Rationale and Objectives
Pulmonary endarterectomy (PEA) is one of the most effective treatments for chronic
thromboembolic pulmonary hypertension (CTEPH). Right heart catheterization (RHC) is
the gold standard assessment for pulmonary circulatory dynamics. However, computed
tomography (CT) is less invasive than RHC and can elucidate some of the morphological
changes caused by thromboembolism. We hypothesized that CT could facilitate the evaluation
of heterogeneous pulmonary perfusion. This study investigated whether CT imaging features
reflect the disease severity and changes in pulmonary circulatory dynamics in patients
with CTEPH before and after PEA.
Materials and Methods
This retrospective study included 58 patients with CTEPH who underwent PEA. Pre-PEA
and post-PEA CT images were assessed for heterogeneity using CT texture analysis (CTTA).
The CT parameters were compared with the results of the RHC and other clinical indices
and analyzed with receiver operating characteristic curves analysis for patients with
and without residual pulmonary hypertension (PH) (post-PEA mean pulmonary artery pressure
≥ 25 mmHg).
Results
CT measurements reflecting heterogeneity were significantly correlated with mean pulmonary
artery pressure. Kurtosis, skewness, and uniformity were significantly lower, and
entropy was significantly higher in patients with residual PH than patients without
residual PH. Area under the curve values of pre-PEA and post-PEA entropy between patients
with and without residual PH were 0.71 (95% confidence interval 0.57–0.84) and 0.75
(0.63–0.88), respectively.
Conclusion
Heterogeneity of lung density might reflect pulmonary circulatory dynamics, and CTTA
for heterogeneity could be a less invasive technique for evaluation of changes in
pulmonary circulatory dynamics in patients with CTEPH undergoing PEA.
Key Words
Abbreviations:
AaDO2 (alveolar-arterial oxygen difference), APTE (acute pulmonary thromboembolism), CI (cardiac index), CO (cardiac output), CSA < 5 (cross-sectional area of small pulmonary vessels less than 5 mm2 on CT images), CTEPH (chronic thromboembolic pulmonary hypertension), CTTA (CT texture analysis), DLCO (diffusing capacity for carbon monoxide), HU (Hounsfield unit), mPAP (mean pulmonary artery pressure), PaCO2 (partial pressure of carbon dioxide in pulmonary arterial blood), PaO2 (partial pressure of oxygen in pulmonary arterial blood), PAWP (pulmonary artery wedge pressure), PE (pulmonary embolism), PEA (pulmonary endarterectomy), PH (pulmonary hypertension), PVR (pulmonary vascular resistance), RHC (right heart catheterization), ROI (region of interest), sPAP (systolic pulmonary artery pressure), TLA (total lung area %), CSA < 5 (the percentages of CSA < 5)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: April 22, 2022
Accepted:
March 1,
2022
Received in revised form:
February 21,
2022
Received:
November 5,
2021
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
