Zusammenfassung !Zielsetzung: Ziel der Studie war es zu untersuchen, ob die automatisierte Quantifizierung des perfundierten Lungenblutvolumens (PBV) in der dual-energy CT Pulmonalis-Angiografie (DE-CTPA) zur Beurteilung des Schweregrades einer chronisch-thromboembolischen pulmonalen Hypertonie (CTEPH) genutzt werden kann. Methoden: Die automatisierte Quantifizierung des PBV wurde bei 25 konsekutiven Patienten mit CTEPH durchgeführt, die mittels DE-CTPA untersucht wurden. Die PBV-Werte wurden mit Parametern aus Rechtsherzkatheteruntersuchung (pulmonalarterieller Druck, Herzindex und pulmonalem Gefäßwiderstand) sowie der 6-Minuten-Gehstrecke korreliert. Hierbei wurde der Korrelationskoeffizient nach Pearson verwendet und mittels multivariater linearer Regression für Alter und Geschlecht adjustiert. Ergebnisse: Die aus der DE-CTPA ermittelten PBVWerte korrelierten negativ mit dem systolischen (r = -0,64, p = 0,001) und mittleren (r = -0,57, p = 0,004) pumonalarteriellen Blutdruck. Es zeigte sich ein Trend zu einer negativen Korrelation zwischen PBV-Werten und dem pulmonalen Gefäßwiderstand (r = -0,20, p = 0,35). Zwischen PBV und Herzindex sowie 6-Minuten-Gehstrecke wurden keine signifikanten Korrelationen gefunden. Durch multivariate lineare Regression wurde bestätigt, dass diese Korrelationen von Alter und Geschlecht unabhänig waren. Schlussfolgerung: Die DE-CTPA kann bei Patienten mit CTEPH für eine automatisierte Quantifizierung des perfundierten Lungenblutvolumens genutzt werden. Deren Ergebnisse korrelieren invers mit systolischem und mittlerem pulmonalarteriellen Druck und können daher den Schweregrad der pulmonalen Hypertonie bei diesen Patienten abschätzen. Abstract !Objectives: The aim of the study was to determine whether automated quantification of pulmonary perfused blood volume (PBV) in dual-energy computed tomography pulmonary angiography (DE-CTPA) can be used to assess the severity of chronic thromboembolic pulmonary hypertension (CTEPH). Methods: Automated quantification of PBV was performed in 25 consecutive CTEPH patients undergoing DE-CTPA. PBV values were correlated with cardiac index and pulmonary vascular resistance quantified by right heart catheterization and walking distance in the 6-minute walk test using Pearson's correlation coefficient and multivariate linear regression analysis to control for age and gender. Results: DE-CTPA derived PBV values inversely correlated with systolic (r = -0.64, p = 0.001) and mean (r = -0.57, p = 0.004) pulmonary arterial pressure. There was a trend for PBV values to inversely correlate with pulmonary vascular resistance (r = -0.20, p = 0.35). No significant correlation was found between PBV values and cardiac index or 6-minute walking distance. These correlations were confirmed to be independent of age and gender on multivariate linear regression analysis. Conclusion: DE-CTPA can be used for an automated quantification of pulmonary PBV in chronic thromboembolic pulmonary hypertension. PBV values correlate inversely with systolic and mean pulmonary arteria...
Dual-energy computed tomography pulmonary angiography can be used for an immediate, reader-independent estimation of global pulmonary PBV in acute PE, which inversely correlates with thrombus load, laboratory parameters of PE severity, and the necessity for ICU admission.
