Abstract

To evaluate mosaic perfusion patterns and vascular lesions in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using C-Arm computed tomography (CACT) compared to computed tomography pulmonary angiography (CTPA). We included 41 patients (18 female; mean age 59.9 ± 18.3 years) with confirmed CTEPH who underwent CACT and CTPA within 21 days (average 5.3 ± 5.2). Two readers (R1; R2) independently evaluated datasets from both imaging techniques for mosaic perfusion patterns and presence of CTEPH-typical vascular lesions. The number of pulmonary arterial segments with typical findings was evaluated and the percentage of affected segments was calculated and categorized: < 25%; 25–49%; 50–75%; < 75% of all pulmonary arterial segments affected by thromboembolic vascular lesions. Inter-observer agreement was calculated for both modalities using the intraclass-correlation-coefficient (ICC). Based on consensus reading the inter-modality agreement (CACTcons vs. CTPAcons) was calculated using the ICC. Inter-observer agreement was excellent for central vascular lesions (ICC > 0.87) and the percentage of affected segments (ICC > 0.76) and good for the perceptibility of mosaic perfusion (ICC > 0.6) and attribution of the pattern of mosaic perfusion (ICC > 0.6) for both readers on CACT and CTPA. Inter-modality agreement was excellent for the perceptibility of mosaic perfusion (ICC = 1), the present perfusion pattern (ICC = 1) and central vascular lesions (ICC = 1). However, inter-modality agreement for the percentage of affected segments was fair (ICC = 0.50), with a greater proportion of identified affected segments on CACTcons. CACT demonstrates a high agreement with CTPA regarding the detection of mosaic perfusion. CACT detects a higher number of peripheral vascular lesions compared to CTPA.

Highlights

  • Abbreviations balloon pulmonary angioplasty (BPA) Balloon Pulmonary Angioplasty CACT C-Arm computed tomography CTEPH Chronic thromboembolic pulmonary hypertension CTPA Computed tomography pulmonary angiography digital subtraction angiography (DSA) Digital subtraction angiography

  • Mosaic perfusion detected on CTPA, is a frequent secondary diagnostic parameter in patients suffering from CTEPH, even in the absence of vascular lesions, reflecting the severity of perfusion changes due to chronic pulmonary ­embolism[3,7,8]

  • We aimed to evaluate the perceptibility of patterns of mosaic perfusion and peripheral vascular lesions typical for CTEPH on CACT in comparison to CTPA and to determine its diagnostic value for detection of perfusion inhomogeneities of the lung parenchyma

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Summary

Introduction

Abbreviations BPA Balloon Pulmonary Angioplasty CACT C-Arm computed tomography CTEPH Chronic thromboembolic pulmonary hypertension CTPA Computed tomography pulmonary angiography DSA Digital subtraction angiography. Detection of mosaic perfusion on CTPA in patients with known pulmonary hypertension should trigger further diagnostic work-up, typically including digital subtraction angiography (DSA)[1,4]. C-Arm computed tomography (CACT) of the pulmonary arteries is an alternative 3D imaging modality that combines imaging features typical for DSA and CTPA It can be acquired during the same session as DSA and offers images with a high spatial resolution that can lead to a more comprehensive imaging work-up of patients with suspected ­CTEPH9. We aimed to evaluate the perceptibility of patterns of mosaic perfusion and peripheral vascular lesions typical for CTEPH on CACT in comparison to CTPA and to determine its diagnostic value for detection of perfusion inhomogeneities of the lung parenchyma

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