Higuchi Satoshi, Satoh Taijyu, Takagi Hidenobu, Nakada Mitsuru, Kawahara Takuya, Yaoita Nobuhiro, Sugiyama Shuhei, Onuma Tomoya, Shirata Kenta, Kayano Shingo, Ota Hideki, Yasuda Satoshi, Takase Kei
Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands.
JHLT Open. 2025 Jul 18;10:100344. doi: 10.1016/j.jhlto.2025.100344. eCollection 2025 Nov.
CT pulmonary angiography (CTPA) plays a critical role in guiding balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, conventional CT (cCT) has limited sensitivity in detecting peripheral lesions, which is critical for avoiding complications. This study compared ultra-high-resolution CT (UHRCT; 0.25 mm detector elements) and conventional CT (cCT; 0.6 mm detector elements) in identifying and classifying segmental and subsegmental lesions, using invasive selective angiography during BPA as the reference standard.
This single-center retrospective study included 42 patients with newly diagnosed CTEPH who underwent CT pulmonary angiography (CTPA) with either cCT or UHRCT and subsequently completed BPA. The morphology and location of lesions were independently assessed using selective angiography and CTPA. Sensitivity, specificity, and lesion classification accuracy were assessed using selective angiography as the reference standard.
A total of 1687 branches in 42 patients (male/female 11/31, mean age 66 years) were analyzed. The sensitivity and specificity of cCT were 54.6% (95% CI: 48.2-60.8) and 85.2% (95% CI: 75.6-91.4), respectively. In contrast, UHRCT demonstrated significantly higher sensitivity (94.3%, 95% CI: 91.9-96.1) but lower specificity (60.2%, 95% CI: 46.7-72.2). The sensitivity difference was more prominent in subsegmental branches (p for interaction = 0.11). UHRCT more accurately classified lesion types in 83.7% of cases (95% CI: 76.7-88.9), versus 69.1% (95% CI: 58.3-78.1) with cCT. Web lesions remained the most difficult to detect.
Higher-spatial-resolution CTPA provides a higher lesion detection sensitivity, particularly in subsegmental branches, and more accurately classified lesion type in patients with CTEPH treated with BPA, potentially aiding procedural planning and guidance.
CT肺动脉造影（CTPA）在指导慢性血栓栓塞性肺动脉高压（CTEPH）患者进行球囊肺动脉血管成形术（BPA）中起着关键作用。然而，传统CT（cCT）在检测外周病变方面的敏感性有限，而这对于避免并发症至关重要。本研究以BPA期间的有创选择性血管造影为参考标准，比较了超高分辨率CT（UHRCT；探测器元件为0.25mm）和传统CT（cCT；探测器元件为0.6mm）在识别和分类节段性及亚节段性病变方面的差异。
这项单中心回顾性研究纳入了42例新诊断的CTEPH患者，这些患者接受了cCT或UHRCT的CT肺动脉造影（CTPA），随后完成了BPA。使用选择性血管造影和CTPA独立评估病变的形态和位置。以选择性血管造影为参考标准评估敏感性、特异性和病变分类准确性。
共分析了42例患者（男/女11/31，平均年龄66岁）的1687个分支。cCT的敏感性和特异性分别为54.6%（95%CI：48.2 - 60.8）和85.2%（95%CI：75.6 - 91.4）。相比之下，UHRCT显示出显著更高的敏感性（94.3%，95%CI：91.9 - 96.1）但特异性较低（60.2%，95%CI：46.7 - 72.2）。亚节段分支中的敏感性差异更为显著（交互作用p = 0.11）。UHRCT在83.7%的病例中更准确地分类病变类型（95%CI：76.7 - 88.9），而cCT为69.1%（95%CI：58.3 - 78.1）。网状病变仍然最难检测。
更高空间分辨率的CTPA具有更高的病变检测敏感性，尤其是在亚节段分支中，并且能更准确地对接受BPA治疗的CTEPH患者的病变类型进行分类，可能有助于手术规划和指导。