Objectives: The objective of this study was to determine whether automated quantification of lung perfused blood volume (PBV) in dual-energy computed tomographic pulmonary angiography (DE-CTPA) can be used to assess the severity and regional distribution of pulmonary hypoperfusion in emphysema. Materials and Methods: We retrospectively analyzed 40 consecutive patients (mean age, 67 [13] years) with pulmonary emphysema, who have no cardiopulmonary comorbidities, and a DE-CTPA negative for pulmonary embolism. Automated quantification of global and regional pulmonary PBV was performed using the syngo Dual Energy application (Siemens Healthcare). Similarly, the global and regional degrees of parenchymal hypodensity were assessed automatically as the percentage of voxels with a computed tomographic density less than j900 Hounsfield unit. Emphysema severity was rated visually, and pulmonary function tests were obtained by chart review, if available. Results: Global PBV generated by automated quantification of pulmonary PBV in the DE-CTPA data sets showed a moderately strong but highly significant negative correlation with residual volume in percentage of the predicted residual volume (r = j0.62; P = 0.002; n = 23) and a positive correlation with forced expiratory volume in 1 second in percentage of the predicted forced expiratory volume in 1 second (r = 0.67; P G 0.001; n = 23). Global PBV values strongly correlated with diffusing lung capacity for carbon monoxide (r = 0.80; P G 0.001; n = 15). Pulmonary PBV values decreased with visual emphysema severity (r = j0.46, P = 0.003, n = 40). Moderate negative correlations were found between global PBV values and parenchymal hypodensity both in a per-patient (r = j0.63; P G 0.001; n = 40) and per-region analyses (r = j0.62; P G 0.001; n = 40). Conclusions: Dual-energy computed tomographic pulmonary angiography allows simultaneous assessment of lung morphology, parenchymal density, and pulmonary PBV. In patients with pulmonary emphysema, automated quantification of pulmonary PBV in DE-CTPA can be used for a quick, reader-independent estimation of global and regional pulmonary perfusion, which correlates with several lung function parameters.Key Words: pulmonary emphysema, severity, distribution, pulmonary perfusion, dual-energy CT (Invest Radiol 2013;48: 79Y85) C hronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide.1,2 It is characterized by airflow limitation and lung inflammation resulting in a progressive deterioration in lung function. Emphysema is a common component of COPD, in which airway obstruction, inflammation, and aberrant activity of proteolytic enzymes cause irreversible destruction of the alveolar walls and enlargement of distal airspaces. Currently, screening for and early diagnosis of COPD and emphysema largely rely on spirometric lung function tests. 4 Spirometry, however, strongly depends on patients' cooperation and is unable to localize emphysematous changes within the lung. Because pulmonary e...
CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion. Br J Radiol 2014;87:20140079. FULL PAPER Dual-energy CT pulmonary angiography in patients with suspected pulmonary embolism: value for the detection and quantification of pulmonary venous congestion S F THIEME, F G MEINEL, A GRAEF, A D HELCK, M F REISER and T RC JOHNSON Results: No significant difference of PBV but significant differences of mean PA and LA enhancement and individual enhancement differences (PA 2 LA) were found between the populations. PA 2 LA was higher in patients with elevated BNP and proBNP and was positively correlated with these values. Receiver operating characteristic analysis revealed a moderate discriminatory power of the PA 2 LA difference for the presence of cardiac biomarker elevations. Conclusion: PBV in DE-CTPA is not altered in patients with signs of congestive heart failure. However, differences in enhancement values in the pre-and postpulmonary vessels were found in comparison with the control population. Advances in knowledge: Altered pulmonary vascular haemodynamics in pulmonary venous congestion are not reflected in dual-energy-derived PBV maps. In the diagnosis of left heart failure in patients with chest pain and dyspnoea, density measurements in the pulmonary artery and in the left atrium in CTPA images may be a helpful diagnostic tool.In the diagnostic algorithms for patients with acute dyspnoea, CT pulmonary angiography (CTPA) plays a major role, specifically in cases when pulmonary embolism (PE) is suspected. Whenever no PE can be detected, radiologists face the challenge to detect alternative pathological thoracic findings. An undiagnosed acute or chronic left heart failure with pulmonary congestion can be an alternative cause of acute dyspnoea. Although there are some direct and indirect CT criteria that suggest the diagnosis of congestive heart failure with pulmonary venous hypertension (e.g. dilated pulmonary veins with a blurry appearance of the vessel walls, thickening of the interlobular septal lines, ground-glass opacities/alveolar oedema, pleural effusions and an enlargement of the left atrium and/or ventricle), the diagnosis of left heart failure on the basis of CT findings is often equivocal and rather rater dependent. For suspected left heart failure, chest radiography represents the primary diagnostic tool rather than CT. Still, if CTPA is performed in chest pain workup, an improved, more objective diagnosis of congestive heart failure would be desirable. Dual-energy CTPA (DE-CTPA) can quantify the iodinerelated pulmonary beam absorption and thus allow an automated, reader-independent, software-based quantification of the pulmonary content of iodinated contrast material [termed "perfused blood volume" (PBV)].1 Based on the assumption that an impaired left heart function leads to variances in the pulmonary blood content and in the dynamics of the pulmonary passage of the contrast bolus, we tried to find out if ...
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