary hypertension. Clin Chest Med 31:741–758

    Article  PubMed  Google Scholar 

  20. Pontana F, Faivre JB, Remy-Jardin M et al (2008) Lung perfusion with dual-energy multidetector-row CT (MDCT): feasibility for the evaluation of pulmonary embolism in 117 consecutive patients. Acad Radiol 15:1494–1504

    Article  PubMed  Google Scholar 

  21. Apfalter P, Bachmann V, Meyer M et al (2012) Prognostic value of perfusion defect volume at dual-energy CTA in patients with pulmonary embolism: correlation with CTA obstruction scores, CT parameters or right ventricular dysfunction and adverse clinical outcome. Eur J Radiol 81:3592–3597

    Article  Google Scholar 

  22. Okada M, Nakashima Y, Kunihiro Y et al (2013) Volumetric evaluation of dual-energy perfusion CT for the assessment of intrapulmonary clot burden. Clin Radiol 68:e669–e675

    Article  CAS  PubMed  Google Scholar 

  23. Renard B, Remy-Jardin M, Santangelo T et al (2011) Dual-energy CT angiography of chronic thromboembolic disease : can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects ? Eur J Radiol 79:467–472

    Article  PubMed  Google Scholar 

  24. Nakazawa T, Watanabe Y, Hori Y et al (2011) Lung perfused blood volume images with dual-energy computed tomography for chronic thromboembolic pulmonary hypertension: correlation to scintigraphy with single-photon emission computed tomography. J Comput Assist Tomogr 35:590–595

    Article  PubMed  Google Scholar 

  25. Ameli-Renani S, Ramsay L, Bacon JL et al (2014) Dual-energy computed tomography in the assessment of vascular and parenchymal enhancement in suspected pulmonary hypertension. J Thorac Imaging 29:98–106

    Article  PubMed  Google Scholar 

  26. Dournes G, Verdier D, Montaudon M et al (2014) Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy. Eur Radiol 24:42–51

    Article  PubMed  Google Scholar 

  27. Deak PD, Smal Y, Kalender WA (2010) Multisection CT protocols: sex- and age-specific conversion factors used to determine effective dose from dose-length-product. Radiology 257:158–166

    Article  PubMed  Google Scholar 

  28. Boyden EA (1954) Segmental anatomy of the lungs. Mc Graw Hill, New York

    Google Scholar 

  29. Remy-Jardin M, Duhamel A, Deken V, Bouaziz N, Dumont P, Remy J (2005) Systemic collateral supply in chronic thromboembolic and primary pulmonary hypertension: assessment with multi-detector row helical CT angiography. Radiology 235:274–281

    Article  PubMed  Google Scholar 

  30. Landis JR, Koch GG (1977) The measurement of interobserver agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  31. Bergin CJ, Sirlin C, Deutsch R et al (2000) Predictors of patient response to pulmonary thromboendarterectomy. AJR 174:509–515

    Article  CAS  PubMed  Google Scholar 

  32. Tanabe N, Sugiura T, Jujo T et al (2012) Subpleural perfusion as a predictor for a poor surgical outcome in chronic thromboembolic pulmonary hypertension. Chest 141:929–934

    Article  PubMed  Google Scholar 

  33. Pepke-Zaba J (2010) Diagnostic testing to guide the management of chronic thromboembolic pulmonary hypertension: state-of-the art. Eur Respir Rev 19:55–58

    Article  CAS  PubMed  Google Scholar 

  34. Ley S, Kreitner KF, Morgenstern I et al (2002) Bronchopulmonary shunts in patients with chronic thromboembolic pulmonary hypertension: evaluation with helical CT and MR imaging. AJR 179:1209–1215

    Article  PubMed  Google Scholar 

  35. Hong YJ, Kim JY, Choe KO et al (2013) Different perfusion pattern between acute and chronic pulmonary thromboembolism : evaluation with two-phase dual-energy perfusion CT. AJR 200:812–817

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Martine REMY-JARDIN. Two authors of this manuscript declare relationships with Siemens Healthcare: Pr Jacques REMY is consultant for Siemens; Pr Martine REMY-JARDIN has received research support for clinical research activities. The authors state that this work has not received any funding. One of the authors (Pr Alain DUHAMEL) has significant statistical expertise. He is the head of the department of biomedical statistics at our University Centre. Institutional review board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: prospective, observational, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Thoracic Imaging, Hospital Calmette, University of Lille, CHU Lille, EA 2694, F-59000, Lille, France

    Julien Le Faivre, Suonita Khung, Jean-Baptiste Faivre, Jacques Remy & Martine Remy-Jardin

  2. Department of Biostatistics, University of Lille, CHU Lille, EA 2694, F-59000, Lille, France

    Alain Duhamel

  3. Department of Cardiology, Cardiology Hospital, University of Lille, CHU Lille, F-59000, Lille, France

    Nicolas Lamblin

Authors
  1. Julien Le Faivre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alain Duhamel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suonita Khung
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean-Baptiste Faivre
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Nicolas Lamblin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jacques Remy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Martine Remy-Jardin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martine Remy-Jardin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Le Faivre, J., Duhamel, A., Khung, S. et al. Impact of CT perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience in 62 patients. Eur Radiol 26, 4011–4020 (2016). https://doi.org/10.1007/s00330-016-4262-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4262-1

Keywords

Search

Navigation