Automated Quantification of Pulmonary Perfused Blood Volume by Dual-Energy CTPA in Chronic Thromboembolic Pulmonary Hypertension

Abstract

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 CT to estimate clinical severity of chronic thromboembolic pulmonary hypertension: Comparison with invasive right heart catheterization

“…Although their data are in partial agreement with ours, the limited statistical power of the cited work resulted in a significant correlation only between the lung PBV and PAP [21]. The advantages of automated quantification include reader-independence and speed.…”

“…Meinel et al correlated automatically calculated lung PBV measurements with the PAP, PVR, CI, and 6MWD in 25 CTEPH patients [21]. Although their data are in partial agreement with ours, the limited statistical power of the cited work resulted in a significant correlation only between the lung PBV and PAP [21].…”

Chronic Thromboembolic Pulmonary Hypertension (CTEPH) – Potential Role of Multidetector-Row CT (MD-CT) and MR Imaging in the Diagnosis and Differential Diagnosis of the Disease

“…Furthermore, the technique can be used for automated quantification of pulmonary perfused blood volume (PBV) in patients with CTEPH. These PBV values correlated inversely with systolic and mean pulmonary arterial pressures [41].…”

“…Even for ECG-gated MD-CTPA, significant correlations could be found in patients with CTEPH between the curvature of the interventricular septum and the mean and systolic pulmonary arterial pressures as determined by RHC [26]. There was also a correlation between the Cobb angle which is defined as the angle between the interventricular septum and the line between the sternal midpoint and thoracic vertebral spinous process measured during diastole with PVR [41,50]. However, the results of these studies were not validated in prospective cohort studies.…”

The State of Vascular Bed, Parenchyma and Perfusion of Lungs in Chronic Thromboembolic Pulmonary Hypertension According to Data of Subtraction Pulmonary Angiography

“…Важнейшим критерием эффективности лечения и прогноза у больных ХТЭЛГ помимо оценки клинических показателей и сосудистого русла является состояние перфузии легочной ткани. Новые модальности КТ отвечают основным требованиям современной диагностики ЛГ, позволяя проводить комплексную оценку состояния кровоснабжения и перфузии легких [5][6][7][8][9][10].…”