Comparison of C-arm Computed Tomography and Digital Subtraction Angiography in Patients with Chronic Thromboembolic Pulmonary Hypertension

Abstract

Purpose

To assess the feasibility and diagnostic performance of contrast-enhanced, C-arm computed tomography (CACT) of the pulmonary arteries compared to digital subtraction angiography (DSA) in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH).

Materials

Fifty-two patients with CTEPH underwent ECG-gated DSA and contrast-enhanced CACT. Two readers (R1, R2) independently evaluated pulmonary artery segments and their sub-segmental branching using DSA and CACT for optimal image quality. Afterwards, the diagnostic findings, i.e., intraluminal filling defects, stenosis, and occlusion, were compared. Inter-modality and inter-observer agreement was calculated, and subsequently consensus reading was done and correlated to a reference standard representing the overall consensus of both modalities. Fisher’s exact test and Cohen’s Kappa were applied.

Results

A total of 1352 pulmonary segments were evaluated, of which 1255 (92.8 %) on DSA and 1256 (92.9 %) on CACT were rated to be fully diagnostic. The main causes of the non-diagnostic image quality were motion artifacts on CACT (R1:37, R2:78) and insufficient contrast enhancement on DSA (R1:59, R2:38). Inter-observer agreement was good for DSA (κ = 0.74) and CACT (κ = 0.75), while inter-modality agreement was moderate (R1: κ = 0.46, R2: κ = 0.47). Compared to the reference standard, the inter-modality agreement for CACT was excellent (κ = 0.96), whereas it was inferior for DSA (κ = 0.61) due to the higher number of abnormal consensus findings read as normal on DSA.

Conclusion

CACT of the pulmonary arteries is feasible and provides additional information to DSA. CACT has the potential to improve the diagnostic work-up of patients with CTEPH and may be particularly useful prior to surgical or interventional treatment.

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Conflict of interest

Jan Hinrichs: No conflict of interest; Steffen Marquardt: No conflict of interest; Christian von Falck: Grants from Siemens Healthcare outside the submitted work; Marius Hoeper: Fees from Actelion, personal fees from Bayer, personal fees from GSK, personal fees from Pfizer, outside the submitted work; Karen Olsson: No conflict of interest; Frank Wacker: Grants from Siemens Healthcare, grants from DFG, Rebirth-Cluster of Excellence, grants from BMBF, German Centre for Lung Research (DZL), grants from Promedicus Ltd., outside the submitted work; Bernhard Meyer: Grants from Siemens Healthcare, during the conduct of the study, outside the submitted work; grants from Promedicus Ltd., outside the submitted work.

Statement of Informed Consent and Human Rights

Our local ethics committee approved our protocol, and written informed consent was obtained from each study patient. The study follows the ethical standards of the Declaration of Helsinki. Under “Materials and Methods”—The article includes no identifying information (does not apply to this article).

Statement of Human Rights and Animal rights

The study follows the ethical standards of the Declaration of Helsinki. Under “Materials and Methods”—Animal studies are not part of this article (does not apply to this article).

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Correspondence to Jan B. Hinrichs.

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Hinrichs, J.B., Marquardt, S., von Falck, C. et al. Comparison of C-arm Computed Tomography and Digital Subtraction Angiography in Patients with Chronic Thromboembolic Pulmonary Hypertension. Cardiovasc Intervent Radiol 39, 53–63 (2016). https://doi.org/10.1007/s00270-015-1090-7

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Keywords

  • C-arm computed tomography
  • Cone beam CT
  • Chronic thromboembolic pulmonary hypertension
  • Balloon pulmonary angioplasty