Xi Linfeng, Wang Jianping, Liu Anqi, Ni Yifei, Du Jie, Huang Qiang, Li Yishan, Wen Jing, Wang Hongyi, Zhang Shuai, Zhang Yunxia, Zhang Zhu, Wang Dingyi, Xie Wanmu, Gao Qian, Cheng Yong, Zhai Zhenguo, Liu Min
China-Japan Friendship Hospital, Capital Medical University, Beijing, China.
National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China.
Insights Imaging. 2025 Aug 18;16(1):182. doi: 10.1186/s13244-025-02067-6.
To develop PerAIDE, an AI-driven system for automated analysis of pulmonary perfusion blood volume (PBV) using dual-energy computed tomography pulmonary angiography (DE-CTPA) in patients with chronic pulmonary thromboembolism (CPE).
In this prospective observational study, 32 patients with chronic thromboembolic pulmonary disease (CTEPD) and 151 patients with chronic thromboembolic pulmonary hypertension (CTEPH) were enrolled between January 2022 and July 2024. PerAIDE was developed to automatically quantify three distinct perfusion patterns-normal, reduced, and defective-on DE-CTPA images. Two radiologists independently assessed PBV scores. Follow-up imaging was conducted 3 months after balloon pulmonary angioplasty (BPA).
PerAIDE demonstrated high agreement with the radiologists (intraclass correlation coefficient = 0.778) and reduced analysis time significantly (31 ± 3 s vs. 15 ± 4 min, p < 0.001). CTEPH patients had greater perfusion defects than CTEPD (0.35 vs. 0.29, p < 0.001), while reduced perfusion was more prevalent in CTEPD (0.36 vs. 0.30, p < 0.001). Perfusion defects correlated positively with pulmonary vascular resistance (ρ = 0.534) and mean pulmonary artery pressure (ρ = 0.482), and negatively with oxygenation index (ρ = -0.441). PerAIDE effectively differentiated CTEPH from CTEPD (AUC = 0.809, 95% CI: 0.745-0.863). At the 3-month post-BPA, a significant reduction in perfusion defects was observed (0.36 vs. 0.33, p < 0.01).
CTEPD and CTEPH exhibit distinct perfusion phenotypes on DE-CTPA. PerAIDE reliably quantifies perfusion abnormalities and correlates strongly with clinical and hemodynamic markers of CPE severity.
ClinicalTrials.gov, NCT06526468. Registered 28 August 2024- Retrospectively registered, https://clinicaltrials.gov/study/NCT06526468?cond=NCT06526468&rank=1 .
PerAIDE is a dual-energy computed tomography pulmonary angiography (DE-CTPA) AI-driven system that rapidly and accurately assesses perfusion blood volume in patients with chronic pulmonary thromboembolism, effectively distinguishing between CTEPD and CTEPH phenotypes and correlating with disease severity and therapeutic response.
Right heart catheterization for definitive diagnosis of chronic pulmonary thromboembolism (CPE) is invasive. PerAIDE-based perfusion defects correlated with disease severity to aid CPE-treatment assessment. CTEPH demonstrates severe perfusion defects, while CTEPD displays predominantly reduced perfusion. PerAIDE employs a U-Net-based adaptive threshold method, which achieves alignment with and faster processing relative to manual evaluation.
开发PerAIDE，一种用于使用双能计算机断层扫描肺动脉造影（DE-CTPA）对慢性肺血栓栓塞症（CPE）患者的肺灌注血容量（PBV）进行自动分析的人工智能驱动系统。
在这项前瞻性观察研究中，2022年1月至2024年7月期间纳入了32例慢性血栓栓塞性肺疾病（CTEPD）患者和151例慢性血栓栓塞性肺动脉高压（CTEPH）患者。开发PerAIDE以自动量化DE-CTPA图像上三种不同的灌注模式——正常、减少和缺陷。两名放射科医生独立评估PBV评分。在球囊肺动脉成形术（BPA）后3个月进行随访成像。
PerAIDE与放射科医生的评估结果高度一致（组内相关系数 = 0.778），并显著缩短了分析时间（31±3秒对15±4分钟，p < 0.001）。CTEPH患者的灌注缺陷比CTEPD患者更严重（0.35对0.29，p < 0.001），而灌注减少在CTEPD中更为普遍（0.36对0.30，p < 0.001）。灌注缺陷与肺血管阻力（ρ = 0.534）和平均肺动脉压（ρ = 0.482）呈正相关，与氧合指数（ρ = -0.441）呈负相关。PerAIDE有效地将CTEPH与CTEPD区分开来（AUC = 0.809，95% CI：0.745 - 0.863）。在BPA后3个月，观察到灌注缺陷显著减少（0.36对0.33，p < 0.01）。
CTEPD和CTEPH在DE-CTPA上表现出不同的灌注表型。PerAIDE可靠地量化灌注异常，并与CPE严重程度的临床和血流动力学标志物密切相关。
ClinicalTrials.gov，NCT06526468。2024年8月28日注册——回顾性注册，https://clinicaltrials.gov/study/NCT06526468?cond=NCT06526468&rank=1 。
PerAIDE是一种双能计算机断层扫描肺动脉造影（DE-CTPA）人工智能驱动系统，可快速准确地评估慢性肺血栓栓塞症患者的灌注血容量，有效区分CTEPD和CTEPH表型，并与疾病严重程度和治疗反应相关。
用于慢性肺血栓栓塞症（CPE）明确诊断的右心导管检查具有侵入性。基于PerAIDE的灌注缺陷与疾病严重程度相关，有助于CPE治疗评估。CTEPH表现出严重的灌注缺陷，而CTEPD主要表现为灌注减少。PerAIDE采用基于U-Net的自适应阈值方法，相对于人工评估实现了对齐并加快了处理速度。
