Tamura Masashi, Yamada Yoshitake, Kawakami Takashi, Kataoka Masaharu, Iwabuchi Yu, Sugiura Hiroaki, Hashimoto Masahiro, Nakahara Tadaki, Okuda Shigeo, Nakatsuka Seishi, Sano Fumiya, Abe Takayuki, Maekawa Yuichiro, Fukuda Keiichi, Jinzaki Masahiro
Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Int J Cardiol. 2017 Sep 15;243:538-543. doi: 10.1016/j.ijcard.2017.05.006. Epub 2017 May 4.
For treatment of chronic thromboembolic pulmonary hypertension (CTEPH), the evaluation of segmental pulmonary perfusion is important. There are no previous reports about lung subtraction iodine mapping (LSIM) computed tomography (CT) for evaluation of segmental pulmonary perfusion in patients with CTEPH, using lung perfusion SPECT/CT (LPS) as the reference.
50 patients (age, 60.7±16.7years) with known or suspected CTEPH were enrolled in this study. Non-contrast chest CT and CT pulmonary angiography (CTPA) were performed on a 320-detector row CT system. Then, based on a non-rigid registration followed by subtraction of non-contrast images from contrast-enhanced images, color-coded LSIM images were generated. LPS was performed using a SPECT/CT system within a period of 2months, and served as the reference standard. LSIM and CTPA images were evaluated in a blinded manner for the detection of pulmonary perfusion defects on a segment-by-segment basis.
The sensitivity, specificity, accuracy, and positive and negative predictive values of LSIM for the detection of segmental perfusion defects were 95% (734/773), 84% (107/127), 93% (841/900), 97% (734/754) and 73% (107/146), respectively, while the corresponding values for CTPA were 65% (505/773), 61% (78/127), 65% (583/900), 91% (505/554) and 23% (78/346). Generalized estimating equations analyses revealed a significantly better performance of LSIM than that of CTPA regarding the sensitivity, accuracy, and positive and negative predictive values (all P<0.0001).
LSIM is a feasible technique for segment-based evaluation of pulmonary perfusion in patients with CTEPH, and it provides a significantly higher diagnostic accuracy compared with CTPA.
对于慢性血栓栓塞性肺动脉高压（CTEPH）的治疗，肺段灌注评估至关重要。此前尚无关于使用肺灌注单光子发射计算机断层扫描/计算机断层扫描（LPS）作为参考，通过肺减影碘图（LSIM）计算机断层扫描（CT）评估CTEPH患者肺段灌注的报道。
本研究纳入了50例已知或疑似CTEPH的患者（年龄60.7±16.7岁）。在320排CT系统上进行非增强胸部CT和CT肺动脉造影（CTPA）。然后，基于非刚性配准，从增强图像中减去非增强图像，生成彩色编码的LSIM图像。在2个月内使用SPECT/CT系统进行LPS检查，并将其作为参考标准。以盲法评估LSIM和CTPA图像，逐段检测肺灌注缺损。
LSIM检测段灌注缺损的敏感性、特异性、准确性、阳性和阴性预测值分别为95%（734/773）、84%（107/127）、93%（841/900）、97%（734/754）和73%（107/146），而CTPA的相应值分别为65%（505/773）、61%（78/127）、65%（583/900）、91%（505/554）和23%（78/346）。广义估计方程分析显示，在敏感性、准确性以及阳性和阴性预测值方面，LSIM的表现显著优于CTPA（所有P<0.0001）。
LSIM是一种用于CTEPH患者基于段的肺灌注评估的可行技术，与CTPA相比，其诊断准确性显著更高。
