Abstract
Purpose: Dual-energy CT (DECT) can be used for quantification of lung perfusion blood volume (PBV), allowing objective evaluation. However, no reports have investigated pulmonary perfusion correlating with pulmonary artery pressure (PAP) in patients with chronic pulmonary diseases. The purpose was to evaluate automated quantification of the lung PBV using dual-energy CT, and its correlation with PAP. Methods: 274 patients who underwent echocardiography within two weeks also underwent CT. The population was divided into high (≥40 mmHg) and low (<40 mmHg) estimated systolic PAP (sPAP) groups (n = 63 and n = 211, respectively). We retrospectively eva-luated the lung PBV using Syngo software, and correlations between the lung PBV and estimated sPAP. Results: Lung PBV values were 25.0 ± 9.6 and 29.0 ± 9.3 Hounsfield units (HU) in high and low sPAP groups, respectively, with a significant difference between them (p = 0.003). In the high sPAP group with underlying lung diseases (n = 15), chronic thromboembolism (n = 25), pulmonary artery stenosis (n = 12), and left heart failure (n = 11), using the Dana Point classification system, lung PBV values were 18.6 ± 1.6, 25.1 ± 4.5, 25.8 ± 4.5, and 32.7 ± 9.4 HU, respectively. There were significant differences in quantification of the lung PBV among them. The mean sPAP of subjects with left heart failure was significantly higher than in the others. In subjects with left heart failure, a positive correlation between the lung PBV value and sPAP was noted (R = 0.721, p < 0.0001). Conclusions: Automated quantification of the lung PBV may estimate the high sPAP. The lung PBV may contribute to clarifying the etiology of a high PAP due to left heart failure.
Highlights
Dual-energy CT systems have been widely used for the various organs
We evaluated the relationship between automated quantification of the lung perfusion blood volume (PBV) and underlying diseases in the high pulmonary artery pressure (PAP) group
In subjects with a high systolic PAP (sPAP), the underlying diseases were determined based on medical records and CT findings by a radiologist as follows: pulmonary artery stenosis (n = 12) [idiopathic pulmonary hypertension (PH) (n = 10) and congenital shunt disease (n = 2)], left heart failure (n = 11) [mitral valve stenosis (n = 7), aortic valve stenosis (n = 3), and/or mitral valve regurgitation (n = 3)], lung disease (n = 15), and chronic thromboembolism (n = 25), using the Dana Point classification system [7]-[9]
Summary
Dual-energy CT systems have been widely used for the various organs. Dual-energy CT pulmonary angiography does not expose subjects to any significant additional radiation beyond that of standard CT pulmonary angiography [1]-[4]. Post-processing software can provide an iodine distribution map image. These maps represent the cartography of iodine content in the lung parenchyma at the time point of the first pass of contrast media in each examination [4]. Recent softwares (Syngo MultiModality; Siemens Healthcare, Erlagen, Germany) have been suggested for quantification of lung perfusion blood volume (PBV), allowing objective evaluation [3] [4]. Few reports have investigated pulmonary perfusion correlating with pulmonary artery pressure (PAP) in patients with chronic pulmonary diseases
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