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Quantitative lobar pulmonary perfusion assessment on dual-energy CT pulmonary angiography: applications in pulmonary embolism

  • Computed Tomography
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Abstract

Purpose

To assess quantitative lobar pulmonary perfusion on DECT-PA in patients with and without pulmonary embolism (PE).

Materials and methods

Our retrospective study included 88 adult patients (mean age 56 ± 19 years; 38 men, 50 women) who underwent DECT-PA (40 PE present; 48 PE absent) on a 384-slice, third-generation, dual-source CT. All DECT-PA examinations were reviewed to record the presence and location of occlusive and non-occlusive PE. Transverse thin (1 mm) DECT images (80/150 kV) were de-identified and exported offline for processing on a stand-alone deep learning–based prototype for automatic lung lobe segmentation and to obtain the mean attenuation numbers (in HU), contrast amount (in mg), and normalized iodine concentration per lung and lobe. The zonal volumes and mean enhancement were obtained from the Lung Analysis™ application. Data were analyzed with receiver operating characteristics (ROC) and analysis of variance (ANOVA).

Results

The automatic lung lobe segmentation was accurate in all DECT-PA (88; 100%). Both lobar and zonal perfusions were significantly lower in patients with PE compared with those without PE (p < 0.0001). The mean attenuation numbers, contrast amounts, and normalized iodine concentrations in different lobes were significantly lower in the patients with PE compared with those in the patients without PE (AUC 0.70–0.78; p < 0.0001). Patients with occlusive PE had significantly lower quantitative perfusion compared with those without occlusive PE (p < 0.0001).

Conclusion

The deep learning–based prototype enables accurate lung lobe segmentation and assessment of quantitative lobar perfusion from DECT-PA.

Key Points

• Deep learning–based prototype enables accurate lung lobe segmentation and assessment of quantitative lobar perfusion from DECT-PA.

• Quantitative lobar perfusion parameters (AUC up to 0.78) have a higher predicting presence of PE on DECT-PA examinations compared with the zonal perfusion parameters (AUC up to 0.72).

• The lobar-normalized iodine concentration has the highest AUC for both presence of PE and for differentiating occlusive and non-occlusive PE.

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Abbreviations

ANOVA:

Analysis of variance

AUC:

Area under the curve

CT:

Computed tomography

CTEPH:

Chronic thromboembolic pulmonary hypertension

DECT:

Dual-energy computed tomography

DECT-PA:

Dual-energy computed tomography pulmonary angiography

FOV:

Field of view

HU:

Hounsfield units

IRB:

Institutional review board

PBV:

Perfused blood volume

PE:

Pulmonary embolism

ROC:

Receiver operating characteristics

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Funding

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

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Authors and Affiliations

  1. Department of Thoracic Imaging, Massachusetts General Hospital, 75 Blossom Court, Boston, MA, USA

    Ramandeep Singh, Ryan Zipan Nie, Fatemeh Homayounieh & Mannudeep K. Kalra

  2. Harvard Medical School, Boston, MA, USA

    Ramandeep Singh, Ryan Zipan Nie, Fatemeh Homayounieh & Mannudeep K. Kalra

  3. Siemens Healthcare, Forchheim, Germany

    Bernhard Schmidt & Thomas Flohr

Authors
  1. Ramandeep Singh
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  2. Ryan Zipan Nie
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  3. Fatemeh Homayounieh
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  4. Bernhard Schmidt
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  6. Mannudeep K. Kalra
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Corresponding author

Correspondence to Ramandeep Singh.

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Guarantor

The scientific guarantor of this publication is Mannudeep K Kalra.

Conflict of interest

Two authors (Bernhard Schmidt and Thomas Flohr) are employees of Siemens Healthcare. One author (Mannudeep K. Kalra) has received research grant from Siemens Healthineers. The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Singh, R., Nie, R.Z., Homayounieh, F. et al. Quantitative lobar pulmonary perfusion assessment on dual-energy CT pulmonary angiography: applications in pulmonary embolism. Eur Radiol 30, 2535–2542 (2020). https://doi.org/10.1007/s00330-019-06607-9

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  • DOI: https://doi.org/10.1007/s00330-019-06607-9

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