Eun Young Kim, Presenter: Nothing to Disclose

Joon Beom Seo MD, PhD, Abstract Co-Author: Speaker, Siemens AG

Eunsol Lee MD, Abstract Co-Author: Nothing to Disclose

Hye Jeon Hwang MD, Abstract Co-Author: Nothing to Disclose

Sang Young Oh MD, Abstract Co-Author: Nothing to Disclose

To assess perfusion pattern on a dual-energy pulmonary CT angiography (DECTA) of pulmonary hypertension (PHT) with variable causes. To investigate whether the extent of perfusion defect can be used in the severity assessment of PHT.

Between Mar 2007 and Feb 2011, DECTA scans of 62 consecutive patients (M:F=24:38; mean age, 58 years) with PHT were retrospectively included with following inclusion criteria; 1) absence of acute pulmonary thromboembolism, 2) TR Vmax above 3m/s on echocardiography performed at the same time. The patients were classified into primary or secondary PHT based on imaging and clinical features. Secondary PHT was further categorized into 4 groups; cardiogenic, COPD, vascular obstruction, and ILD. Vascular obstruction includes chronic embolism, fibrosing mediastinitis and Takayasu’s arteritis. Perfusion pattern of iodine map was visually assessed and divided into normal (NL), diffuse heterogeneously decreased (DH), multifocal geographic (MG) and multiple peripheral wedging (PW) patterns. The extent of perfusion defect (PD), diameter of main pulmonary artery (MPA) and ratio of ascending aorta diameter/MPA (APR) were measured. Pearson correlation analysis was performed between TR Vmax on echocardiography and CT imaging parameters.

Common perfusion patterns of primary PHT were DH or NL (14/30 (47%) and 13/30 (43%), respectively). The perfusion patterns of secondary PHT were variable according to the causes as follows; NL (6/9) in cardiogenic, MG (8/9) in COPD, PW (4/8) in vascular obstruction and variable in ILD. On the correlation analysis, in primary PHT, TR Vmax was correlated with PD, MPA and APR (r=0.53, r=0.40, r=-0.50, respectively, all p<0.05). In secondary PHT, TR Vmax was correlated with PD and MPA (r=0.38, r=0.53, respectively, all p<0.05). In both group, however, PD was not correlated with MPA or APR.

Different perfusion patterns were observed on DECTA of PHT according to the causes. PD and MPA were correlated with the severity of PHT.  

DECTA may be useful in assessing the patient with PHT, allowing for the identification of cause and severity assessment.  

Kim, E, Seo, J, Lee, E, Hwang, H, Oh, S, Dual-Energy CT Angiography for Assessment of Perfusion Pattern and Severity in Patients with Pulmonary Hypertension.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11011274.html