Korean Journal of Radiology

  • 제15권2호
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  • Pages.286-294
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  • 2014
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지
DOI QR코드

DOI QR Code

Assessment of Perfusion Pattern and Extent of Perfusion Defect on Dual-Energy CT Angiography: Correlations between the Causes of Pulmonary Hypertension and Vascular Parameters

  • Kim, Eun Young (Department of Radiology, Chonbuk National University Medical School and Hospital, Research Institute of Clinical Medicine) ;
  • Seo, Joon Beom (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Oh, Sang Young (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Choong Wook (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hwang, Hye Jeon (Department of Radiology, Hallym University College of Medicine, Hallym University Sacred Heart Hospital) ;
  • Lee, Sang Min (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Young Kyung (Department of Radiology, Seoul Medical Center)
  • 투고 : 2013.06.26
  • 심사 : 2014.01.10
  • 발행 : 2014.04.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To assess perfusion patterns on a dual-energy pulmonary CT angiography (DECTA) of pulmonary hypertension (PHT) with variable causes and to assess whether the extent of perfusion defect can be used in the severity assessment of PHT. Materials and Methods: Between March 2007 and February 2011, DECTA scans of 62 consecutive patients (24 men, 38 women; mean age, $58.5{\pm}17.3$ [standard deviation] years; range, 19-87 years) with PHT were retrospectively included with following inclusion criteria; 1) absence of acute pulmonary thromboembolism, 2) maximal velocity of tricuspid regurgitation jet (TR Vmax) above 3 m/s on echocardiography performed within one week of the DECTA study. Perfusion patterns of iodine map were divided into normal (NL), diffuse heterogeneously decreased (DH), multifocal geographic and multiple peripheral wedging patterns. The extent of perfusion defects (PD), the diameter of main pulmonary artery (MPA) and the ratio of ascending aorta diameter/MPA (aortopulmonary ratio, APR) were measured. Pearson correlation analysis was performed between TR Vmax on echocardiography and CT imaging parameters. Results: Common perfusion patterns of primary PHT were DH (n = 15) and NL (n = 12). The perfusion patterns of secondary PHT were variable. On the correlation analysis, in primary PHT, TR Vmax significantly correlated with PD, MPA and APR (r = 0.52, r = 0.40, r = -0.50, respectively, all p < 0.05). In secondary PHT, TR Vmax significantly correlated with PD and MPA (r = 0.38, r = 0.53, respectively, all p < 0.05). Conclusion: Different perfusion patterns are observed on DECTA of PHT according to the causes. PD and MPA are significantly correlated with the TR Vmax.

