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Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH)

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Abstract

Objectives

To evaluate the concordance between DECT perfusion and ventilation/perfusion (V/Q) scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

Eighty patients underwent V/Q scintigraphy and DECT perfusion on a 2nd- and 3rd-generation dual-source CT system. The imaging criteria for diagnosing CTEPH relied on at least one segmental triangular perfusion defect on DECT perfusion studies and V/Q mismatch on scintigraphy examinations.

Results

Based on multidisciplinary expert decisions that did not include DECT perfusion, 36 patients were diagnosed with CTEPH and 44 patients with other aetiologies of PH. On DECT perfusion studies, there were 35 true positives, 6 false positives and 1 false negative (sensitivity 0.97, specificity 0.86, PPV 0.85, NPV 0.97). On V/Q scans, there were 35 true positives and 1 false negative (sensitivity 0.97, specificity 1, PPV 1, NPV 0.98). There was excellent agreement between CT perfusion and scintigraphy in diagnosing CTEPH (kappa value 0.80). Combined information from DECT perfusion and CT angiographic images enabled correct reclassification of the 6 false positives and the unique false negative case of DECT perfusion.

Conclusion

There is excellent agreement between DECT perfusion and V/Q scintigraphy in diagnosing CTEPH. The diagnostic accuracy of DECT perfusion is reinforced by the morpho-functional analysis of data sets.

Key Points

• Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially curable by surgery.

• The triage of patients with pulmonary hypertension currently relies on scintigraphy.

• Dual-energy CT (DECT) can provide standard diagnostic information and lung perfusion from a single acquisition.

• There is excellent agreement between DECT perfusion and scintigraphy in separating CTEPH and non-CTEPH patients.

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Abbreviations

CT:

Computed tomography

CTA:

Computed tomography angiography

CTEPH:

Chronic thromboembolic pulmonary hypertension

DECT:

Dual-energy CT

MDCT:

Multidetector CT

PAH:

Pulmonary arterial hypertension

PBV:

Pulmonary blood volume

PH:

Pulmonary hypertension

V/Q:

Ventilation/perfusion

References

  1. Simonneau G, Gatzoulis MA, Adiata I et al (2013) Updated clinical classification of pulmonary hypertension. J Am Coll Cardiol 62:D34–D41

    Article  Google Scholar 

  2. Lang I, Madani M (2014) Update on chronic thromboembolic pulmonary hypertension. Circulation 130:508–518

    Article  Google Scholar 

  3. Ascha M, Renapurkar RD, Tonelli AR (2017) A review of imaging modalities in pulmonary hypertension. Ann Thorac Med 12:61–73

    Article  CAS  Google Scholar 

  4. Mc Laughlin VV, Langer A, Tan M et al (2013) Contemporary trends in the diagnosis and management of pulmonary arterial hypertension. An initiative to close the care gap. Chest 143:324–332

    CAS  Google Scholar 

  5. Galie N, Humbert M, Vachiery JL et al (2016) 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 37:67–119

    Article  Google Scholar 

  6. Piazza G, Goldhaber SZ (2011) Chronic thromboembolic pulmonary hypertension. N Engl J Med 364:351–360

    Article  CAS  Google Scholar 

  7. Mc Cann C, Gopalan D, Sheares K, Screaton N (2012) Imaging of pulmonary hypertension, part 1: clinical perspectives, classification, imaging techniques and imaging algorithm. Postgrad Med J 88:271–279

    Article  Google Scholar 

  8. Freed BH, Collins JD, François CJ et al (2016) MR and CT imaging for the evaluation of pulmonary hypertension. JACC Cardiovasc Imaging 9:715–732

    Article  Google Scholar 

  9. Fuld MK, Halaweisch AF, Haynes SE et al (2013) Pulmonary perfused blood volume with dual-energy CT as surrogate for pulmonary perfusion assessed with dynamic multidetector CT. Radiology 267:747–756

    Article  Google Scholar 

  10. Pelgrim GJ, van Hamersvek RW, Willemink MJ et al (2017) Accuracy of iodine quantification using dual-energy CT in latest generation dual source and dual layer CT. Eur Radiol 27:3904–3912

    Article  Google Scholar 

  11. Felloni P, Duhamel A, Faibre JB et al (2017) Regional distribution of pulmonary blood volume with dual-energy computed tomography: results in 42 subjects. Acad Radiol 11:1412–1421

    Article  Google Scholar 

  12. Renard B, Remy-Jardin M, Santangelo T et al (2011) Dual-energy CT angiography of chronic thromboembolic disease: can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects? Eur J Radiol 79:467–472

