TY - JOUR
T1 - C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT
AU - Hinrichs, Jan B.
AU - Werncke, Thomas
AU - Kaireit, Till
AU - Hoeper, Marius M.
AU - Olsson, Karen M.
AU - Kamp, Jan Christopher
AU - Wacker, Frank K.
AU - Bengel, Frank
AU - Von Falck, Christian
AU - Schatka, Imke
AU - Meyer, Bernhard C.
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Purpose To determine if C-Arm computed tomography (CACT) has added diagnostic value in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) with a positive mismatch pattern in ventilation/perfusion single photon emission computed tomography (V/Q SPECT). Materials and Methods 28 patients (23 men, 5 women, 62 ± 18 years) with CTEPH who had undergone SPECT, followed by CACT and right heart catheterization (RHC) were included. Two independent readers reviewed SPECT and CACT. Findings indicating CTEPH and their location (segmental or sub-segmental) were identified (V/Q mismatch in SPECT and vascular pathologies in CACT). Inter-modality agreement was calculated (Cohen's Kappa). Findings were scored on a 3-point-scale. The sum of the score (pulmonary artery CTEPH severity score (PACSS)) was calculated for each patient and imaging modality, correlated to RHC (spearman's correlation) and compared to the final therapeutic decision of the CTEPH board (including the consensus of SPECT, selective pulmonary DSA and CACT). Results Overall, 504 pulmonary artery segments were assessed in SPECT and CACT. SPECT had identified 266/504 (53 %) arterial segments without and 238/504 (47 %) segments with a V/Q mismatch indicating CTEPH. CACT detected 131/504 (26 %) segments without abnormal findings and 373/504 (74 %) segments with findings indicating CTEPH. Inter-modality agreement was fair (κ= 0.38). PACSS of CACT correlated mildly significantly with the mean pulmonary artery pressure (PAPmean; rho = 0.48, p = 0.01), while SPECT missed significance (rho = 0.32, p = 0.1). Discrepant findings were mostly attributed to a higher frequency of sub-segmental pulmonary arterial pathologies on CACT (145 sub-segmental findings indicating CTEPH) rated as normal on SPECT. Conclusion In patients with CTEPH, contrast-enhanced CACT detects additional findings with a better correlation to the severity of PAPmean than V/Q SPECT. CACT indicates abnormalities even in segments without V/Q abnormalities. Key points CACT has additional value in V/Q SPECT-positive CTEPH patients. SPECT may underestimate the extent of CTEPH. CACT indicates abnormalities even in segments without V/Q abnormalities. Citation Format Hinrichs JB, Werncke T, Kaireit T et al. C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT. Fortschr Röntgenstr.
AB - Purpose To determine if C-Arm computed tomography (CACT) has added diagnostic value in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) with a positive mismatch pattern in ventilation/perfusion single photon emission computed tomography (V/Q SPECT). Materials and Methods 28 patients (23 men, 5 women, 62 ± 18 years) with CTEPH who had undergone SPECT, followed by CACT and right heart catheterization (RHC) were included. Two independent readers reviewed SPECT and CACT. Findings indicating CTEPH and their location (segmental or sub-segmental) were identified (V/Q mismatch in SPECT and vascular pathologies in CACT). Inter-modality agreement was calculated (Cohen's Kappa). Findings were scored on a 3-point-scale. The sum of the score (pulmonary artery CTEPH severity score (PACSS)) was calculated for each patient and imaging modality, correlated to RHC (spearman's correlation) and compared to the final therapeutic decision of the CTEPH board (including the consensus of SPECT, selective pulmonary DSA and CACT). Results Overall, 504 pulmonary artery segments were assessed in SPECT and CACT. SPECT had identified 266/504 (53 %) arterial segments without and 238/504 (47 %) segments with a V/Q mismatch indicating CTEPH. CACT detected 131/504 (26 %) segments without abnormal findings and 373/504 (74 %) segments with findings indicating CTEPH. Inter-modality agreement was fair (κ= 0.38). PACSS of CACT correlated mildly significantly with the mean pulmonary artery pressure (PAPmean; rho = 0.48, p = 0.01), while SPECT missed significance (rho = 0.32, p = 0.1). Discrepant findings were mostly attributed to a higher frequency of sub-segmental pulmonary arterial pathologies on CACT (145 sub-segmental findings indicating CTEPH) rated as normal on SPECT. Conclusion In patients with CTEPH, contrast-enhanced CACT detects additional findings with a better correlation to the severity of PAPmean than V/Q SPECT. CACT indicates abnormalities even in segments without V/Q abnormalities. Key points CACT has additional value in V/Q SPECT-positive CTEPH patients. SPECT may underestimate the extent of CTEPH. CACT indicates abnormalities even in segments without V/Q abnormalities. Citation Format Hinrichs JB, Werncke T, Kaireit T et al. C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT. Fortschr Röntgenstr.
KW - CTEPH
KW - SPECT
KW - chronic thromboembolic pulmonary hypertension
KW - cone-beam computed tomography
KW - lung perfusion
KW - radiation exposure pulmonary CACT
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UR - http://www.scopus.com/inward/citedby.url?scp=84992724062&partnerID=8YFLogxK
U2 - 10.1055/s-0042-116232
DO - 10.1055/s-0042-116232
M3 - Article
C2 - 27784118
AN - SCOPUS:84992724062
SN - 1438-9029
VL - 189
SP - 49
EP - 56
JO - RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
JF - RöFo : Fortschritte auf dem Gebiete der Röntgenstrahlen und der Nuklearmedizin
IS - 1
ER -