키워드

과제정보

연구 과제 주관 기관 : Ministry of Health & Welfare

참고문헌

  1. Powe JE, Palevsky HI, McCarthy KE, Alavi A. Pulmonary arterial hypertension: value of perfusion scintigraphy. Radiology 1987;164:727-730 https://doi.org/10.1148/radiology.164.3.3615869
  2. Ogawa Y, Nishimura T, Hayashida K, Uehara T, Shimonagata T. Perfusion lung scintigraphy in primary pulmonary hypertension. Br J Radiol 1993;66:677-680 https://doi.org/10.1259/0007-1285-66-788-677
  3. Bartalena T, Oboldi D, Guidalotti PL, Rinaldi MF, Bertaccini P, Napoli G, et al. Lung perfusion in patients with pulmonary hypertension: comparison between MDCT pulmonary angiography with minIP reconstructions and 99mTc-MAA perfusion scan. Invest Radiol 2008;43:368-373 https://doi.org/10.1097/RLI.0b013e31816901e2
  4. Kumar AM, Parker JA. Ventilation/perfusion scintigraphy. Emerg Med Clin North Am 2001;19:957-973 https://doi.org/10.1016/S0733-8627(05)70229-7
  5. McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association developed in collaboration with the American College of Chest Physicians; American Thoracic Society, Inc.; and the Pulmonary Hypertension Association. J Am Coll Cardiol 2009;53:1573-1619 https://doi.org/10.1016/j.jacc.2009.01.004
  6. Yock PG, Popp RL. Noninvasive estimation of right ventricular systolic pressure by Doppler ultrasound in patients with tricuspid regurgitation. Circulation 1984;70:657-662 https://doi.org/10.1161/01.CIR.70.4.657
  7. Barst RJ, McGoon M, Torbicki A, Sitbon O, Krowka MJ, Olschewski H, et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004;43(12 Suppl S):40S-47S https://doi.org/10.1016/j.jacc.2004.02.032
  8. Bossone E, Citro R, Blasi F, Allegra L. Echocardiography in pulmonary arterial hypertension: an essential tool. Chest 2007;131:339-341 https://doi.org/10.1378/chest.06-2475
  9. Bossone E, Bodini BD, Mazza A, Allegra L. Pulmonary arterial hypertension: the key role of echocardiography. Chest 2005;127:1836-1843 https://doi.org/10.1378/chest.127.5.1836
  10. Bossone E, D'Andrea A, D'Alto M, Citro R, Argiento P, Ferrara F, et al. Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis. J Am Soc Echocardiogr 2013;26:1-14 https://doi.org/10.1016/j.echo.2012.10.009
  11. Engelke C, Schaefer-Prokop C, Schirg E, Freihorst J, Grubnic S, Prokop M. High-resolution CT and CT angiography of peripheral pulmonary vascular disorders. Radiographics 2002;22:739-764 https://doi.org/10.1148/radiographics.22.4.g02jl01739
  12. Rossi A, Attinà D, Borgonovi A, Buia F, De Luca F, Guidalotti PL, et al. Evaluation of mosaic pattern areas in HRCT with Min-IP reconstructions in patients with pulmonary hypertension: could this evaluation replace lung perfusion scintigraphy? Eur J Radiol 2012;81:e1-e6 https://doi.org/10.1016/j.ejrad.2010.09.032
  13. Kuriyama K, Gamsu G, Stern RG, Cann CE, Herfkens RJ, Brundage BH. CT-determined pulmonary artery diameters in predicting pulmonary hypertension. Invest Radiol 1984;19:16-22 https://doi.org/10.1097/00004424-198401000-00005
  14. Ng CS, Wells AU, Padley SP. A CT sign of chronic pulmonary arterial hypertension: the ratio of main pulmonary artery to aortic diameter. J Thorac Imaging 1999;14:270-278 https://doi.org/10.1097/00005382-199910000-00007
  15. Tan RT, Kuzo R, Goodman LR, Siegel R, Haasler GB, Presberg KW. Utility of CT scan evaluation for predicting pulmonary hypertension in patients with parenchymal lung disease. Medical College of Wisconsin Lung Transplant Group. Chest 1998;113:1250-1256 https://doi.org/10.1378/chest.113.5.1250
  16. Fink C, Johnson TR, Michaely HJ, Morhard D, Becker C, Reiser M, et al. Dual-energy CT angiography of the lung in patients with suspected pulmonary embolism: initial results. Rofo 2008;180:879-883
  17. Hoey ET, Gopalan D, Ganesh V, Agrawal SK, Qureshi N, Tasker AD, et al. Dual-energy CT pulmonary angiography: a novel technique for assessing acute and chronic pulmonary thromboembolism. Clin Radiol 2009;64:414-419 https://doi.org/10.1016/j.crad.2008.11.007
  18. Chae EJ, Seo JB, Jang YM, Krauss B, Lee CW, Lee HJ, et al. Dual-energy CT for assessment of the severity of acute pulmonary embolism: pulmonary perfusion defect score compared with CT angiographic obstruction score and right ventricular/left ventricular diameter ratio. AJR Am J Roentgenol 2010;194:604-610 https://doi.org/10.2214/AJR.09.2681