    Article  Google Scholar 

  13. Hoey ETD, Mirsadraee S, Pepke-Zaba J, Jenkins DP, Gopalan D, Screaton NJ (2011) Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: initial experience. AJR Am J Roentgenol 196:524–532

    Article  Google Scholar 

  14. Nakazawa T, Watanabe Y, Hori Y et al (2011) Lung perfused blood volume images with dual-energy computed tomography for chronic thromboembolic pulmonary hypertension: correlation to scintigraphy with single-photon emission computed tomography. J Comput Assist Tomogr 35:590–595

    Article  Google Scholar 

  15. Le Faivre J, Duhamel A, Khung S et al (2016) Impact of perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience in 62 patients. Eur Radiol 26:4011–4020

    Article  Google Scholar 

  16. Dournes G, Verdier D, Montaudon M et al (2014) Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy. Eur Radiol 24:42–51

    Article  Google Scholar 

  17. Giordano J, Khung S, Duhamel A et al (2017) Lung perfusion characteristics in pulmonary arterial hypertension (PAH) and peripheral forms of chronic thromboembolic pulmonary hypertension (pCTEPH): dual-energy CT experience in 31 patients. Eur Radiol 27:1631–1639

    Article  Google Scholar 

  18. Boyden EA (1954) Segmental anatomy of the lungs. McGraw Hill, New York

    Google Scholar 

  19. Bajc M, Neilly JB, Miniati M et al (2009) EANM guidelines for ventilation/perfusion scintigraphy. Eur J Nucl Med Mol Imaging 36:1356–1370

    Article  CAS  Google Scholar 

  20. Cohen J (1960) A coefficient of agreement for nominal scales. Educ Psychol Meas 20:37–46

    Article  Google Scholar 

  21. Fleiss JL (1986) Reliability of measurement. In: The design and analysis of clinical experiments. Wiley, Hoboken, p 1–32

  22. Takagi H, Ota H, Sugimura K et al (2016) Dual-energy CT to estimate clinical severity of chronic thromboembolic pulmonary hypertension: comparison with invasive right heart catheterisation. Eur J Radiol 85:1574–1580

    Article  Google Scholar 

  23. Pontana F, Faivre JB, Remy-Jardin M et al (2008) Lung perfusion with dual-energy multidetector-row CT (MDCT): feasibility for the evaluation of acute pulmonary embolism in 117 consecutive patients. Acad Radiol 15:1494–1504

    Article  Google Scholar 

  24. Takx RAP, Henzler T, Schoepf UJ et al (2017) Predictive value of perfusion defects on dual-energy CTA in the absence of thromboembolic clots. J Cardiovasc Comput Tomogr 11:183–187

    Article  Google Scholar 

  25. Tamura M, Yamada Y, Kawakami T et al (2017) Diagnostic accuracy of lung subtraction iodine mapping CT for the evaluation of pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: correlation with SPECT/CT. Int J Cardiol 243:538–543

    Article  Google Scholar 

  26. Hong YJ, Kim JY, Choe KO et al (2013) Different perfusion pattern between acute and chronic pulmonary thromboembolism: evaluation with two-phase dual-energy perfusion CT. AJR Am J Roentgenol 200:812–817

    Article  Google Scholar 

  27. Koike H, Sueyoshi E, Sakamoto I, Uetani M (2017) Clinical significance of late phase lung perfusion blood volume (LPBV) quantified by dual-energy computed tomography in patients with thromboembolism. J Thorac Imaging 32:43–49

    Article  Google Scholar 

  28. Wagenvoort CA (1995) Pathology of pulmonary thromboembolism. Chest 107:10S–17S

    Article  CAS  Google Scholar 

  29. Oser RF, Zuckerman DA, Guttierez FR, Brink JA (1996) Anatomic distribution of pulmonary emboli at pulmonary angiography: implications for cross-sectional imaging. Radiology 199:31–35

    Article  CAS  Google Scholar 

  30. Burrowes KS, Clark AR, Tawhai MH (2011) Blood flow redistribution and ventilation-perfusion mismatch during embolic pulmonary arterial occlusion. Pulm Circ 1:365–376

    Article  CAS  Google Scholar 

  31. Tang CX, Yang GF, Schoepf UJ et al (2016) Chronic thromboembolic pulmonary hypertension comparison of dual-energy computed tomography and single photon emission computed tomography in canines. Eur J Radiol 85:498–506

