Skip to main content
Log in

Lung perfusion characteristics in pulmonary arterial hypertension (PAH) and peripheral forms of chronic thromboembolic pulmonary hypertension (pCTEPH): Dual-energy CT experience in 31 patients

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

Abstract

Purpose

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).

Results

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.

Conclusion

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.

Key Points

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

PH:

Pulmonary hypertension

PAH:

Pulmonary arterial hypertension

CTEPH:

Chronic thromboembolic pulmonary hypertension

pCTEPH:

Peripheral chronic thromboembolic pulmonary hypertension

GGO:

Ground-glass opacities

DECT:

Dual-energy CT

References

  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 46:879–882

    Article  Google Scholar 

  2. Coulden R (2006) State-of-the-art imaging techniques in chronic thromboembolic pulmonary hypertension. Proc Am Thorac Soc 3:577–583

    Article  PubMed  Google Scholar 

  3. McLaughlin VV, Archer SL, Badesch DB et al (2009) ACCF/AHA 2009 expert consensus document on pulmonary hypertension. J Am Coll Cardiol 53:1573–1619

    Article  PubMed  Google Scholar 

  4. Lang IM, Plank C, Sadushi-Kolici R, Jakowitsch J, Klepetko W, Maurer G (2010) Imaging in pulmonary hypertension. J Am Coll Cardiol Img 3:1287–1295

    Article  Google Scholar 

  5. McLaughlin VV, Langer A, Tan M et al (2013) Contemporary trends in the diagnosis and management of pulmonary arterial hypertension. Chest 143:324–332

    Article  CAS  PubMed  Google Scholar 

  6. 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 

  7. Moser KM, Auger WR, Fedullo PF (1990) Chronic major vessel thrombo-embolic pulmonary hypertension. Circulation 81:1735–1743

    Article  CAS  PubMed  Google Scholar 

  8. Gopalan D, McCann C, Shaeres K, Screaton N (2012) Imaging in pulmonary hypertension, part 3: small vessel diseases. Postgrad Med J 88:397–406

    Article  PubMed  Google Scholar 

  9. 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 

  10. Hoey ETD, Mirsadraee S, Pepke-Zaba J, Jenkins DP, Gopalan D, Screaton NJ (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 

  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 35:590–595

    Article  PubMed  Google Scholar 

  12. 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 

  13. Kim EY, Seo JB, Oh SY et al (2014) Assessment of perfusion pattern and extent of perfusion defect on dual-energy CT angiography: correlations between the causes of pulmonary hypertension and vascular parameters. Korean J Radiol 15:286–294

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sheehan R, Perloff JK, Fishbein MC, Gjertson D, Aberle DR (2005) Pulmonary neovascularity. A distinctive radiographic finding in Eisenmenger syndrome. Circulation 112:2778–2785

    Article  PubMed  Google Scholar 

  15. Modolon C, Attinà D, Buia F et al (2012) Lung neovascularity in pulmonary arterial hypertension associated with congenital heart defects and idiopathic pulmonary arterial hypertension: study of 198 patients. Eur Radiol 22:1059–1066

    Article  PubMed  Google 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 Radiol

  17. Kim BH, Seo JB, Chae EJ, Lee HJ, Hwang HJ, Lim C (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 

  18. 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 

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

    Article  PubMed  Google Scholar 

  20. Pansini V, Remy-Jardin M, Faivre JB et al (2009) Assessment of lobar perfusion in smokers according to the presence and severity of emphysema: preliminary experience with dual-energy CT angiography. Eur Radiol 19:2834–2843

    Article  PubMed  Google Scholar 

  21. Alford S, van Beek EJR, McLennan G, Hoffman EA (2010) Heterogeneity of pulmonary perfusion as a mechanistic image-based phenotype in emphysema susceptible smokers. Proc Natl Acad Sci 107:7485–7490

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Rich S, Pietra GG, Kieras K, Hart K, Brundage BH (1986) Primary pulmonary hypertension: radiographic and scintigraphic patterns of histologic subtypes. Ann Intern Med 105:499–502

    Article  CAS  PubMed  Google Scholar 

  23. Ogawa Y, Nishimura T, Hayashida K, Uchara T, Shimonagata T (1993) Perfusion lung scintigraphy in primary pulmonary hypertension. Br J Radiol 66:677–680

    Article  CAS  PubMed  Google Scholar 

  24. Wilson AG, Harris CN, Lavender JP, Oakley CM (1973) Perfusion lung scanning in obliterative pulmonary hypertension. Br Heart J 35:917–930

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Powe JE, Palevsky HI, McCarthy KE, Alavi A (1987) Pulmonary arterial hypertension: value of perfusion scintigraphy. Radiology 164:727–730

    Article  CAS  PubMed  Google Scholar 

  26. Rich JD, Rich S (2014) Clinical diagnosis of pulmonary hypertension. Circulation 130:1820–1830

    Article  PubMed  Google Scholar 

  27. Galiè N, Hoeper MM, Humbert M et al (2009) Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 30:2493–2537

    Article  PubMed  Google Scholar 

  28. 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 

Download references

Acknowledgments

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.

Author information

Authors and Affiliations

Authors

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

Giordano, J., Khung, S., Duhamel, A. et al. Lung perfusion characteristics in pulmonary arterial hypertension (PAH) and peripheral forms of chronic thromboembolic pulmonary hypertension (pCTEPH): Dual-energy CT experience in 31 patients. Eur Radiol 27, 1631–1639 (2017). https://doi.org/10.1007/s00330-016-4500-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4500-6

Keywords

Navigation