Gertz Roman Johannes, Lennartz Simon, Kaya Kenan, Wawer Matos Reimer Robert Peter, Pennig Lenhard, Kottlors Jonathan, Kröger Jan Robert, Gietzen Carsten Herbert, Große Hokamp Nils, Rosenkranz Stephan, Fintelmann Florian Johannes, Pienn Michael, Bunck Alexander Christian
Department of Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital Minden, Ruhr University Bochum, Bochum, Germany.
Int J Cardiovasc Imaging. 2025 Feb;41(2):303-314. doi: 10.1007/s10554-024-03309-2. Epub 2024 Dec 25.
To evaluate dual-layer dual-energy computed tomography (dlDECT)-based characterization of thrombus composition for differentiation of acute pulmonary embolism (PE) and chronic thromboembolic pulmonary hypertension (CTEPH). This retrospective single center cohort study included 49 patients with acute PE and 33 patients with CTEPH who underwent CT pulmonary angiography on a dlDECT from 06/2016 to 06/2022. Conventional images), material specific images (virtual non-contrast [VNC], iodine density overlay [IDO], electron density [ED]), and virtual monoenergetic images (VMI) were analyzed. Regions-of-interest (ROIs) were manually placed in pulmonary artery thrombi, and morphological imaging characteristics for acute and chronic PE were assessed. Area under the receiver operating characteristics curve (AUC) of ROI measurements, morphological imaging features, and their combination in distinguishing between acute PE and CTEPH were evaluated. Compared to PE, thrombi in patients with CTEPH had lower attenuation on conventional images (Median [inter-quartile range]: 40 [35-47] HU vs 64 [52-83] HU) and VMI reconstructions (59 [46-72] HU vs 101 [80-123] HU) as well as decreased iodine uptake (IDO: 0.5 [0.2-1.0] vs 1.2 [0.5-1.8]; p for all < 0.001). Conventional images and VMI reconstructions were the most accurate for differentiating between acute and chronic thrombi (conventional: AUC 0.92, 95% CI 0.86-0.98; VMI: AUC 0.91, 95% CI 0.85-0.97). Main pulmonary artery (MPA) diameter combined with thrombus attenuation significantly increased the AUC compared to MPA diameter alone (p = 0.002 respectively). Thrombi in patients with CTEPH exhibit lower attenuation and reduced contrast enhancement. Analyzing attenuation in pulmonary thrombi may add diagnostic information to established morphological parameters in differentiating acute PE from CTEPH.
评估基于双层双能量计算机断层扫描（dlDECT）的血栓成分特征，以区分急性肺栓塞（PE）和慢性血栓栓塞性肺动脉高压（CTEPH）。这项回顾性单中心队列研究纳入了49例急性PE患者和33例CTEPH患者，这些患者在2016年6月至2022年6月期间接受了dlDECT的CT肺动脉造影检查。分析了常规图像、物质特异性图像（虚拟平扫[VNC]、碘密度叠加[IDO]、电子密度[ED]）和虚拟单能量图像（VMI）。在肺动脉血栓中手动放置感兴趣区（ROIs），并评估急性和慢性PE的形态学成像特征。评估ROI测量的受试者操作特征曲线下面积（AUC）、形态学成像特征及其在区分急性PE和CTEPH中的组合。与PE相比，CTEPH患者的血栓在常规图像上的衰减较低（中位数[四分位间距]：40[35-47]HU对64[52-83]HU），在VMI重建上也较低（59[46-72]HU对101[80-123]HU），碘摄取减少（IDO：[0.2-1.0]对1.2[0.5-1.8]；所有p<0.001）。常规图像和VMI重建在区分急性和慢性血栓方面最准确（常规：AUC 0.9, 95% CI 0.86-0.98；VMI：AUC 0.91, 95% CI 0.85-0.97）。与单独的主肺动脉（MPA）直径相比，MPA直径与血栓衰减相结合显著提高了AUC（分别为p = 0.002）。CTEPH患者的血栓表现出较低的衰减和对比增强减弱。分析肺血栓的衰减可能会为区分急性PE和CTEPH的既定形态学参数增加诊断信息。