  19. Lee CW, Seo JB, Song JW, Kim MY, Lee HY, Park YS, et al. Evaluation of computer-aided detection and dual energy software in detection of peripheral pulmonary embolism on dual-energy pulmonary CT angiography. Eur Radiol 2011;21:54-62 https://doi.org/10.1007/s00330-010-1903-7
  20. Pontana F, Remy-Jardin M, Duhamel A, Faivre JB, Wallaert B, Remy J. Lung perfusion with dual-energy multi-detector row CT: can it help recognize ground glass opacities of vascular origin? Acad Radiol 2010;17:587-594 https://doi.org/10.1016/j.acra.2009.12.013
  21. Hoey ET, Mirsadraee S, Pepke-Zaba J, Jenkins DP, Gopalan D, Screaton NJ. Dual-energy CT angiography for assessment of regional pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension: initial experience. AJR Am J Roentgenol 2011;196:524-532 https://doi.org/10.2214/AJR.10.4842
  22. Renard B, Remy-Jardin M, Santangelo T, Faivre JB, Tacelli N, Remy J, et al. Dual-energy CT angiography of chronic thromboembolic disease: can it help recognize links between the severity of pulmonary arterial obstruction and perfusion defects? Eur J Radiol 2011;79:467-472 https://doi.org/10.1016/j.ejrad.2010.04.018
  23. Nakazawa T, Watanabe Y, Hori Y, Kiso K, Higashi M, Itoh T, et al. Lung perfused blood volume images with dual-energy computed tomography for chronic thromboembolic pulmonary hypertension: correlation to scintigraphy with single-photon emission computed tomography. J Comput Assist Tomogr 2011;35:590-595 https://doi.org/10.1097/RCT.0b013e318224e227
  24. Weitzenblum E, Apprill M, Oswald M, Chaouat A, Imbs JL. Pulmonary hemodynamics in patients with chronic obstructive pulmonary disease before and during an episode of peripheral edema. Chest 1994;105:1377-1382 https://doi.org/10.1378/chest.105.5.1377
  25. Kim BH, Seo JB, Chae EJ, Lee HJ, Hwang HJ, Lim C. Analysis of perfusion defects by causes other than acute pulmonary thromboembolism on contrast-enhanced dual-energy CT in consecutive 537 patients. Eur J Radiol 2012;81:e647-e652 https://doi.org/10.1016/j.ejrad.2012.01.026
  26. Pierson DJ. Pathophysiology and clinical effects of chronic hypoxia. Respir Care 2000;45:39-51; discussion 51-53
  27. Grosse C, Grosse A. CT findings in diseases associated with pulmonary hypertension: a current review. Radiographics 2010;30:1753-1777 https://doi.org/10.1148/rg.307105710
  28. Shorr AF, Wainright JL, Cors CS, Lettieri CJ, Nathan SD. Pulmonary hypertension in patients with pulmonary fibrosis awaiting lung transplant. Eur Respir J 2007;30:715-721 https://doi.org/10.1183/09031936.00107206
  29. Patel NM, Lederer DJ, Borczuk AC, Kawut SM. Pulmonary hypertension in idiopathic pulmonary fibrosis. Chest 2007;132:998-1006 https://doi.org/10.1378/chest.06-3087
  30. Devaraj A, Wells AU, Meister MG, Corte TJ, Hansell DM. The effect of diffuse pulmonary fibrosis on the reliability of CT signs of pulmonary hypertension. Radiology 2008;249:1042-1049 https://doi.org/10.1148/radiol.2492080269
  31. Guazzi M, Borlaug BA. Pulmonary hypertension due to left heart disease. Circulation 2012;126:975-990 https://doi.org/10.1161/CIRCULATIONAHA.111.085761
  32. Au VW, Jones DN, Slavotinek JP. Pulmonary hypertension secondary to left-sided heart disease: a cause for ventilationperfusion mismatch mimicking pulmonary embolism. Br J Radiol 2001;74:86-88 https://doi.org/10.1259/bjr.74.877.740086
  33. Galie N, Torbicki A, Barst R, Dartevelle P, Haworth S, Higenbottam T, et al. Guidelines on diagnosis and treatment of pulmonary arterial hypertension. The Task Force on Diagnosis and Treatment of Pulmonary Arterial Hypertension of the European Society of Cardiology. Eur Heart J 2004;25:2243-2278 https://doi.org/10.1016/j.ehj.2004.09.014
  34. Hatle L, Angelsen BA, Tromsdal A. Non-invasive estimation of pulmonary artery systolic pressure with Doppler ultrasound. Br Heart J 1981;45:157-165 https://doi.org/10.1136/hrt.45.2.157
  35. Arcasoy SM, Christie JD, Ferrari VA, Sutton MS, Zisman DA, Blumenthal NP, et al. Echocardiographic assessment of pulmonary hypertension in patients with advanced lung disease. Am J Respir Crit Care Med 2003;167:735-740 https://doi.org/10.1164/rccm.200210-1130OC

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