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Semi-Quantitative Analysis of Lung Perfusion SPECT/CT for Evaluation of Response to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

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Abstract

Purpose

We aimed to investigate the response to balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH) using semi-quantitative analysis of lung perfusion SPECT/CT.

Methods

This is a single-center retrospective study of patients with CTEPH who underwent BPA and pre- and post-BPA lung perfusion SPECT/CT between 2015 and 2022. Segmental defects on SPECT/CT were visually assessed and semi-quantitatively scored as 1 (large defect) or 0.5 (moderate defect) in accordance with modified PIOPED II criteria. The perfusion defect score was defined as (Σ segmental defect scores/18) × 100 (%). Associations between perfusion defect score and hemodynamic or functional parameters including WHO functional class, six-minute walking distance (6MWD), serum B-type natriuretic peptide (BNP), mean arterial pulmonary pressure (mPAP), pulmonary vascular resistance (PVR), and tricuspid regurgitation pressure gradient (TRPG) on echocardiography were statistically analyzed.

Results

A total of 24 consecutive patients were included. The perfusion defect score significantly improved after BPA (median 58.3% vs. 47.2%, P < 0.001), in conjunction with the WHO functional class, 6MWD, serum BNP, mPAP, and TRPG. Perfusion defect scores were significantly correlated with 6MWD (rho = − 0.583, P < 0.001), serum BNP (rho = 0.514, P < 0.001), mPAP (rho = 0.583, P < 0.001), and PVR (rho = 0.575, P < 0.001). The improvement in the perfusion defect score was significantly associated with improvement in mPAP (rho = 0.844, P < 0.001).

Conclusion

Our results suggest that semi-quantitative analysis of lung perfusion SPECT/CT can provide a potential imaging biomarker for monitoring the efficacy of BPA.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Shin Ae Han, Sangwon Han, Jin-Sook Ryu & Dae Hyuk Moon

  2. Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Jinho Lee, Do-Yoon Kang, Dae-Hee Kim, Duk-Woo Park & Jong‑Min Song

  3. Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Jae Seung Lee

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  1. Shin Ae Han
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Correspondence to Sangwon Han.

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Ethical Statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the respective Institutional Research Committee and with the 2013 Helsinki Declaration and its later amendments or comparable ethical standards. The local institutional review board approved this retrospective study (IRB No. 2022-1324).

Informed Consent

The requirement for obtaining informed consent was waived (IRB No. 2022-1324).

Consent for Publication

The Institutional Review Board at our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

Conflict of Interest

Shin Ae Han, Sangwon Han, Jinho Lee, Do-Yoon Kang, Jae Seung Lee, Dae-Hee Kim, Duk-Woo Park, Jong-Min Song, Jin-Sook Ryu, Dae-Hyuk Moon declare that they have no conflicts of interest.

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Han, S.A., Han, S., Lee, J. et al. Semi-Quantitative Analysis of Lung Perfusion SPECT/CT for Evaluation of Response to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension. Nucl Med Mol Imaging (2024). https://doi.org/10.1007/s13139-024-00858-1

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