C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT

Jan B. Hinrichs, Thomas Werncke, Till Kaireit, Marius M. Hoeper, Karen M. Olsson, Jan Christopher Kamp, Frank K. Wacker, Frank Bengel, Christian Von Falck, Imke Schatka, Bernhard C. Meyer

Research output: Contribution to journalArticle

Abstract

Purpose To determine if C-Arm computed tomography (CACT) has added diagnostic value in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) with a positive mismatch pattern in ventilation/perfusion single photon emission computed tomography (V/Q SPECT). Materials and Methods 28 patients (23 men, 5 women, 62 ± 18 years) with CTEPH who had undergone SPECT, followed by CACT and right heart catheterization (RHC) were included. Two independent readers reviewed SPECT and CACT. Findings indicating CTEPH and their location (segmental or sub-segmental) were identified (V/Q mismatch in SPECT and vascular pathologies in CACT). Inter-modality agreement was calculated (Cohen's Kappa). Findings were scored on a 3-point-scale. The sum of the score (pulmonary artery CTEPH severity score (PACSS)) was calculated for each patient and imaging modality, correlated to RHC (spearman's correlation) and compared to the final therapeutic decision of the CTEPH board (including the consensus of SPECT, selective pulmonary DSA and CACT). Results Overall, 504 pulmonary artery segments were assessed in SPECT and CACT. SPECT had identified 266/504 (53 %) arterial segments without and 238/504 (47 %) segments with a V/Q mismatch indicating CTEPH. CACT detected 131/504 (26 %) segments without abnormal findings and 373/504 (74 %) segments with findings indicating CTEPH. Inter-modality agreement was fair (κ= 0.38). PACSS of CACT correlated mildly significantly with the mean pulmonary artery pressure (PAPmean; rho = 0.48, p = 0.01), while SPECT missed significance (rho = 0.32, p = 0.1). Discrepant findings were mostly attributed to a higher frequency of sub-segmental pulmonary arterial pathologies on CACT (145 sub-segmental findings indicating CTEPH) rated as normal on SPECT. Conclusion In patients with CTEPH, contrast-enhanced CACT detects additional findings with a better correlation to the severity of PAPmean than V/Q SPECT. CACT indicates abnormalities even in segments without V/Q abnormalities. Key points CACT has additional value in V/Q SPECT-positive CTEPH patients. SPECT may underestimate the extent of CTEPH. CACT indicates abnormalities even in segments without V/Q abnormalities. Citation Format Hinrichs JB, Werncke T, Kaireit T et al. C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT. Fortschr Röntgenstr.

Original languageEnglish (US)
Pages (from-to)49-56
Number of pages8
JournalRoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren
Volume189
Issue number1
DOIs
StatePublished - Jan 1 2017
Externally publishedYes

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Single-Photon Emission-Computed Tomography
Pulmonary Hypertension
Tomography
Pulmonary Artery
Cardiac Catheterization
Pathology
Lung
Blood Vessels
Ventilation
Perfusion

Keywords

  • chronic thromboembolic pulmonary hypertension
  • cone-beam computed tomography
  • CTEPH
  • lung perfusion
  • radiation exposure pulmonary CACT
  • SPECT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT. / Hinrichs, Jan B.; Werncke, Thomas; Kaireit, Till; Hoeper, Marius M.; Olsson, Karen M.; Kamp, Jan Christopher; Wacker, Frank K.; Bengel, Frank; Von Falck, Christian; Schatka, Imke; Meyer, Bernhard C.

In: RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren, Vol. 189, No. 1, 01.01.2017, p. 49-56.

