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Chronic thromboembolic pulmonary hypertension: Evaluation of 2D-perfusion angiography in patients who undergo balloon pulmonary angioplasty

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the feasibility of 2D-perfusion angiography (2D-PA) in order to quantify perfusion changes of the lung parenchyma pre- and post-balloon pulmonary angioplasty (BPA).

Methods

Thirty consecutive interventions in 16 patients with 99 treated pulmonary artery segments were included. To quantify changes in pulmonary blood flow using 2D-PA, the acquired digital subtraction angiographies (DSA) pre- and post-BPA were post-processed. A reference ROI in the treated pulmonary artery and a distal target ROI in the lung parenchyma were placed in corresponding areas on DSA pre- and post-BPA. Time to peak (TTP), peak density (PD) and area under the curve (AUC) were assessed. The ratios reference ROI to target ROI (TTPparenchyma/TTPinflow; PDparenchyma/PDinflow; AUCparenchyma/AUCinflow) were calculated. Relative differences of the 2D-PA parameters were correlated to changes in the pulmonary-flow-grade-score.

Results

The pulmonary-flow-grade-score improved after BPA (p<0.0001). Likewise, the ratio TTPparenchyma/TTPinflow shortened by 10% (p=0.0002), the PDparenchyma/PDinflow increased by 46% (p<0.0001) and the AUCparenchyma/AUCinflow increased by 36% (p<0.0001). A significant correlation between changes in the pulmonary-flow-grade-score and changes in PDparenchyma/PDinflow (ρ=0.48, p<0.0001) and AUCparenchyma/AUCinflow (ρ=0.31, p=0.0018) was observed.

Conclusion

Quantification of pulmonary perfusion pre- and post-BPA using 2D-PA is feasible and has the potential to improve monitoring of BPA.

Key points

• Quantification of BPA results by use of 2D-PA is feasible.

• 2D-PA allows objective assessment of changes in lung parenchymal perfusion.

• 2D-PA has the potential to optimize BPA.

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Abbreviations

2D-PA:

2D perfusion angiography

AUC:

Area under the curve

BMI:

Body mass index

BPA:

Balloon pulmonary angioplasty

CACT:

C-Arm computed tomography

CTEPH:

Chronic thromboembolic pulmonary hypertension

DSA:

Digital subtraction angiography

mPAP:

Mean pulmonary arterial pressure

PD:

Peak density

PEA:

Pulmonary endarterectomy

PH:

Pulmonary hypertension

PVR:

Pulmonary vascular resistance

ROI:

Region of interest

TACE:

Transarterial chemoembolisation

TTP:

Time to peak

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany

    Sabine K. Maschke, Julius Renne, Thomas Werncke, Frank K. Wacker, Bernhard C. Meyer & Jan B. Hinrichs

  2. Clinic for Pneumology, Hannover Medical School, Hannover, Germany

    Karen M. Olsson & Marius M. Hoeper

Authors
  1. Sabine K. Maschke
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  2. Julius Renne
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  3. Thomas Werncke
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  4. Karen M. Olsson
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  5. Marius M. Hoeper
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  6. Frank K. Wacker
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  7. Bernhard C. Meyer
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  8. Jan B. Hinrichs
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Corresponding author

Correspondence to Jan B. Hinrichs.

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Guarantor

The scientific guarantor of this publication is Frank Wacker.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Siemens Healthcare and ProMedicus (Bernhard Meyer and Frank Wacker; outside the submitted work); Bayer (Marius Hoeper and Karen Olsson; outside the submitted work).

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.

Funding

The study was funded in parts by the the German Centre for Lung Research (DZL) and by personal grants from the “Junge Akademie” of Hannover Medical School (Dr. Hinrichs and Dr. Renne).

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

No study subjects or cohorts have been previously reported.

Methodology:

• Retrospective

• Experimental / intra-individual comparison

• Performed at one institution

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Cite this article

Maschke, S.K., Renne, J., Werncke, T. et al. Chronic thromboembolic pulmonary hypertension: Evaluation of 2D-perfusion angiography in patients who undergo balloon pulmonary angioplasty. Eur Radiol 27, 4264–4270 (2017). https://doi.org/10.1007/s00330-017-4806-z

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  • DOI: https://doi.org/10.1007/s00330-017-4806-z

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