    Article  Google Scholar 

  32. Kim BH, Seo JB, Chae EJ et al (2012) Analysis of perfusion defects by causes other than acute pulmonary thromboembolism on contrast-enhanced dual-energy CT in consecutive 537 patients. Eur J Radiol 81:e647–e652

    Article  Google Scholar 

  33. Ohira H, Beanlands RS, Davies RA, Mielniczuk L (2015) The role of nuclear imaging in pulmonary hypertension. J Nucl Cardiol 22:141–157

    Article  CAS  Google Scholar 

  34. Ling IT, Naqvi HA, Siew TK, Loh NK, Ryan GF (2012) SPECT ventilation perfusion scanning with the addition of low-dose CT for the investigation of suspected pulmonary embolism. Intern Med J 42:1257–1261

    Article  CAS  Google Scholar 

  35. Lu Y, Lorenzoni A, Fox JJ et al (2014) Noncontrast perfusion single-photon emission CT/CT scanning. A new test for the expedited, high-accuracy diagnosis of acute pulmonary embolism. Chest 145:1079–1088

    Article  Google Scholar 

  36. Dong C, Zhou M, Liu D et al (2015) Diagnostic accuracy of computed tomography for chronic thromboembolic pulmonary hypertension: a systematic review and meta-analysis. PLoS One 10:e0126985

    Article  Google Scholar 

  37. Tunariu N, Gibbs SJR, Win Z et al (2007) Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med 48:680–684

    Article  Google Scholar 

  38. Meinel FG, Graef A, Thierfelder KM et al (2014) Automated quantification of pulmonary perfused blood volume by dual-energy CTPA in chronic thromboembolic pulmonary hypertension. Rofo 186:151–156

    CAS  PubMed  Google Scholar 

  39. Rajaram S, Swift AJ, Capener D et al (2012) Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension. Eur Radiol 22:310–317

    Article  Google Scholar 

  40. Ley S (2015) Imaging pulmonary arterial thromboembolism: challenges and opportunities. Magn Reson Imaging Clin N Am 23:261–271

    Article  Google Scholar 

  41. Francois CJ (2016) Schiebler ML. Imaging of pulmonary hypertension. Radiol Clin North Am 54:1133–1149

    Article  Google Scholar 

  42. Goldberg AB, Mazur W, Kalra DK (2017) Pulmonary hypertension: diagnosis, imaging techniques and novel therapies. Cardiovasc Diagn Ther 78:405–417

    Article  Google Scholar 

  43. Renapurkar RD, Shrikanthan S, Heresi GA et al (2017) Imaging in chronic thromboembolic pulmonary hypertension. J Thorac Imaging 32:71–88

    Article  Google Scholar 

  44. Johns CS, Swift A, Rajaram S et al (2017) Lung perfusion: MRI versus SPECT for screening in suspected chronic thromboembolic pulmonary hypertension. J Magn Reson Imaging 46:1693–1697

    Article  Google Scholar 

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Thoracic Imaging, Calmette Hospital (EA 2694); CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France

    Matthieu Masy, Jessica Giordano, Jacques Remy & Martine Remy-Jardin

  2. Department of Nuclear Medicine; Salengro Hospital, University of Lille, CHU Lille, F-59000, Lille, France

    Grégory Petyt & Claude Hossein-Foucher

  3. Department of Biostatistics (EA 2694), CHRU et Université de Lille 2 Nord de France, F-59000, Lille, France

    Alain Duhamel & Maeva Kyheng

  4. Department of Cardiology; Cardiology Hospital, University of Lille, CHU Lille, F-59000, Lille, France

    Pascal De Groote, Marie Fertin & Nicolas Lamblin

  5. INSERM U1167, Institut Pasteur de Lille, F-59000, Lille, France

    Pascal De Groote, Marie Fertin & Nicolas Lamblin

  6. Department of Pulmonology, Calmette Hospital; University of Lille, CHU Lille, F-59000, Lille, France

    Jean-François Bervar

Authors
  1. Matthieu Masy
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  2. Jessica Giordano
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  3. Grégory Petyt
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  11. Jacques Remy
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Corresponding author

Correspondence to Martine Remy-Jardin.

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Guarantor

The scientific guarantor of this publication is Pr Martine Remy-Jardin.

Conflict of interest

Only two authors Martine Remy-Jardin and Jacques Remy declare conflict of interest with Siemens Healthineers.

The other authors have no conflicts of interest related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the institutional review board.

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Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Masy, M., Giordano, J., Petyt, G. et al. Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol 28, 5100–5110 (2018). https://doi.org/10.1007/s00330-018-5467-2

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  • DOI: https://doi.org/10.1007/s00330-018-5467-2

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