Research output: Contribution to journalArticle

Hinrichs, Jan B. ; Werncke, Thomas ; Kaireit, Till ; Hoeper, Marius M. ; Olsson, Karen M. ; Kamp, Jan Christopher ; Wacker, Frank K. ; Bengel, Frank ; Von Falck, Christian ; Schatka, Imke ; Meyer, Bernhard C. / C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT. In: RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren. 2017 ; Vol. 189, No. 1. pp. 49-56.
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abstract = "Purpose To determine if C-Arm computed tomography (CACT) has added diagnostic value in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) with a positive mismatch pattern in ventilation/perfusion single photon emission computed tomography (V/Q SPECT). Materials and Methods 28 patients (23 men, 5 women, 62 ± 18 years) with CTEPH who had undergone SPECT, followed by CACT and right heart catheterization (RHC) were included. Two independent readers reviewed SPECT and CACT. Findings indicating CTEPH and their location (segmental or sub-segmental) were identified (V/Q mismatch in SPECT and vascular pathologies in CACT). Inter-modality agreement was calculated (Cohen's Kappa). Findings were scored on a 3-point-scale. The sum of the score (pulmonary artery CTEPH severity score (PACSS)) was calculated for each patient and imaging modality, correlated to RHC (spearman's correlation) and compared to the final therapeutic decision of the CTEPH board (including the consensus of SPECT, selective pulmonary DSA and CACT). Results Overall, 504 pulmonary artery segments were assessed in SPECT and CACT. SPECT had identified 266/504 (53 {\%}) arterial segments without and 238/504 (47 {\%}) segments with a V/Q mismatch indicating CTEPH. CACT detected 131/504 (26 {\%}) segments without abnormal findings and 373/504 (74 {\%}) segments with findings indicating CTEPH. Inter-modality agreement was fair (κ= 0.38). PACSS of CACT correlated mildly significantly with the mean pulmonary artery pressure (PAPmean; rho = 0.48, p = 0.01), while SPECT missed significance (rho = 0.32, p = 0.1). Discrepant findings were mostly attributed to a higher frequency of sub-segmental pulmonary arterial pathologies on CACT (145 sub-segmental findings indicating CTEPH) rated as normal on SPECT. Conclusion In patients with CTEPH, contrast-enhanced CACT detects additional findings with a better correlation to the severity of PAPmean than V/Q SPECT. CACT indicates abnormalities even in segments without V/Q abnormalities. Key points CACT has additional value in V/Q SPECT-positive CTEPH patients. SPECT may underestimate the extent of CTEPH. CACT indicates abnormalities even in segments without V/Q abnormalities. Citation Format Hinrichs JB, Werncke T, Kaireit T et al. C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT. Fortschr R{\"o}ntgenstr.",
keywords = "chronic thromboembolic pulmonary hypertension, cone-beam computed tomography, CTEPH, lung perfusion, radiation exposure pulmonary CACT, SPECT",
author = "Hinrichs, {Jan B.} and Thomas Werncke and Till Kaireit and Hoeper, {Marius M.} and Olsson, {Karen M.} and Kamp, {Jan Christopher} and Wacker, {Frank K.} and Frank Bengel and {Von Falck}, Christian and Imke Schatka and Meyer, {Bernhard C.}",
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TY - JOUR

T1 - C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT

AU - Hinrichs, Jan B.

AU - Werncke, Thomas

AU - Kaireit, Till

AU - Hoeper, Marius M.

AU - Olsson, Karen M.

AU - Kamp, Jan Christopher

AU - Wacker, Frank K.

