La radiologia medica

, Volume 122, Issue 7, pp 495–504 | Cite as

A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension

  • Maria Barbara LeoneEmail author
  • Marica Giannotta
  • Massimiliano Palazzini
  • Mariano Cefarelli
  • Sofia Martìn Suàrez
  • Enrico Gotti
  • Maria Letizia Bacchi Reggiani
  • Maurizio Zompatori
  • Nazzareno Galiè



The aim of this study was to retrospectively assess the relationship between radiological and hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We introduced a new CT-score to evaluate hemodynamic changes, only employing CT-pulmonary angiography (CTPA).

Materials and methods

145 patients affected by CTEPH underwent hemodynamic and CTPA evaluation. Among these 145 patients, 69 underwent pulmonary endarterectomy (PEA) and performed a CTPA evaluation even after surgery. Hemodynamic assessment considered the values of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR), obtained through right heart catheterization (RHC). Radiological evaluation included CTPA signs of pulmonary hypertension.


A highly significant statistical correlation was observed between the new CT-score and both mPAP and PVR (p < 0.000) in the whole sample and also in the subgroup who underwent PEA. In addition, mPAP and PVR showed an important association with the severity of mosaic perfusion (p < 0.000). mPAP also correlated with main pulmonary artery diameter (p < 0.01); a significant association was found in both between PVR and tricuspid regurgitation(p < 0.000) and with PVR and presence of unilateral or bilateral pulmonary thromboembolic occlusion (p < 0.05).


Our results confirm the diagnostic role of CTPA in evaluating patients with CTEPH and in addition open a new horizon in assessing hemodynamic changes in patients with CTEPH, only employing a CTPA, especially when RHC is contraindicated or not possible.


Chronic thromboembolic pulmonary hypertension CT-pulmonary angiography Right heart catheterization Pulmonary endarterectomy A new CT-score for CTEPH 

Abbreviations and acronyms


Azygos vein


Bronchial arteries hypertrophy


Collateral circles


Cardio-pulmonary bypass


Coronary sinus


Chronic thromboembolic pulmonary hypertension


Computed tomography pulmonary angiography


Interventricular septum bowing


Left ventricle diameter


Mosaic perfusion


Pulmonary endarterectomy


Pulmonary artery


Pulmonary embolism


Pulmonary hypertension


Right atrium


Right ventricle


Right ventricle free wall thickness


Standard deviation


Superior vena cava


Tricuspid regurgitation


Compliance with ethical standards

No funds were used for the present study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Italian Society of Medical Radiology 2017

Authors and Affiliations

  • Maria Barbara Leone
    • 1
    Email author
  • Marica Giannotta
    • 1
  • Massimiliano Palazzini
    • 3
  • Mariano Cefarelli
    • 2
  • Sofia Martìn Suàrez
    • 2
  • Enrico Gotti
    • 3
  • Maria Letizia Bacchi Reggiani
    • 4
  • Maurizio Zompatori
    • 1
  • Nazzareno Galiè
    • 3
  1. 1.Department of Specialized, Diagnostic and Experimental MedicineUniversity of Bologna, Sant’Orsola-Malpighi HospitalBolognaItaly
  2. 2.Heart and Lung Transplantation Program, Cardiac Surgery DepartmentS. Orsola-Malpighi HospitalBolognaItaly
  3. 3.Institute of CardiologyS. Orsola-Malpighi HospitalBolognaItaly
  4. 4.Department of Cardiovascular DiseasesUniversity of Bologna, S. Orsola-Malpighi HospitalBolognaItaly

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