Journal
EUROPEAN RADIOLOGY
Volume 27, Issue 4, Pages 1631-1639Publisher
SPRINGER
DOI: 10.1007/s00330-016-4500-6
Keywords
Chronic thromboembolism; Pulmonary hypertension; CT angiography; Dual-energy CT; Lung perfusion
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To compare lung perfusion in PAH and pCTEPH on dual-energy CT (DECT) examinations. Thirty-one patients with PAH (group 1; n = 19) and pCTEPH (group 2; n = 12) underwent a dual-energy chest CTA with reconstruction of diagnostic and perfusion images. Perfusion alterations were analysed at a segmental level. V/Q scintigraphy was available in 22 patients (group 1: 13/19; group 2: 9/12). CT perfusion was abnormal in 52.6 % of group 1 patients and in 100 % of group 2 patients (p = 0.0051). The patterns of perfusion alteration significantly differed between the two groups (p < 0.0001): (1) in group 1, 96.6 % of segments with abnormal perfusion showed patchy defects; (2) in group 2, the most frequent abnormalities consisted of patchy (58.5 %) and PE-type (37.5 %) defects. Paired comparison of CT perfusion and scintigraphy showed concordant findings in 76.9 % of group 1 (10/13) and 100 % of group 2 (9/9) patients, with a predominant or an exclusive patchy pattern in group 1 and a mixed pattern of abnormalities in group 2. Lung perfusion alterations at DECT are less frequent and more homogeneous in PAH than in pCTEPH, with a high level of concordant findings with V/Q scintigraphy. Depiction of chronic pulmonary embolism exclusively located on peripheral arteries is difficult. The main differential diagnosis of pCTEPH is PAH. The pattern of DECT perfusion changes can help differentiate PAH and pCETPH. In PAH, almost all segments with abnormal perfusion showed patchy defects. In pCTEPH, patchy and PE-type defects were the most frequent abnormalities.
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