Bird Elizabeth, Hasenstab Kyle, Kim Nick, Madani Michael, Malhotra Atul, Hahn Lewis, Kligerman Seth, Hsiao Albert, Contijoch Francisco
From the Department of Bioengineering (E.B., A.H., F.C.), Department of Radiology (K.H., L.H., S.K., A.H., F.C.), Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine (N.K., A.M.), and Department of Surgery (M.M.), University of California San Diego, 9500 Gilman Dr, MC 0412, La Jolla, CA 92093.
Radiol Cardiothorac Imaging. 2023 Aug 10;5(4):e220221. doi: 10.1148/ryct.220221. eCollection 2023 Aug.
To assess if a novel automated method to spatially delineate and quantify the extent of hypoperfusion on multienergy CT angiograms can aid the evaluation of chronic thromboembolic pulmonary hypertension (CTEPH) disease severity.
Multienergy CT angiograms obtained between January 2018 and December 2020 in 51 patients with CTEPH (mean age, 47 years ± 17 [SD]; 27 women) were retrospectively compared with those in 110 controls with no imaging findings suggestive of pulmonary vascular abnormalities (mean age, 51 years ± 16; 81 women). Parenchymal iodine values were automatically isolated using deep learning lobar lung segmentations. Low iodine concentration was used to delineate areas of hypoperfusion and calculate hypoperfused lung volume (HLV). Receiver operating characteristic curves, correlations with preoperative and postoperative changes in invasive hemodynamics, and comparison with visual assessment of lobar hypoperfusion by two expert readers were evaluated.
Global HLV correctly separated patients with CTEPH from controls (area under the receiver operating characteristic curve = 0.84; 10% HLV cutoff: 90% sensitivity, 72% accuracy, and 64% specificity) and correlated moderately with hemodynamic severity at time of imaging (pulmonary vascular resistance [PVR], ρ = 0.67; < .001) and change after surgical treatment (∆PVR, ρ = -0.61; < .001). In patients surgically classified as having segmental disease, global HLV correlated with preoperative PVR (ρ = 0.81) and postoperative ∆PVR (ρ = -0.70). Lobar HLV correlated moderately with expert reader lobar assessment (ρ = 0.71 for reader 1; ρ = 0.67 for reader 2).
Automated quantification of hypoperfused areas in patients with CTEPH can be performed from clinical multienergy CT examinations and may aid clinical evaluation, particularly in patients with segmental-level disease. CT-Spectral Imaging (Multienergy), Pulmonary, Pulmonary Arteries, Embolism/Thrombosis, Chronic Thromboembolic Pulmonary Hypertension, Multienergy CT, Hypoperfusion© RSNA, 2023.
评估一种在多能量CT血管造影上对低灌注范围进行空间描绘和量化的新型自动化方法是否有助于评估慢性血栓栓塞性肺动脉高压（CTEPH）的疾病严重程度。
回顾性比较了2018年1月至2020年12月期间51例CTEPH患者（平均年龄47岁±17[标准差]；27例女性）和110例无提示肺血管异常影像学表现的对照者（平均年龄51岁±16；81例女性）的多能量CT血管造影。使用深度学习肺叶分割自动分离实质碘值。低碘浓度用于描绘低灌注区域并计算低灌注肺体积（HLV）。评估了受试者操作特征曲线、与术前和术后有创血流动力学变化的相关性，以及与两名专家读者对肺叶低灌注的视觉评估的比较。
整体HLV能正确区分CTEPH患者和对照者（受试者操作特征曲线下面积=0.84；10%HLV截断值：90%敏感性、72%准确性和64%特异性），并且与成像时的血流动力学严重程度（肺血管阻力[PVR]，ρ=0.67；P<0.001）和手术治疗后的变化（∆PVR，ρ=-0.61；P<0.001）中度相关。在手术分类为节段性疾病的患者中，整体HLV与术前PVR（ρ=0.81）和术后∆PVR（ρ=-0.70）相关。肺叶HLV与专家读者的肺叶评估中度相关（读者1的ρ=0.71；读者2的ρ=0.67）。
CTEPH患者低灌注区域的自动化量化可通过临床多能量CT检查进行，可能有助于临床评估，尤其是节段性疾病患者。CT光谱成像（多能量）、肺、肺动脉、栓塞/血栓形成、慢性血栓栓塞性肺动脉高压、多能量CT、低灌注©RSNA，2023年。
