Dual-energy CT angiography of chronic thromboembolic disease: Can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects?

Renard, B.; Rémy‐Jardin, Martine; Santangelo, Teresa; Faivre, J; Tacelli, Nunzia; Rémy, Jacques; Duhamel, Alain

doi:10.1016/j.ejrad.2010.04.018

Cited by 59 publications

(44 citation statements)

References 23 publications

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“…5). Several articles have assessed the role of DECT in the diagnosis of pulmonary thromboembolism (37)(38)(39)(40)(41)(42)(43)(44). Krisska et al (40) obtained a high negative predictive value by using perfusion images.…”

Section: Thorax Applicationsmentioning

confidence: 99%

Dual-energy CT revisited by multidetector ct: review of principles and clinical applications

Karçaaltıncaba

Aktaş²

2010

Diagn Interv Radiol

153

127

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A lthough dual-energy CT (DECT) was first conceived in 1976, it has not been used widely for clinical indications (1-11). Recently, the simultaneous acquisition of dual-energy data has been introduced using multidetector CT (MDCT) with two X-ray tubes and rapid peak kilovoltage (kVp) switching (gemstone spectral imaging, GSI) (12-16). Two major advantages of DECT are material decomposition by the almost simultaneous acquisition of two image series with different kVp (80 and 140 kVp) and the elimination of misregistration artifacts. In general, noncontrast (unenhanced) images can be avoided by using the dual-energy mode for body and neurological applications; iodine can be removed from the image, and a virtual non-contrast (water) image can be acquired. The major advantage of 80-kVp compared to 140-kVp images is a higher image contrast (Fig. 1). Hounsfield unit measurements on DECT are not absolute and can change depending on the kVp used for the acquisition (at different keV). Typically, a combination of 80/140 kVp is used for DECT, but for some applications, 100/140 kVp is preferred. In this study, we summarized the clinical applications of DECT in the brain, chest and abdomen and in the cardiovascular and musculoskeletal systems (Table 1). Technique and principlesThe basic principle of dual-energy is the acquisition of 2 datasets from the same anatomic location with different kVp (usually 80 and 140 kVp) (1,2,17,18). In the early days of CT, consecutive single-slice acquisitions with different kVp were performed as a dual-energy technique, but this method suffered from breathing and partial volume artifacts (1, 2). At present, an entire body can be scanned within seconds using the DECT technique, and thus, misregistration artifacts due to breathing are eliminated.Currently, three systems are capable of the nearly simultaneous acquisition of dual-energy data during a single breath hold (12, 14, 15): 64-slice dual-source CT (Definition, Siemens Medical Systems; Erlangen, Germany), 128-slice dual-source CT (Definition Flash, Siemens Medical Systems) and high-definition 64-MDCT (Discovery 750 HD, GE Healthcare; Milwaukee, Wisconsin, USA). In the two systems available from Siemens, the two tubes (tubes A and B) use different kVp (80 and 140 kVp), and in 64-MDCT, the kVp switches from 80 to 140 kVp in less than 0.5 ms. In dual systems, there is concern regarding the susceptibility of the system to cardiac motion due to the time difference (75 or 83 ms) between the tube A and tube B acquisitions of the dual-energy data, but the dual-source CT and 64-MDCT have not been compared to evaluate this issue. The technical specifications of the DECT systems are summarized in Table 2.The images presented in this article were acquired using a 64-slice dual source CT (Definition, Siemens Medical Systems) and a 64-MDCT (Discovery 750HD, GE Healthcare). The DECT data acquired by both systems can be evaluated with a dedicated workstation using dual-energy software that ABSTRACT Although dual-energy CT (DECT) was first conceived in ...

