Lung perfusion characteristics in pulmonary arterial hypertension (PAH) and peripheral forms of chronic thromboembolic pulmonary hypertension (pCTEPH): Dual-energy CT experience in 31 patients
To compare lung perfusion in PAH and pCTEPH on dual-energy CT (DECT) examinations.
Materials and methods
Thirty-one patients with PAH (group 1; n = 19) and pCTEPH (group 2; n = 12) underwent a dual-energy chest CTA with reconstruction of diagnostic and perfusion images. Perfusion alterations were analysed at a segmental level. V/Q scintigraphy was available in 22 patients (group 1: 13/19; group 2: 9/12).
CT perfusion was abnormal in 52.6 % of group 1 patients and in 100 % of group 2 patients (p = 0.0051). The patterns of perfusion alteration significantly differed between the two groups (p < 0.0001): (1) in group 1, 96.6 % of segments with abnormal perfusion showed patchy defects; (2) in group 2, the most frequent abnormalities consisted of patchy (58.5 %) and PE-type (37.5 %) defects. Paired comparison of CT perfusion and scintigraphy showed concordant findings in 76.9 % of group 1 (10/13) and 100 % of group 2 (9/9) patients, with a predominant or an exclusive patchy pattern in group 1 and a mixed pattern of abnormalities in group 2.
Lung perfusion alterations at DECT are less frequent and more homogeneous in PAH than in pCTEPH, with a high level of concordant findings with V/Q scintigraphy.
• Depiction of chronic pulmonary embolism exclusively located on peripheral arteries is difficult.
• The main differential diagnosis of pCTEPH is PAH.
• The pattern of DECT perfusion changes can help differentiate PAH and pCETPH.
• In PAH, almost all segments with abnormal perfusion showed patchy defects.
• In pCTEPH, patchy and PE-type defects were the most frequent abnormalities.
KeywordsChronic thromboembolism Pulmonary hypertension CT angiography Dual-energy CT Lung perfusion
Pulmonary arterial hypertension
Chronic thromboembolic pulmonary hypertension
Peripheral chronic thromboembolic pulmonary hypertension
The scientific guarantor of this publication is Martine Remy-Jardin, MD, PhD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise: Prof. Alain Duhamel (Head of the Department of Biomedical Statistics–Lille University Centre). Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: prospective study, observational study, performed at one institution.
- 1.Galiè N, Humbert M, Vachiery JL et al (2015) 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ZRS): endorsed by the Association for European Paediatric and Congenital Cardiology (AEPC) and the International Society for Heart and Lung Transplantation (ISHLT). Eur Respir J 46:879–882CrossRefGoogle Scholar
- 11.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 35:590–595CrossRefPubMedGoogle Scholar
- 16.Le Faivre J, Duhamel A, Khung S et al (2016) Impact of CT perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience on 62 patients. Eur RadiolGoogle Scholar