Organized thrombus in pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension; imaging with cone beam computed tomography.
OBJECTIVE
To assess the usefulness of cone-beam CT (CBCT) during pulmonary angiography for the evaluation of organized thrombus at segmental or subsegmental arteries in patients with chronic thromboembolic pulmonary hypertension (CTEPH).


METHODS
The segmental and/or subsegmental pulmonary arteries of 13 patients with CTEPH were evaluated by CBCT. We classified representative forms of organized thrombus into 4 types (type 1: webs, type 2: web and slits, type 3: slits, and type 4: narrowing or complete occlusion), and the distribution and frequency of the organized thrombus were evaluated. The relative detectability of these lesions using CBCT was compared with that in contrast-enhanced CT pulmonary angiography (CTPA).


RESULTS
Type 1 lesions were most frequently observed in both segmental (30/65 = 46 %) and subsegmental branches (72/156 = 46 %). Type 2 lesions were relatively less frequent than type 1, but subsegmental branches were frequently involved (29/156 = 19 %). Type 3 lesions observed as a thin flap in 9/156 subsegmental branches (6 %). Comparing with CTPA, all 40 lesions in segmental branches were detectable in CTPA, whereas only 62 lesions among 90 lesions (69 %) in subsegmental branches could be observed by CTPA.


CONCLUSIONS
CBCT is found to be useful for the treatment planning of balloon pulmonary angioplasty distal to segmental arteries.
Department of Radiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan, musugijp@c3-net.ne.jp.
Munehiro
M
Sugiyama
Tetsuya
T
Fukuda
Yoshihiro
Y
Sanda
Yoshiaki
Y
Morita
Masahiro
M
Higashi
Takeshi
T
Ogo
Akihiro
A
Tsuji
Jun
J
Demachi
Norifumi
N
Nakanishi
Hiroaki
H
Naito
D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D003287:Contrast Media; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013927:Thrombosis / Q000000981:diagnostic imaging*
D003287:Contrast Media