Intraprocedural Angiographic Lung Perfusion: A Novel Application for Real-Time Integration Into a Fluoroscopic...

Assessment of differential lung perfusion is currently limited to periprocedural lung perfusion scans (LPS) or magnetic resonance imaging (MRI), which do not enable for real-time decision making. This study demonstrates the development and evaluation of a novel angiographic lung perfusion (ALP) technique in patients with congenital heart disease.

The ALP technique was used to analyze differential branch pulmonary artery (PA) flow in retrospectively identified PA angiograms with corresponding LPS or MRI. Intraclass correlation coefficient and agreement were assessed. Two mathematical models were tested (area under curve and slope) at 2 time points (second peak and average).

Twenty-five angiograms were analyzed. The most common cardiac anatomy was tetralogy of Fallot, and most common indication for catheterization was unilateral branch PA stenosis. The slope-based methods demonstrated high intraclass correlation coefficients with LPS/MRI (ICC, 0.84-0.86), indicating good reliability (ranging moderate-to-excellent), whereas Bland-Altman analysis showed low overall bias.

This ALP quantification application enables accurate lung perfusion assessment with potential for real-time integration into a fluoroscopic platform. This method provides a potential method for quantifying clinically meaningful intraprocedural information, particularly in assessing relative changes in differential perfusion before and after PA interventions. Further prospective studies are needed to confirm accuracy and clinical utility in broader populations.