Chronic thromboembolic hypertension predictors in computed tomography angiography. Single-centre study

Area of Science:

• Radiology
• Cardiology
• Pulmonary Medicine

Background:

• Chronic thromboembolic pulmonary hypertension (CTEPH) is a curable cause of pulmonary hypertension, necessitating early diagnosis.
• Computed tomography pulmonary angiography (CTPA) is vital for CTEPH diagnosis, but radiological features can overlap with other conditions.
• Radiologist expertise influences the detection of subtle radiological findings in CTEPH.

Purpose of the Study:

• To determine the frequency of characteristic radiological features in CTEPH.
• To compare the prevalence of these features in CTEPH versus chronic thromboembolic disease (CTED), pulmonary arterial hypertension (PAH), and acute pulmonary embolism (APE).
• To evaluate the diagnostic predictive value of identified radiological features for CTEPH.

Main Methods:

• Retrospective analysis of 115 patients across four groups: CTEPH (n=35), CTED (n=20), PAH (n=24), and APE (n=36), matched for age and sex.
• Review of CTPA scans for signs of chronic embolism, pulmonary hypertension, and right heart overload.
• Assessment of sensitivity, specificity, accuracy, and predictive values using ROC analysis (AUC).

Main Results:

• Vessel narrowing, intimal irregularities, bands, and webs were present in 100% of CTEPH patients, showing high diagnostic value (AUC=0.906) at the segmental level.
• Mosaic perfusion (AUC=0.740) and vessel size variability (AUC=0.788) exhibited moderate predictive value.
• The study identified specific CTPA findings with varying degrees of diagnostic utility for CTEPH.

Conclusions:

• CTPA plays a crucial role in differentiating CTEPH from other pulmonary vascular diseases.
• No single radiological feature provides absolute diagnostic certainty for CTEPH.
• An integrated approach combining vascular, parenchymal, and cardiac findings on CTPA is essential for accurate CTEPH diagnosis.