title: Dual-energy CT perfusion and angiography in chronic thromboembolic pulmonary hypertension: diagnostic accuracy and concordance with radionuclide scintigraphy.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of dual-energy computed tomography (DECT) perfusion and angiography versus ventilation/perfusion (V/Q) scintigraphy in chronic thromboembolic pulmonary hypertension (CTEPH), and to assess the per-segment concordance rate of DECT and scintigraphy.
  
  
  METHODS
  Forty consecutive patients with proven pulmonary hypertension underwent V/Q scintigraphy and DECT perfusion and angiography. Each imaging technique was assessed for the location of segmental defects. Diagnosis of CTEPH was established when at least one segmental perfusion defect was detected by scintigraphy. Diagnostic accuracy of DECT perfusion and angiography was assessed and compared with scintigraphy. In CTEPH patients, the per-segment concordance between scintigraphy and DECT perfusion/angiography was calculated.
  
  
  RESULTS
  Fourteen patients were diagnosed with CTEPH and 26 with other aetiologies. DECT perfusion and angiography correctly identified all CTEPH patients with sensitivity/specificity values of 1/0.92 and 1/0.93, respectively. At a segmental level, DECT perfusion showed moderate agreement (κ = 0.44) with scintigraphy. Agreement between CT angiography and scintigraphy ranged from fair (κ = 0.31) to slight (κ = 0.09) depending on whether completely or partially occlusive patterns were considered, respectively.
  
  
  CONCLUSIONS
  Both DECT perfusion and angiography show satisfactory performance for the diagnosis of CTEPH. DECT perfusion is more accurate than angiography at identifying the segmental location of abnormalities.
  
  
  CONCLUSIONS
  • Chronic thromboembolic pulmonary hypertension (CTEPH) is potentially treatable by surgery. • Dual-energy computed tomography (DECT) allows angiography and perfusion using a single acquisition. • Both DECT perfusion and angiography showed satisfactory diagnostic performance in CTEPH. • DECT perfusion was more accurate than angiography in identifying segmental abnormalities.
authors: CHU Bordeaux, Department of Medical Imaging, Hôpital Haut-Lévêque, Avenue de Magellan, 33600, Pessac, France.
authors: Gaël
authors: G
authors: Dournes
authors: Damien
authors: D
authors: Verdier
authors: Michel
authors: M
authors: Montaudon
authors: Eric
authors: E
authors: Bullier
authors: Annalisa
authors: A
authors: Rivière
authors: Claire
authors: C
authors: Dromer
authors: François
authors: F
authors: Picard
authors: Marc-Alain
authors: MA
authors: Billes
authors: Olivier
authors: O
authors: Corneloup
authors: François
authors: F
authors: Laurent
authors: Mathieu
authors: M
authors: Lederlin
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D055420:Perfusion Imaging / Q000379:methods*; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
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