Kroeger Jan Robert, Zöllner Jakob, Gerhardt Felix, Rosenkranz Stephan, Gertz Roman Johannes, Kerszenblat Shir, Pahn Gregor, Maintz David, Bunck Alexander C
Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Germany.
Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Quant Imaging Med Surg. 2022 Feb;12(2):1121-1129. doi: 10.21037/qims-21-229.
To evaluate whether volumetric iodine quantification of the lung allows for the automatic identification of patients with chronic thromboembolic pulmonary hypertension (CTEPH) and whether the extent of pulmonary malperfusion correlates with invasive hemodynamic parameters.
Retrospective data base search identified 30 consecutive patients with CTEPH who underwent CT pulmonary angiography (CTPA) on a spectral-detector CT scanner. Thirty consecutive patients who underwent an identical CT examination for evaluation of suspected acute pulmonary embolism and had no signs of pulmonary embolism or PH, served as control cohort. Lungs were automatically segmented for all patients and normal and malperfused volumes were segmented based on iodine density thresholds. Results were compared between groups. For correlation analysis between the extent of malperfused volume and mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) 3 patients were excluded because of a time span of more than 30 days between CTPA and right heart catheterization.
Patients with CTEPH had a higher percentage of malperfused lung compared to controls (43.25%±24.72% 21.82%±20.72%; P=0.001) and showed reduced mean iodine density in malperfused and normal-perfused lung areas, as well as in the vessel volume. Controls showed a left-tailed distribution of iodine density in malperfused lung areas while patients with CTEPH had a more symmetrical distribution (Skew: -0.382±0.435 -0.010±0.396; P=0.004). Patients with CTEPH showed a significant correlation between the percentage of malperfused lung volume and the PVR (r=0.57, P=0.001).
Volumetric iodine quantification helps to identify patients with CTEPH by showing increased areas of malperfusion. The extent of malperfusion might provide a measurement for disease severity in patients with CTEPH.
评估肺部碘定量是否能够自动识别慢性血栓栓塞性肺动脉高压（CTEPH）患者，以及肺灌注不良的程度是否与有创血流动力学参数相关。
通过回顾性数据库搜索，确定了30例连续接受光谱探测器CT扫描仪进行CT肺动脉造影（CTPA）的CTEPH患者。30例连续接受相同CT检查以评估疑似急性肺栓塞且无肺栓塞或肺动脉高压迹象的患者作为对照队列。对所有患者的肺部进行自动分割，并根据碘密度阈值分割正常和灌注不良的体积。比较两组结果。为了分析灌注不良体积程度与平均肺动脉压（mPAP）和肺血管阻力（PVR）之间的相关性，排除了3例CTPA与右心导管检查之间时间间隔超过30天的患者。
与对照组相比，CTEPH患者的肺灌注不良百分比更高（43.25%±24.72%对21.82%±20.72%；P=0.001），并且在灌注不良和正常灌注的肺区域以及血管体积中平均碘密度降低。对照组在灌注不良的肺区域碘密度呈左尾分布，而CTEPH患者的分布更对称（偏度：-0.382±0.435对-0.010±0.396；P=0.004）。CTEPH患者的肺灌注不良体积百分比与PVR之间存在显著相关性（r=0.57，P=0.001）。
体积碘定量通过显示灌注不良面积增加有助于识别CTEPH患者。灌注不良的程度可能为CTEPH患者的疾病严重程度提供一种衡量方法。
