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Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: initial experience.

Hoey, Edward T D and Mirsadraee, Saeed and Pepke-Zaba, Joanna and Jenkins, David P and Gopalan, Deepa and Screaton, Nicholas J (2011) Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: initial experience. AJR. American journal of roentgenology, 196 (3). pp. 524-32. ISSN 1546-3141. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://www.ajronline.org/doi/abs/10.2214/AJR.10.48...

Abstract

OBJECTIVE

This study assessed the utility of dual-energy pulmonary CT angiography (CTA) for noninvasive assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Regional perfusion abnormalities were correlated with hemodynamic parameters and structural abnormalities on pulmonary CTA.

SUBJECTS AND METHODS

Twenty patients with CTEPH (11 men and nine women; mean age, 61.5 years) underwent pulmonary CTA with a dual-energy technique. Right heart catheterization data were available in 15 cases. Scan parameters were as follows: tube A, 140 kV (75 mA); tube B, 80 kV (300 mA); gantry rotation, 500 milliseconds; pitch, 0.5; and collimation, 14 × 1.2 mm. An iodine map was generated via three-material-decomposition and was scored for extent of hypoperfusion. Correlation was made with mosaic attenuation pattern, extent of vascular obstruction, and right heart hemodynamics. Iodine attenuation values were analyzed within completely occluded, partially occluded, and disease-free lobes.

RESULTS

A strong correlation existed between dual-energy CT-derived perfusion and mosaic attenuation pattern when both lobar (r > 0.6; n = 20; p < 0.006) and whole-lung scores were assessed (r = 0.77; n = 20; p < 0.001). There was no statistically significant correlation between dual-energy CT perfusion and vascular obstructive index, mean pulmonary artery pressure, or pulmonary vascular resistance (p > 0.08). Of 42 completely occluded lobes, 27 (64%) had demonstrable residual perfusion (mismatching), suggesting that blood supply was maintained via systemic collaterals.

CONCLUSION

Dual-energy CT can offer a "one-stop" assessment of anatomy and perfusion in CTEPH. The additional information provided by dual-energy CT could have a future role in helping guide patient selection for thromboendarterectomy surgery.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WN Medical imaging. Radiology
Divisions: Clinical Support > Radiology
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 02 Dec 2014 10:55
Last Modified: 02 Dec 2014 10:55
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/748

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