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Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH)

European Radiology volume 28, pages 5100–5110 (2018)Cite this article

Abstract

Objectives

To evaluate the concordance between DECT perfusion and ventilation/perfusion (V/Q) scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

Eighty patients underwent V/Q scintigraphy and DECT perfusion on a 2nd- and 3rd-generation dual-source CT system. The imaging criteria for diagnosing CTEPH relied on at least one segmental triangular perfusion defect on DECT perfusion studies and V/Q mismatch on scintigraphy examinations.

Results

Based on multidisciplinary expert decisions that did not include DECT perfusion, 36 patients were diagnosed with CTEPH and 44 patients with other aetiologies of PH. On DECT perfusion studies, there were 35 true positives, 6 false positives and 1 false negative (sensitivity 0.97, specificity 0.86, PPV 0.85, NPV 0.97). On V/Q scans, there were 35 true positives and 1 false negative (sensitivity 0.97, specificity 1, PPV 1, NPV 0.98). There was excellent agreement between CT perfusion and scintigraphy in diagnosing CTEPH (kappa value 0.80). Combined information from DECT perfusion and CT angiographic images enabled correct reclassification of the 6 false positives and the unique false negative case of DECT perfusion.

Conclusion

There is excellent agreement between DECT perfusion and V/Q scintigraphy in diagnosing CTEPH. The diagnostic accuracy of DECT perfusion is reinforced by the morpho-functional analysis of data sets.

Key Points

• Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by surgery.

• The triage of patients with pulmonary hypertension currently relies on scintigraphy.

• Dual-energy CT (DECT) can provide standard diagnostic information and lung perfusion from a single acquisition.

• There is excellent agreement between DECT perfusion and scintigraphy in separating CTEPH and non-CTEPH patients.

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Abbreviations

CT:

Computed tomography

CTA:

Computed tomography angiography

CTEPH:

Chronic thromboembolic pulmonary hypertension

DECT:

Dual-energy CT

MDCT:

Multidetector CT

PAH:

Pulmonary arterial hypertension

PBV:

Pulmonary blood volume

PH:

Pulmonary hypertension

V/Q:

Ventilation/perfusion

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Funding

The authors state that this work has not received any funding.

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Affiliations

  1. Department of Thoracic Imaging, Calmette Hospital (EA 2694); CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France

    Matthieu Masy, Jessica Giordano, Jacques Remy & Martine Remy-Jardin

  2. Department of Nuclear Medicine; Salengro Hospital, University of Lille, CHU Lille, F-59000, Lille, France

    Grégory Petyt & Claude Hossein-Foucher

  3. Department of Biostatistics (EA 2694), CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France

    Alain Duhamel & Maeva Kyheng

  4. Department of Cardiology; Cardiology Hospital, University of Lille, CHU Lille, F-59000, Lille, France

    Pascal De Groote, Marie Fertin & Nicolas Lamblin

  5. INSERM U1167, Institut Pasteur de Lille, F-59000, Lille, France

    Pascal De Groote, Marie Fertin & Nicolas Lamblin

  6. Department of Pulmonology, Calmette Hospital; University of Lille, CHU Lille, F-59000, Lille, France

    Jean-François Bervar

Authors
  1. Matthieu Masy
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  2. Jessica Giordano
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  3. Grégory Petyt
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  4. Claude Hossein-Foucher
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  5. Alain Duhamel
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  6. Maeva Kyheng
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  7. Pascal De Groote
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  8. Marie Fertin
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  9. Nicolas Lamblin
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  10. Jean-François Bervar
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  11. Jacques Remy
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  12. Martine Remy-Jardin
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Corresponding author

Correspondence to Martine Remy-Jardin.

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The scientific guarantor of this publication is Pr Martine Remy-Jardin.

Conflict of interest

Only two authors Martine Remy-Jardin and Jacques Remy declare conflict of interest with Siemens Healthineers.

The other authors have no conflicts of interest related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the institutional review board.

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Methodology

• retrospective

• observational

• performed at one institution

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Masy, M., Giordano, J., Petyt, G. et al. Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol 28, 5100–5110 (2018). https://doi.org/10.1007/s00330-018-5467-2

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  • DOI: https://doi.org/10.1007/s00330-018-5467-2

Keywords

  • Pulmonary hypertension
  • Pulmonary embolism
  • CT angiography