title: Lung perfusion characteristics in pulmonary arterial hypertension (PAH) and peripheral forms of chronic thromboembolic pulmonary hypertension (pCTEPH): Dual-energy CT experience in 31 patients.
abstract: OBJECTIVE
  To compare lung perfusion in PAH and pCTEPH on dual-energy CT (DECT) examinations.
  
  
  METHODS
  Thirty-one patients with PAH (group 1; n = 19) and pCTEPH (group 2; n = 12) underwent a dual-energy chest CTA with reconstruction of diagnostic and perfusion images. Perfusion alterations were analysed at a segmental level. V/Q scintigraphy was available in 22 patients (group 1: 13/19; group 2: 9/12).
  
  
  RESULTS
  CT perfusion was abnormal in 52.6 % of group 1 patients and in 100 % of group 2 patients (p = 0.0051). The patterns of perfusion alteration significantly differed between the two groups (p < 0.0001): (1) in group 1, 96.6 % of segments with abnormal perfusion showed patchy defects; (2) in group 2, the most frequent abnormalities consisted of patchy (58.5 %) and PE-type (37.5 %) defects. Paired comparison of CT perfusion and scintigraphy showed concordant findings in 76.9 % of group 1 (10/13) and 100 % of group 2 (9/9) patients, with a predominant or an exclusive patchy pattern in group 1 and a mixed pattern of abnormalities in group 2.
  
  
  CONCLUSIONS
  Lung perfusion alterations at DECT are less frequent and more homogeneous in PAH than in pCTEPH, with a high level of concordant findings with V/Q scintigraphy.
  
  
  CONCLUSIONS
  • Depiction of chronic pulmonary embolism exclusively located on peripheral arteries is difficult. • The main differential diagnosis of pCTEPH is PAH. • The pattern of DECT perfusion changes can help differentiate PAH and pCETPH. • In PAH, almost all segments with abnormal perfusion showed patchy defects. • In pCTEPH, patchy and PE-type defects were the most frequent abnormalities.
authors.affiliation: Department of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Université de Lille 2 Nord de France, 59000, Lille, France.
authors.forename: Jessica
authors.initials: J
authors.lastname: Giordano
authors.affiliation: Department of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Université de Lille 2 Nord de France, 59000, Lille, France.
authors.forename: Suonita
authors.initials: S
authors.lastname: Khung
authors.affiliation: Department of Biostatistics, University Lille, CHU Lille, EA 2694, 59000, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Department of Nuclear Medicine, Hospital Salengro, University Lille, CHU Lille, 59000, Lille, France.
authors.forename: Claude
authors.initials: C
authors.lastname: Hossein-Foucher
authors.affiliation: Department of Nuclear Medicine, Hospital Salengro, University Lille, CHU Lille, 59000, Lille, France.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Bellèvre
authors.affiliation: Department of Cardiology, Cardiology Hospital, University Lille, CHU Lille, 59000, Lille, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lamblin
authors.affiliation: Department of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Université de Lille 2 Nord de France, 59000, Lille, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Remy
authors.affiliation: Department of Thoracic Imaging, Hospital Calmette (EA 2694), CHRU et Université de Lille 2 Nord de France, 59000, Lille, France. martine.remy@chru-lille.fr.
authors.forename: Martine
authors.initials: M
authors.lastname: Remy-Jardin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods; D002908:Chronic Disease; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult
keywords: CT angiography; Chronic thromboembolism; Dual-energy CT; Lung perfusion; Pulmonary hypertension