Schüßler Armin, Richter Manuel, Tello Khodr, Steiner Dagmar, Seeger Werner, Krombach Gabriele Anja, Roller Fritz Christian
Department of Diagnostic and Interventional Radiology, University Hospital Gießen, Justus Liebig University, Gießen, Germany.
Member of the German Centre for Lung Research (DZL), Germany.
Rofo. 2021 Nov;193(11):1318-1326. doi: 10.1055/a-1502-7541. Epub 2021 Jun 17.
The purpose of this study was to assess the diagnostic accuracy of computed tomography pulmonary angiogram (CTPA) including dual energy and reconstruction of iodine maps for diagnosing CTEPH. This method for detecting embolisms and perfusion failures was compared with V/Q-SPECT. An additional purpose was to compare the applied radiation dose of both techniques.
71 patients (49 women) with suspected CTEPH were included in this prospective study. The patients received a V/Q-SPECT and a dual-energy CTPA. Iodine maps were reconstructed from the data set. CTPA and the iodine maps were read by an experienced radiologist unaware of the clinical information as well as the results of the V/Q-SPECT. Results were compared to the V/Q-SPECT. DLP and the applied amount of radionuclides (MAA, Technegas) were obtained for comparison of radiation dose.
For the diagnosis of CTEPH, the sensitivity of DECT was 1.000, specificity 0.966, PPV 0.867 and NPV 1.000, respectively. There was not a considerable difference in the x-ray exposure between the DECT examination and the V/Q-SPECT (1.892 mSv vs. 1.911 mSv; p = 0.6115). Both examination modalities were highly consistent regarding the classification of pathological segments (1177/1278 segments, 92,09 %, κ = 0,5938).
This study presents the DECT, in combination with reconstructed iodine maps, as a potential alternative to the current imaging technique of first choice, V/Q-SPECT. For creating future prospective diagnostic algorithms, the implementation of DECT screening with iodine maps should be considered.
· DECT correctly identified all CTEPH patients.. · There is substantial agreement between DECT and V/Q-SPECT in the classification of pathological segments.. · There is no significant difference in radiation exposure during DECT examination and V/Q-SPECT examination.. · Reduced radiation dose does not negatively impact image quality..
· Schüßler A, Richter M, Tello K et al. Evaluation der diagnostischen Genauigkeit und der Strahlendosis der Dual-Energy-Computertomografie (DECT) bei chronisch thromboembolischer pulmonaler Hypertonie (CTEPH). Fortschr Röntgenstr 2021; 193: 1318 - 1326.
本研究旨在评估计算机断层扫描肺动脉造影（CTPA），包括双能量成像和碘图重建，用于诊断慢性血栓栓塞性肺动脉高压（CTEPH）的诊断准确性。将这种检测栓塞和灌注异常的方法与通气/灌注单光子发射计算机断层扫描（V/Q-SPECT）进行比较。另一个目的是比较两种技术的辐射剂量。
本前瞻性研究纳入了71例疑似CTEPH的患者（49例女性）。患者接受了V/Q-SPECT和双能量CTPA检查。从数据集重建碘图。由一位不了解临床信息以及V/Q-SPECT结果的经验丰富的放射科医生解读CTPA和碘图。将结果与V/Q-SPECT进行比较。获取剂量长度乘积（DLP）和放射性核素的应用量（MAA、锝气体）以比较辐射剂量。
对于CTEPH的诊断，双能量CT（DECT）的敏感性为1.000，特异性为0.966，阳性预测值为0.867，阴性预测值为1.000。DECT检查和V/Q-SPECT之间的X线暴露没有显著差异（1.892 mSv对1.911 mSv；p = 0.6115）。两种检查方式在病理节段分类方面高度一致（1177/1278节段，92.09%，κ = 0.5938）。
本研究表明，DECT结合重建碘图，可作为当前首选成像技术V/Q-SPECT的潜在替代方法。在创建未来的前瞻性诊断算法时，应考虑实施带有碘图的DECT筛查。
·DECT正确识别了所有CTEPH患者。·DECT和V/Q-SPECT在病理节段分类方面有高度一致性。·DECT检查和V/Q-SPECT检查期间的辐射暴露无显著差异。·降低辐射剂量对图像质量无负面影响。
·Schüßler A, Richter M, Tello K等。慢性血栓栓塞性肺动脉高压（CTEPH）中双能量计算机断层扫描（DECT）的诊断准确性和辐射剂量评估。Fortschr Röntgenstr 2021; 193: 1318 - 1326。
