Dual-energy Computed Tomography in the Assessment of Vascular and Parenchymal Enhancement in Suspected Pulmonary Hypertension

Ameli-Renani, Seyed; Ramsay, Laurie; Bacon, Jenny; Rahman, Farzana; Nair, Arjun; Smith, Veronica; Baskerville, Kate; Devaraj, Anand; Madden, Brendan; Vlahos, Ioannis

doi:10.1097/rti.0000000000000061

Cited by 37 publications

(16 citation statements)

References 32 publications

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“…Enhancement in the upper, middle, and lower thirds of the lung can also be assessed similar to the way it is assessed at perfusion imaging in nuclear medicine (Fig 5). The peripheral decrease in lung parenchymal enhancement with increased enhancement of the main pulmonary artery was reported by Ameli-Renani et al (24) in patients with pulmonary artery hypertension.…”

Section: Clinical Applications Vascular Abnormalitiesmentioning

confidence: 52%

Dual-Energy CT: Spectrum of Thoracic Abnormalities

Otrakji¹,

Digumarthy²,

Gullo³

et al. 2016

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Recent studies have demonstrated that dual-energy computed tomography (CT) can provide useful information in several chest-related clinical indications. Compared with single-energy CT, dual-energy CT of the chest is feasible with the use of a radiation-dose-neutral scanning protocol. This article highlights the different types of images that can be generated by using dual-energy CT protocols such as virtual monochromatic, virtual unenhanced (ie, water), and pulmonary blood volume (ie, iodine) images. The physical basis of dual-energy CT and material decomposition are explained. The advantages of the use of virtual low-monochromatic images include reduced volume of intravenous contrast material and improved contrast resolution of images. The use of virtual high-monochromatic images can reduce beam hardening and contrast streak artifacts. The pulmonary blood volume images can help differentiate various parenchymal abnormalities, such as infarcts, atelectasis, and pneumonias, as well as airway abnormalities. The pulmonary blood volume images allow quantitative and qualitative assessment of iodine distribution. The estimation of iodine concentration (quantitative assessment) provides objective analysis of enhancement. The advantages of virtual unenhanced images include differentiation of calcifications, talc, and enhanced thoracic structures. Dual-energy CT has applications in oncologic imaging, including diagnosis of thoracic masses, treatment planning, and assessment of response to treatment. Understanding the concept of dual-energy CT and its clinical application in the chest are the goals of this article.

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Section: Clinical Applications Vascular Abnormalitiesmentioning

confidence: 52%

Dual-Energy CT: Spectrum of Thoracic Abnormalities

Otrakji¹,

Digumarthy²,

Gullo³

et al. 2016

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“…PBV imaging accurately reflects variations in pulmonary perfused blood volume (63). Recent research on humans also demonstrates that the regional variability of PBV measurements (performed either by manual placement of standardized multiple two-dimensional regions of interest or by regional automated volumetric PBV measures) shows a strong correlation with PVR in patients with a wide variety of PH causes (64).…”

Section: Dect For Assessment Of Mlamentioning

confidence: 99%

“…In addition to providing a perfusion map of pulmonary parenchymal iodine content, DECT enables simultaneous assessment of central vascular pulmonary arterial enhancement. A recent retrospective study of DECT found that when a standardized CTPA protocol was used, central pulmonary arterial enhancement in patients with PH was significantly higher than in patients without PH (64). Conversely, global volumetric PBVdetermined parenchymal enhancement in patients with PH was reduced compared with in patients without PH.…”

Section: Quantitative Assessment Of Pulmonary Blood Flow Dynamicsmentioning

confidence: 99%

Dual-Energy CT for Imaging of Pulmonary Hypertension: Challenges and Opportunities

Ameli-Renani¹,

Rahman²,

Nair³

et al. 2014

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Computed tomography (CT) is routinely used in the evaluation of patients with pulmonary hypertension (PH) to assess vascular anatomy and parenchymal morphology. The introduction of dual-energy CT (DECT) enables additional qualitative and quantitative insights into pulmonary hemodynamics and the extent and variability of parenchymal enhancement. Lung perfusion assessed at pulmonary blood volume imaging correlates well with findings at scintigraphy, and pulmonary blood volume defects seen in pulmonary embolism studies infer occlusive disease with increased risk of right heart dysfunction. Similarly, perfusion inhomogeneities seen in patients with PH closely reflect mosaic lung changes and may be useful for severity assessment and prognostication. The use of DECT may increase detection of peripheral thromboembolic disease, which is of particular prognostic importance in patients with chronic thromboembolic PH with microvascular involvement. Other DECT applications for imaging of PH include low-kilovoltage images with greater inherent iodine conspicuity and iodine-selective color-coded maps of vascular perfusion (both of which can improve visualization of vascular enhancement), virtual nonenhanced imaging (which better depicts vascular calcification), and, potentially, ventricular perfusion maps (to assess myocardial ischemia). In addition, quantitative assessment of central vascular and parenchymal enhancement can be used to evaluate pulmonary hemodynamics in patients with PH. The current status and potential advantages and limitations of DECT for imaging of PH are reviewed, and current evidence is supplemented with data from a tertiary referral center for PH.

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“…By contrast, Takagi et al found that whole lung PBV score was not only associated with pulmonary arterial pressure, but also with pulmonary vascular resistance. Increased iodine density in the pulmonary artery with simultaneously decrease in the whole lung iodine density has been found as a feature of increased pulmonary vascular resistance in PH (95). As with CTPA, need for intravenous iodinated contrast medium and exposure to ionizing radiation are shortcomings of this technique.…”

Section: Dual-energy Computed Tomography (Dect)mentioning

confidence: 99%

Chronic pulmonary embolism: diagnosis

Nishiyama

Saboo

Tanabe

et al. 2018

Cardiovasc. Diagn. Ther.

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Chronic thromboembolic pulmonary hypertension (CTEPH) is a complication of venous thromboembolic disease. Differently from other causes of pulmonary hypertension, CTEPH is potentially curable with surgery (thromboendarterectomy) or balloon pulmonary angioplasty. Imaging plays a central role in CTEPH diagnosis. The combination of techniques such as lung scintigraphy, computed tomography and magnetic resonance angiography provides non-invasive anatomic and functional information. Conventional pulmonary angiography (CPA) with right heart catheterization (RHC) is considered the gold standard method for diagnosing CTEPH. In this review, we discuss the utility of these imaging techniques in the diagnosis of CTEPH.

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Dual-energy Computed Tomography in the Assessment of Vascular and Parenchymal Enhancement in Suspected Pulmonary Hypertension

Abstract: PH patients demonstrate increased PAenh with a reciprocal reduction and greater variation in parenchymal enhancement; a DECT ratio of central to parenchymal enhancement correlates with PVR and may help identify PH.

Cited by 37 publications

References 32 publications

Dual-Energy CT: Spectrum of Thoracic Abnormalities

Dual-Energy CT: Spectrum of Thoracic Abnormalities

Dual-Energy CT for Imaging of Pulmonary Hypertension: Challenges and Opportunities

Chronic pulmonary embolism: diagnosis

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