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Morphologic and Functional Dual-Energy CT Parameters in Patients With Chronic Thromboembolic Pulmonary Hypertension

Mnahi Bin Saeedan1, Jennifer Bullen2, Gustavo A Heresi3

  • 1Sections of Thoracic and Cardiovascular Imaging Laboratory, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195.

AJR. American Journal of Roentgenology
|September 29, 2020
PubMed

Insights

Dual-energy CT (DECT) reveals that chronic thromboembolic disease (CTED) patients exhibit similar anatomic and functional changes to those with chronic thromboembolic pulmonary hypertension (CTEPH), suggesting CTED is an intermediate stage of chronic pulmonary embolism.

Area of Science:

  • Radiology
  • Cardiovascular Imaging
  • Pulmonary Medicine

Background:

  • Chronic thromboembolic disease (CTED) and chronic thromboembolic pulmonary hypertension (CTEPH) represent a spectrum of pulmonary vascular disease after pulmonary embolism.
  • Distinguishing between CTED and CTEPH is crucial for appropriate management and prognosis.

Purpose of the Study:

  • To compare morphologic and functional dual-energy CT (DECT) parameters between patients with CTED and CTEPH.
  • To assess the utility of DECT in characterizing the intermediate phenotype of CTED.

Main Methods:

  • A retrospective analysis of 28 CTED and 72 CTEPH patients from a registry.
  • DECT parameters including clot burden score, perfused blood volume (PBV) maps, lung enhancement, and perfusion defect (PD) score were analyzed.
  • Propensity score matching was used to control for confounders.

Main Results:

  • After matching, CTEPH patients had a higher PD score, while unilateral disease was more common in CTED patients.
  • Unmatched CTED patients showed higher PBV percentages, but this difference was not significant after adjusting for clot burden.
  • No significant differences in functional DECT parameters were found after propensity score matching.

Conclusions:

  • Patients with CTED demonstrate anatomic and functional pulmonary vascular and lung parenchymal changes comparable to CTEPH.
  • Functional DECT parameters suggest that CTED represents an intermediate clinical phenotype in the spectrum of chronic pulmonary embolism.

Keywords:
MDCThypertensionpulmonarypulmonary embolism

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