Gertz Roman Johannes, Gerhardt Felix, Kröger Jan Robert, Shahzad Rahil, Caldeira Liliana, Kottlors Jonathan, Große Hokamp Nils, Maintz David, Rosenkranz Stephan, Bunck Alexander Christian
Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Department of Cardiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
Front Cardiovasc Med. 2022 Feb 28;9:835732. doi: 10.3389/fcvm.2022.835732. eCollection 2022.
To evaluate the usefulness of spectral detector CT (SDCT)-derived pulmonary perfusion maps and pulmonary parenchyma characteristics for the semiautomated classification of pulmonary hypertension (PH).
A total of 162 consecutive patients with right heart catheter (RHC)-proven PH of different aetiologies as defined by the current ESC/ERS guidelines who underwent CT pulmonary angiography (CTPA) on SDCT and 20 patients with an invasive rule-out of PH were included in this retrospective study. Semiautomatic lung segmentation into normal and malperfused areas based on iodine density (ID) as well as automatic, virtual non-contrast-based emphysema quantification were performed. Corresponding volumes, histogram features and the ID Skewness-Emphysema-Index (δ-index) accounting for the ratio of ID distribution in malperfused lung areas and the proportion of emphysematous lung parenchyma were computed and compared between groups.
Patients with PH showed a significantly greater extent of malperfused lung areas as well as stronger and more homogenous perfusion defects. In group 3 and 4 patients, ID skewness revealed a significantly more homogenous ID distribution in perfusion defects than in all other subgroups. The δ-index allowed for further subclassification of subgroups 3 and 4 ( < 0.001), identifying patients with chronic thromboembolic PH (CTEPH, subgroup 4) with high accuracy (AUC: 0.92, 95%-CI, 0.85-0.99).
Abnormal pulmonary perfusion in PH can be detected and quantified by semiautomated SDCT-based pulmonary perfusion maps. ID skewness in malperfused lung areas, and the δ-index allow for a classification of PH subgroups, identifying groups 3 and 4 patients with high accuracy, independent of reader expertise.
评估光谱探测器CT（SDCT）衍生的肺灌注图和肺实质特征在肺动脉高压（PH）半自动分类中的应用价值。
本回顾性研究纳入了162例经右心导管（RHC）证实的不同病因的PH患者，这些患者均符合现行ESC/ERS指南的定义，且接受了SDCT上的CT肺血管造影（CTPA）检查，同时纳入了20例经有创检查排除PH的患者。基于碘密度（ID）对肺进行半自动分割，分为正常灌注区和灌注不良区，并进行基于虚拟平扫的肺气肿自动定量分析。计算相应的体积、直方图特征以及ID偏度-肺气肿指数（δ指数），该指数反映了灌注不良肺区域的ID分布比例与肺气肿肺实质比例，对两组进行比较。
PH患者的灌注不良肺区域范围明显更大，灌注缺损更强且更均匀。在3组和4组患者中，ID偏度显示灌注缺损中的ID分布比所有其他亚组更均匀。δ指数可对3组和4组进行进一步亚分类（<0.001），能够高精度地识别慢性血栓栓塞性PH（CTEPH，4组）患者（AUC：0.92，95%CI，0.85 - 0.99）。
基于SDCT的半自动肺灌注图可检测和量化PH患者的异常肺灌注。灌注不良肺区域的ID偏度和δ指数可对PH亚组进行分类，能够高精度地识别3组和4组患者，且与阅片者的专业水平无关。
