Abstract:
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Purpose: To compare the frequency of a systemic collateral supply in patients with chronic thromboembolic pulmonary hypertension and primary pulmonary hypertension using multislice spiral CT angiography.
Methods and Materials: From December 200 to March 2003, 32 consecutive patients with chronic thromboembolic pulmonary hypertension and 15 with primary pulmonary hypertension underwent a multislice spiral CT angiographic evaluation of the pulmonary and sytemic circulations based on the following protocol: (1) collimation: 4 x 1mm; pitch: 1.75 (n=22); collimation: 16 x 0.75 mm; pitch: 1.5 (n=25); (2) administration of a 30% contrast agent at a rate of 4 mL/s using an automatic triggering software programme; and (3) reconstruction of contiguous 1-mm thick transverse CT scans and 3D images of the pulmonary and systemic vessels, namely MIPs and volume-rendered images.
Results: The degree of pulmonary hypertension was comparable in the two groups. Abnormally enlarged systemic arteries were identified in 15 (47%) patients with chronic thromboembolic pulmonary hypertension whereas none of the primary hypertension group had enlarged systemic arteries. Systemic collateral supply observed in patients with chronic thromboembolic pulmonary hypertension was: (a) found as a bilateral (n=11) or unilateral (n=4) finding; (b) originating exclusively from bronchial arteries (n=8) or from both bronchial and nonbronchial systemic arteries (n=7). A total of 28 enlarged systemic arteries were depicted including 15 bronchial, 8 internal thoracic, 3 intercostal et 2 subclavian arteries. The presence of CT features of chronic pulmonary embolism at the level of peripheral pulmonary arteries (p=0.02) and/or a mosaic pattern of ground glass attenuation (p=0.03) was positively correlated to the presence of abnormally enlarged systemic arteries.
Conclusion: Detection of abnormally enlarged systemic arteries on multislice spiral CT angiograms helps to distinguish patients with chronic thromboembolic pulmonary hypertension from those with primary pulmonary hypertension.
Remy-Jardin MD, PhD, M,
Comparison of Systemic Collateral Supply in Patients with Chronic Thromboembolis Pulmonary Hypertension and Primary Pulmonary Hypertension: Noninvasive Assessment with Multislice Spiral CT Angiography. Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL.
http://archive.rsna.org/2003/3104439.html
