Chest
Volume 143, Issue 4, April 2013, Pages 1070-1077
Journal home page for Chest

Original Research
Pulmonary vascular disease
Role of 320-Slice CT Imaging in the Diagnostic Workup of Patients With Chronic Thromboembolic Pulmonary Hypertension

https://doi.org/10.1378/chest.12-0407Get rights and content

Background

Right-sided heart catheterization (RHC) and pulmonary digital subtraction angiography (PDSA) are the standard methods used in diagnosing suspected or definite chronic thromboembolic pulmonary hypertension (CTEPH). We studied the ability of 320-slice CT imaging to detect simultaneously chronic thromboembolic findings in the pulmonary arteries and pulmonary hemodynamics based on the curvature of the interventricular septum (IVS) in CTEPH.

Methods

Forty-four patients with high clinical suspicion of CTEPH underwent RHC, PDSA, and enhanced double-volume retrospective ECG-gated 320-slice CT scan. We measured the sensitivity and specificity of CT imaging to detect thrombi in the pulmonary arteries compared with PDSA. We also compared IVS bowing (expressed as curvature) measured on the short-axis cine heart image with pulmonary arterial pressure (PAP) obtained by RHC.

Results

Compared with PDSA, the sensitivity and specificity of CT imaging to detect chronic thromboembolic findings were 97.0% and 97.1% at the main/lobar level and 85.8% and 94.6% at the segmental level, respectively. The correlation coefficients of IVS curvature with systolic PAP and mean PAP were −0.79 (P < .001) and −0.86 (P < .001), respectively.

Conclusions

The use of 320-slice CT imaging allows for less invasive and simultaneous detection of thrombi and evaluation of pulmonary hemodynamics for the diagnostic work-up of CTEPH.

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 on

lung 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

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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].

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