Chest
Original ResearchPulmonary vascular diseaseRole of 320-Slice CT Imaging in the Diagnostic Workup of Patients With Chronic Thromboembolic Pulmonary Hypertension
Section snippets
Patients
The study group comprised 44 consecutive patients (28 women; mean age, 59 years; range, 33–78 years) with high clinical suspicion of CTEPH based onlung scintigraphy and transthoracic echocardiography. All patients were enrolled from March 2009 to April 2012 and underwent enhanced retrospective ECG-gated 320-slice CT imaging, RHC, and PDSA. The shortest and longest intervals between CT scan and RHC plus PDSA were 2 days and 2 weeks, respectively. The study was approved by the ethics committee of
Results
Forty-four consecutive patients (mean age, 59.2 ± 11.3 years; women, 64%) with CTEPH based on RHC and PDSA findings were included in this study (Table 1). One patient did not undergo PDSA because of an allergic reaction to the contrast media. Thus, there were 86 main arteries, 258 lobar arteries, and 860 segmental arteries included in the statistical analysis. CTPA showed chronic thromboembolic findings in 73 of 344 arteries at the main/lobar level and 199 of 860 arteries at the segmental
Discussion
To our knowledge, this study is the first to assess the utility of 320-slice CT scan in the diagnosis of CTEPH. There are three main findings. First, 320-slice double-volume CTPA, as well as PDSA, can yield images that allow for the diagnosis of thromboembolic changes in the main/lobar and segmental pulmonary arteries in patients with CTEPH. Second, IVS curvature based on retrospective ECG-gated 320-slice CT scan can estimate PAP in patients with CTEPH. Third, this modality allows for
Conclusions
The current study demonstrated that double-volume retrospective ECG-gated 320-slice CT imaging angiography allowed for less invasive and simultaneous assessment of the morphology of the pulmonary arteries and pulmonary hemodynamics by the curvature of the IVS in CTEPH. Further investigation is necessary to ascertain whether this modality can replace PDSA for the diagnosis of CTEPH and to determine whether IVS curvature can predict mortality in patients with CTEPH.
Acknowledgments
Author contributions: Dr Sugiura had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Sugiura: contributed to the study design, data analysis and interpretation, and writing and review of the manuscript.
Dr Tanabe: contributed to the image analysis, data interpretation, and critical review of the manuscript.
Dr Matsuura: contributed to the image analysis and data analysis and interpretation and critical
References (37)
- et al.
Evaluation of patients with suspected chronic thromboembolic pulmonary hypertension
Semin Thorac Cardiovasc Surg
(1999) - et al.
Detection of intracranial aneurysms with 64 channel multidetector row computed tomography: comparison with digital subtraction angiography
Eur J Radiol
(2007) - et al.
Chronic thromboembolic pulmonary hypertension: evaluation with 64-detector row CT versus digital substraction angiography
Eur J Radiol
(2009) - et al.
Echocardiography in chronic thromboembolic pulmonary hypertension
Semin Thorac Cardiovasc Surg
(2006) - et al.
Subpleural perfusion as a predictor for a poor surgical outcome in chronic thromboembolic pulmonary hypertension
Chest
(2012) - et al.
Longterm follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data
Chest
(1982) - et al.
Prognostic factors in medically treated patients with chronic pulmonary embolism
Chest
(2001) - et al.
Predictors of mortality in inoperable chronic thromboembolic pulmonary hypertension
Respir Med
(2009) - et al.
Long-term outcome after pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension
J Thorac Cardiovasc Surg
(2012) - et al.
Lung image quality with 320-row wide-volume CT scans: the effect of prospective ECG-gating and comparisons with 64-row helical CT scans
Acad Radiol
(2012)
Chronic thromboembolic pulmonary hypertension
Am J Respir Crit Care Med
Chronic thromboembolic pulmonary hypertension
Circulation
Pulmonary endarterectomy: experience and lessons learned in 1,500 cases
Ann Thorac Surg
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
Pilot study comparing SPECT perfusion scintigraphy with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension
Respirology
Aortoiliac and lower extremity arteries assessed with 16-detector row CT angiography: prospective comparison with digital subtraction angiography
Radiology
Chronic thromboembolic pulmonary hypertension: diagnostic impact of multislice-CT and selective pulmonary-DSA [in German]
Rofo
Diagnostic performance of state-of-the-art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH)
Eur Radiol
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Funding/Support: This study was partly supported by a grant to the Respiratory Failure Research Group from the Ministry of Health, Labor and Welfare, Japan [No. 23162501 to Dr Tatsumi], and a grant from the Ministry of Education, Culture, Sports, Science and Technology of Japan [No. 22590849 to Dr Tanabe].