Fanny Petit MD, Presenter: Nothing to Disclose

Arnaud Resten MD, Abstract Co-Author: Nothing to Disclose

Sophie Maitre MD, Abstract Co-Author: Nothing to Disclose

Jean-Francois Paul MD, Abstract Co-Author: Nothing to Disclose

Antoine Khalil MD, Abstract Co-Author: Nothing to Disclose

Dominique Musset MD, Abstract Co-Author: Nothing to Disclose

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and serious disease, caused by obstruction of the large pulmonary arteries by recurrent pulmonary emboli. If the disease is proximally located, CTEPH can be cured surgically through a complex procedure, the thromboendarterectomy. Due to a rate of failure of 15%, a severe selection of patient is mandatory. The location and vascular degree of obstruction are mainly evaluated by pulmonary angiography (DSA), and more recently by angiographic multi-detector CT (MDCT). The aim of this study was to compare the ability of MDCT and DSA to depict a proximal location of the disease which determine the feasibility of surgery. MDCT was also evaluated for its ability to evaluate distal obstructions compared with DSA as the gold standard.

MDCT and DSA of 27 consecutive patients treated by thromboendarterectomy for a CTEPH were reviewed retrospectively and independently by two groups of three chest radiologists, without knowledge of surgical results. Operability criterion was the presence of endovascular “material” at the level or before the right and/or left interlobar arteries level. Sensitivity and specificity of MDCT, DSA, and the association of both exams were determined according to the results of thromboendarterectomy. Distal obstruction was also evaluated on the 540 segmental arteries, to compare MDCT and DSA (Spearman test)

Concerning operability, sensitivity were 98% and 96%, and specificity 50% and 75%, respectively for DSA and MDCT. Association of both exams allowed an increase specificity of 100%. MDCT was not efficiency for the evaluation of distal location of the disease (p=0.22).

DSA and MDCT have a high sensitivity to evaluate operability of CTEPH, but specificity’s are poor except in cases where these procedures are associated. Both examinations have to be done before a decision of thromboendarterectomy in order to decrease the level of failure of this curative but complex and dangerous treatment.

Petit, F, Resten, A, Maitre, S, Paul, J, Khalil, A, Musset, D, Comparison of MDCT and DSA for the Decision of Operability of CTEPH by Thromboendarterectomy.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4411908.html