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Quantitative analysis of pulmonary perfusion with dual-energy CT angiography: comparison of two quantification methods in patients with pulmonary embolism

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Abstract

The study aimed to evaluate a quantification method of pulmonary perfusion with Dual-Energy CT Angiography (DE-CTA) normalized by lung density in the prediction of outcome in acute pulmonary embolism (PE). In this prospective study with CTA scans acquired with different breathing protocols, two perfusion parameters were calculated: %PBV (relative value of PBV, expressed per unit volume) and PBVm (PBV normalized by lung density, expressed per unit mass). DE-CTA parameters were correlated with simplified pulmonary embolism severity index (sPESI) and with outcome groups, alone and in combinationwith tomographic right-to-left ventricular ratios (RV/LV). PBVm showed significant correlation with sPESI. PBVm presented higher accuracy than %PBV In the prediction of ICU admission or death in patients with PE, with the best performance when combined with RV/LV volumetric ratio.

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Abbreviations

DE-CTA:

Dual-Energy Computed Tomography Angiography

DIBH:

Deep inspiratory breath hold

ICU:

Intensive Care Unit

PBV:

Perfused blood volume

PE:

Pulmonary Embolism

RVD:

Right ventricular dysfunction

sPESI:

Simplified Pulmonary Embolism Severity Index

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Funding

This work was supported by Financiadora de Estudos e Projetos - FINEP (01140089000).

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Authors and Affiliations

  1. Department of Radiology, Hospital das Clinicas da Faculdade Medicina da Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Hye Ju Lee, Mark Wanderley, Vivian Cardinal da Silva Rubin & Jose Rodrigues Parga

  2. Pneumology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Instituto do Coracao, Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Glasiele Cristina Alcala, Eduardo Leite Vieira Costa & Marcelo Britto Passos Amato

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  1. Hye Ju Lee
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Contributions

HJL, ELVC, JRP and MBPA contributed to the study conception and design. Material preparation, data collection and analysis were performed by HJL, MW, VCDSR and GCA. The first draft of the manuscript was written by HJL. ELVC, JRP and MBPA were responsible for review of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Hye Ju Lee.

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The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This study was performed in accordance with the local institutional review board and local ethics committee approval (SDC 4175/15/002). Informed consent was obtained from all individual participants included in the study.

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Lee, H.J., Wanderley, M., da Silva Rubin, V.C. et al. Quantitative analysis of pulmonary perfusion with dual-energy CT angiography: comparison of two quantification methods in patients with pulmonary embolism. Int J Cardiovasc Imaging 39, 853–862 (2023). https://doi.org/10.1007/s10554-022-02781-y

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