AU - Bengel, Frank

AU - Von Falck, Christian

AU - Schatka, Imke

AU - Meyer, Bernhard C.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Purpose To determine if C-Arm computed tomography (CACT) has added diagnostic value in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) with a positive mismatch pattern in ventilation/perfusion single photon emission computed tomography (V/Q SPECT). Materials and Methods 28 patients (23 men, 5 women, 62 ± 18 years) with CTEPH who had undergone SPECT, followed by CACT and right heart catheterization (RHC) were included. Two independent readers reviewed SPECT and CACT. Findings indicating CTEPH and their location (segmental or sub-segmental) were identified (V/Q mismatch in SPECT and vascular pathologies in CACT). Inter-modality agreement was calculated (Cohen's Kappa). Findings were scored on a 3-point-scale. The sum of the score (pulmonary artery CTEPH severity score (PACSS)) was calculated for each patient and imaging modality, correlated to RHC (spearman's correlation) and compared to the final therapeutic decision of the CTEPH board (including the consensus of SPECT, selective pulmonary DSA and CACT). Results Overall, 504 pulmonary artery segments were assessed in SPECT and CACT. SPECT had identified 266/504 (53 %) arterial segments without and 238/504 (47 %) segments with a V/Q mismatch indicating CTEPH. CACT detected 131/504 (26 %) segments without abnormal findings and 373/504 (74 %) segments with findings indicating CTEPH. Inter-modality agreement was fair (κ= 0.38). PACSS of CACT correlated mildly significantly with the mean pulmonary artery pressure (PAPmean; rho = 0.48, p = 0.01), while SPECT missed significance (rho = 0.32, p = 0.1). Discrepant findings were mostly attributed to a higher frequency of sub-segmental pulmonary arterial pathologies on CACT (145 sub-segmental findings indicating CTEPH) rated as normal on SPECT. Conclusion In patients with CTEPH, contrast-enhanced CACT detects additional findings with a better correlation to the severity of PAPmean than V/Q SPECT. CACT indicates abnormalities even in segments without V/Q abnormalities. Key points CACT has additional value in V/Q SPECT-positive CTEPH patients. SPECT may underestimate the extent of CTEPH. CACT indicates abnormalities even in segments without V/Q abnormalities. Citation Format Hinrichs JB, Werncke T, Kaireit T et al. C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT. Fortschr Röntgenstr.

AB - Purpose To determine if C-Arm computed tomography (CACT) has added diagnostic value in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH) with a positive mismatch pattern in ventilation/perfusion single photon emission computed tomography (V/Q SPECT). Materials and Methods 28 patients (23 men, 5 women, 62 ± 18 years) with CTEPH who had undergone SPECT, followed by CACT and right heart catheterization (RHC) were included. Two independent readers reviewed SPECT and CACT. Findings indicating CTEPH and their location (segmental or sub-segmental) were identified (V/Q mismatch in SPECT and vascular pathologies in CACT). Inter-modality agreement was calculated (Cohen's Kappa). Findings were scored on a 3-point-scale. The sum of the score (pulmonary artery CTEPH severity score (PACSS)) was calculated for each patient and imaging modality, correlated to RHC (spearman's correlation) and compared to the final therapeutic decision of the CTEPH board (including the consensus of SPECT, selective pulmonary DSA and CACT). Results Overall, 504 pulmonary artery segments were assessed in SPECT and CACT. SPECT had identified 266/504 (53 %) arterial segments without and 238/504 (47 %) segments with a V/Q mismatch indicating CTEPH. CACT detected 131/504 (26 %) segments without abnormal findings and 373/504 (74 %) segments with findings indicating CTEPH. Inter-modality agreement was fair (κ= 0.38). PACSS of CACT correlated mildly significantly with the mean pulmonary artery pressure (PAPmean; rho = 0.48, p = 0.01), while SPECT missed significance (rho = 0.32, p = 0.1). Discrepant findings were mostly attributed to a higher frequency of sub-segmental pulmonary arterial pathologies on CACT (145 sub-segmental findings indicating CTEPH) rated as normal on SPECT. Conclusion In patients with CTEPH, contrast-enhanced CACT detects additional findings with a better correlation to the severity of PAPmean than V/Q SPECT. CACT indicates abnormalities even in segments without V/Q abnormalities. Key points CACT has additional value in V/Q SPECT-positive CTEPH patients. SPECT may underestimate the extent of CTEPH. CACT indicates abnormalities even in segments without V/Q abnormalities. Citation Format Hinrichs JB, Werncke T, Kaireit T et al. C-Arm Computed Tomography Adds Diagnostic Information in Patients with Chronic Thromboembolic Pulmonary Hypertension and a Positive V/Q SPECT. Fortschr Röntgenstr.

KW - chronic thromboembolic pulmonary hypertension

KW - cone-beam computed tomography

KW - CTEPH

KW - lung perfusion

KW - radiation exposure pulmonary CACT

KW - SPECT

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