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Section: Thorax Applicationsmentioning

confidence: 99%

Dual-energy CT revisited by multidetector ct: review of principles and clinical applications

Karçaaltıncaba

Aktaş²

2010

Diagn Interv Radiol

153

127

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“…Dual-energy CT thus simultaneously provides high-resolution morphological images of pulmonary parenchyma and functional information on pulmonary perfusion. DE-CTPA therefore represents a very promising imaging modality for patients with CTEPH since it allows simultaneous morphological assessment of pulmonary vasculature and parenchyma and functional assessment of pulmonary perfusion [20,21]. Therefore, the dual-energy technique is likely to increase the sensitivity of CTPA for CTEPH, although this has not yet been demonstrated conclusively.…”

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confidence: 99%

“…Our findings go beyond the data published in the literature. Renard and colleagues correlated perfusion defects on iodine distribution maps in 17 CTEPH patients with vascular changes suggestive for CTEPH including stenosis, obstruction by thrombi, webs and bands, and abrupt vessel narrowing [20]. They found that the most severe vascular changes of CTEPH were seen with a higher frequency in segments with perfusion defects on iodine distribution maps [20].…”

mentioning

confidence: 99%

“…Renard and colleagues correlated perfusion defects on iodine distribution maps in 17 CTEPH patients with vascular changes suggestive for CTEPH including stenosis, obstruction by thrombi, webs and bands, and abrupt vessel narrowing [20]. They found that the most severe vascular changes of CTEPH were seen with a higher frequency in segments with perfusion defects on iodine distribution maps [20]. This provided first evidence that perfusion impairment on DE-CTPA iodine perfusion maps may correlate with disease severity in patients with CTEPH, which is confirmed by our results.…”

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confidence: 99%

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

Meinel¹,

Graef²,

Thierfelder³

et al. 2013

Fortschr Röntgenstr

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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...

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“…A further study showed that perfusion defects were only seen in patients with severe obstruction of the pulmonary arteries. The authors concluded that despite the presence of enlarged systemic arteries in these cases, normal parenchymal reperfusion is not reached via this collateral supply [39]. DE-CT identified all patients with CTEPH among 40 consecutive patients with proven pulmonary hypertension in comparison with V/Q scintigraphy [40].…”

Section: Microcirculationmentioning

confidence: 99%

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

Wirth

Brüggemann

Bostel

et al. 2014

Fortschr Röntgenstr

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Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension (resting mean pulmonary arterial pressure of 25?mm Hg or more determined at right heart catheterization) with persistent pulmonary perfusion defects. It is a rare, but underdiagnosed disease with estimated incidences ranging from 0.5?% to 3.8?% of patients after an acute pulmonary embolism (PE), and in up to 10?% of those with a history of recurrent PE. CTEPH is the only form of pulmonary hypertension that can be surgically treated leading to normalization of pulmonary hemodynamics and exercise capacity in the vast majority of patients. The challenges for imaging in patients with suspected CTEPH are fourfold: the imaging modality should have a high diagnostic accuracy with regard to the presence of CTEPH and allow for differential diagnosis. It should enable detection of patients suitable for PEA with great certainty, and allow for quantification of PH by measuring pulmonary hemodynamics (mPAP and PVR), and finally, it can be used for therapy monitoring. This overview tries to elucidate the potential role of ECG-gated multidetector CT pulmonary angiography (MD-CTPA) and MR imaging, and summarizes the most important results that have been achieved so far. Generally speaking, ECG-gated MD-CTPA is superior to MR in the assessment of parenchymal and vascular pathologies of the lung, and allows for the assessment of cardiac structures. The implementation of iodine maps as a surrogate for lung perfusion enables functional assessment of lung perfusion by CT. MR imaging is the reference standard for the assessment of right heart function and lung perfusion, the latter delineating typical wedge-shaped perfusion defects in patients with CTEPH. New developments show that with MR techniques, an estimation of hemodynamic parameters like mean pulmonary arterial pressure and pulmonary vascular resistance will be possible. CT and MR imaging should be considered as complementary investigations providing comprehensive information in patients with CTEPH. Citation Format: ??Wirth G, Br?ggemann K, Bostel T et?al. 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. Fortschr R?ntgenstr 2014; 186: 751???761

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Dual-energy CT angiography of chronic thromboembolic disease: Can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects?

Cited by 59 publications

References 23 publications

Dual-energy CT revisited by multidetector ct: review of principles and clinical applications

Dual-energy CT revisited by multidetector ct: review of principles and clinical applications

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

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

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