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Radiological differences between chronic thromboembolic pulmonary disease (CTEPD) and chronic thromboembolic
Carmine Capone1,2, Adele Valentini3, Silvia Lina Spinillo1
1Department of Clinical, Surgical, Pediatric and Diagnostic Sciences, Faculty of Medicine and Surgery, University of Pavia, Pavia, Italy.
Insights
Radiological features of chronic thromboembolic pulmonary disease (CTEPD) differ from chronic thromboembolic pulmonary hypertension (CTEPH). Absence of microvascular disease in CTEPD may explain the lack of pulmonary hypertension.
Area of Science:
- Radiology
- Pulmonary Medicine
- Cardiovascular Imaging
Background:
- Chronic thromboembolic pulmonary disease (CTEPD) radiological features require systematic description.
- Understanding CTEPD's distinct pathophysiology from CTEPH is crucial for diagnosis and management.
Purpose of the Study:
- To delineate the radiological characteristics of CTEPD.
- To compare vascular scores between CTEPD and CTEPH patients.
- To investigate the reasons for the absence of resting pulmonary hypertension in CTEPD.
Main Methods:
- Dual-energy computed tomography pulmonary angiography (DE-CTPA) with iodine perfusion maps was used in 85 patients (40 CTEPD, 45 CTEPH).
- CT scans were independently reviewed for vascular obstruction, hypoperfusion, mosaic attenuation, and signs of pulmonary hypertension.
- Single-source CTPA was performed in an additional 6 CTEPD patients.
Main Results:
- Vascular obstruction burden was similar between CTEPD and CTEPH groups.
- CTEPD patients showed significantly smaller perfusion defects on iodine maps and less mosaic attenuation, suggesting absent microvascular disease.
- Indirect signs of pulmonary hypertension were significantly different between the two groups.
Conclusions:
- CTEPD and CTEPH exhibit distinct radiological features, including signs of pulmonary hypertension, mosaic attenuation, and perfusion patterns.
- The absence of peripheral microvascular disease in CTEPD, despite significant thrombotic burden, likely prevents the development of pulmonary hypertension.
- These findings aid in differentiating CTEPD from CTEPH based on imaging.
Objectives:
The aim of this study was to describe the radiological features of chronic thromboembolic pulmonary disease (CTEPD), not yet systematically described in the literature. Furthermore, we compared vascular scores between CTEPD and chronic thromboembolic pulmonary hypertension (CTEPH) patients, trying to explain why pulmonary hypertension does not develop at rest in CTEPD patients.
Methods:
Eighty-five patients (40 CTEPD, 45 CTEPH) referred to our centre for pulmonary endarterectomy underwent dual-energy computed tomography pulmonary angiography (DE-CTPA) with iodine perfusion maps; other 6 CTEPD patients underwent single-source CTPA. CT scans were reviewed independently by an experienced cardiothoracic radiologist and a radiology resident to evaluate scores of vascular obstruction, hypoperfusion and mosaic attenuation, signs of pulmonary hypertension and other CT features typical of CTEPH.
Results:
Vascular obstruction burden was similar in the two groups (p = 0.073), but CTEPD patients have a smaller extension of perfusion defects in the iodine map (p = 0.009) and a smaller number of these patients had mosaic attenuation (p < 0.001) than CTEPH patients, suggesting the absence of microvascular disease. Furthermore, as expected, the two groups were significantly different considering the indirect signs of pulmonary hypertension (p < 0.001).
Conclusions:
CTEPD and CTEPH patients have significantly different radiological characteristics, in terms of signs of pulmonary hypertension, mosaic attenuation and iodine map perfusion extension. Importantly, our results suggest that the absence of peripheral microvascular disease, even in presence of an important thrombotic burden, might be the reason for the absence of pulmonary hypertension in CTEPD.
Key Points:
• CTEPD and CTEPH patients have significantly different radiological characteristics. • The absence of peripheral microvascular disease might be the reason for the absence of pulmonary hypertension in CTEPD.
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