title: Diagnostic performance of state-of-the-art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
abstract: OBJECTIVE
  To determine the most comprehensive imaging technique for the assessment of pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
  
  
  METHODS
  24 patients with CTEPH were examined by ECG-gated multi-detector CT angiography (MD-CTA), contrast-enhanced MR angiography (ce-MRA) and selective digital subtraction angiography (DSA) within 3 days. Two readers in consensus separately evaluated each imaging technique (48 main, 144 lobar and 449 segmental arteries) for typical changes like complete obstructions, vessel cut-offs, intimal irregularities, incorporated thrombus formations, and bands and webs. A joint interpretation of all three techniques served as a reference standard.
  
  
  RESULTS
  Based on image quality, there was no non-diagnostic examination by either imaging technique. DSA did not sufficiently display 1 main, 3 lobar and 4 segmental arteries. The pulmonary trunk was not assessable by DSA. One patient showed thrombotic material at this level only by MD-CTA and MRA. Sensitivity and specificity of MD-CTA regarding CTEPH-related changes at the main/lobar and at the segmental levels were 100%/100% and 100%/99%, of ce-MRA 83.1%/98.6% and 87.7%/98.1%, and of DSA 65.7%/100% and 75.8%/100%, respectively.
  
  
  CONCLUSIONS
  ECG-gated MD-CTA proved the most adequate technique for assessment of the pulmonary arteries in the diagnostic work-up of CTEPH patients.
  
  
  CONCLUSIONS
  • A prospective single-centre study evaluated ECG-gated MDCTA, ce-MRA and DSA in CTEPH patients. • ECG-gated MD-CT angiography outperformed DSA and ce-MRA. • Right heart catheterisation should be reserved only for assessment of pulmonary haemodynamics.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 430, 69120 Heidelberg, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Ley
authors.forename: Julia
authors.initials: J
authors.lastname: Ley-Zaporozhan
authors.forename: Michael B
authors.initials: MB
authors.lastname: Pitton
authors.forename: Jens
authors.initials: J
authors.lastname: Schneider
authors.forename: Gesine M
authors.initials: GM
authors.lastname: Wirth
authors.forename: Eckhard
authors.initials: E
authors.lastname: Mayer
authors.forename: Christoph
authors.initials: C
authors.lastname: Düber
authors.forename: Karl-Friedrich
authors.initials: KF
authors.lastname: Kreitner
mesh_terms: D015901:Angiography, Digital Subtraction; D006328:Cardiac Catheterization; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D007090:Image Interpretation, Computer-Assisted; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000473:pathology*; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol