title: Chronic thromboembolic pulmonary hypertension: Evaluation of 2D-perfusion angiography in patients who undergo balloon pulmonary angioplasty.
abstract: OBJECTIVE
  To evaluate the feasibility of 2D-perfusion angiography (2D-PA) in order to quantify perfusion changes of the lung parenchyma pre- and post-balloon pulmonary angioplasty (BPA).
  
  
  METHODS
  Thirty consecutive interventions in 16 patients with 99 treated pulmonary artery segments were included. To quantify changes in pulmonary blood flow using 2D-PA, the acquired digital subtraction angiographies (DSA) pre- and post-BPA were post-processed. A reference ROI in the treated pulmonary artery and a distal target ROI in the lung parenchyma were placed in corresponding areas on DSA pre- and post-BPA. Time to peak (TTP), peak density (PD) and area under the curve (AUC) were assessed. The ratios reference ROI to target ROI (TTPparenchyma/TTPinflow; PDparenchyma/PDinflow; AUCparenchyma/AUCinflow) were calculated. Relative differences of the 2D-PA parameters were correlated to changes in the pulmonary-flow-grade-score.
  
  
  RESULTS
  The pulmonary-flow-grade-score improved after BPA (p<0.0001). Likewise, the ratio TTPparenchyma/TTPinflowshortened by 10% (p=0.0002), the PDparenchyma/PDinflowincreased by 46% (p<0.0001) and the AUCparenchyma/AUCinflowincreased by 36% (p<0.0001). A significant correlation between changes in the pulmonary-flow-grade-score and changes in PDparenchyma/PDinflow(ρ=0.48, p<0.0001) and AUCparenchyma/AUCinflow(ρ=0.31, p=0.0018) was observed.
  
  
  CONCLUSIONS
  Quantification of pulmonary perfusion pre- and post-BPA using 2D-PA is feasible and has the potential to improve monitoring of BPA.
  
  
  CONCLUSIONS
  • Quantification of BPA results by use of 2D-PA is feasible. • 2D-PA allows objective assessment of changes in lung parenchymal perfusion. • 2D-PA has the potential to optimize BPA.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Sabine K
authors.initials: SK
authors.lastname: Maschke
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Renne
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Werncke
authors.affiliation: Clinic for Pneumology, Hannover Medical School, Hannover, Germany.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Olsson
authors.affiliation: Clinic for Pneumology, Hannover Medical School, Hannover, Germany.
authors.forename: Marius M
authors.initials: MM
authors.lastname: Hoeper
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Frank K
authors.initials: FK
authors.lastname: Wacker
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Meyer
authors.affiliation: Department of Diagnostic and Interventional Radiology, Hannover Medical School, Neuberg-Str. 1, 30625, Hannover, Germany. hinrichs.jan@mh-hannover.de.
authors.forename: Jan B
authors.initials: JB
authors.lastname: Hinrichs
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction / Q000379:methods*; D000800:Angioplasty, Balloon / Q000379:methods*; D019540:Area Under Curve; D005240:Feasibility Studies; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000150:complications*; D015641:Radiography, Interventional; D012189:Retrospective Studies
keywords: 2D-perfusion angiography; Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Percutaneous transluminal pulmonary angioplasty; Pulmonary hypertension