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[Chronic thromboembolic pulmonary hypertension: diagnostic impact of Multislice-CT and selective Pulmonary-DSA]

M B Pitton1, G Kemmerich, S Herber

  • 1Klinik für Radiologie, Johannes Gutenberg-Universitat Mainz, Germany.

Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|April 18, 2002
PubMed

Insights

Multislice-CT and selective pulmonary DSA equally diagnose vessel occlusions in chronic thromboembolic pulmonary hypertension (CTEPH). However, DSA remains superior for detecting non-occlusive changes, making both complementary for CTEPH diagnosis and treatment.

Area of Science:

  • Radiology
  • Cardiovascular Imaging
  • Pulmonary Medicine

Background:

  • Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe condition requiring accurate diagnosis.
  • Imaging modalities play a crucial role in identifying thromboembolic obstructions in pulmonary arteries.
  • Differentiating between occlusive and non-occlusive changes is vital for treatment planning.

Purpose of the Study:

  • To compare the diagnostic accuracy of multislice-CT (MSCT) and selective pulmonary digital subtraction angiography (DSA) in patients with CTEPH.
  • To evaluate the impact of these imaging techniques on diagnosing various types of thromboembolic changes.
  • To determine the complementary role of MSCT and DSA in CTEPH management.

Main Methods:

  • Retrospective analysis of 994 vessel segments from 14 CTEPH patients.
  • Comparison of MSCT (3 mm slice thickness) and selective pulmonary DSA findings.
  • Independent analysis by two investigators using standardized criteria for occlusions and non-occlusive changes.

Main Results:

  • MSCT and DSA showed high concordance (88.9%) for diagnosing vessel patency, including segmental (92.9%) and subsegmental (85.4%) arteries.
  • MSCT was significantly inferior to DSA in detecting any thromboembolic changes (67.0% concordance overall).
  • Non-occlusive vascular changes were significantly underdiagnosed by MSCT (23.1% concordance with DSA).

Conclusions:

  • MSCT and selective pulmonary DSA are equivalent for diagnosing vessel occlusions in CTEPH at segmental and subsegmental levels.
  • Selective pulmonary DSA remains superior for visualizing non-occlusive thromboembolic changes.
  • Both MSCT and DSA serve as complementary tools for accurate CTEPH diagnosis and treatment planning.
Abstract

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