Dual energy CT based scoring in chronic thromboembolic pulmonary hypertension and correlation with clinical and hemodynamic parameters: a retrospective cross-sectional study

Abozeed, Mostafa; Conic, Sofija; Bullen, Jennifer; Rizk, Alain; Saeedan, Mnahi Bin; Karim, Wadih; Heresi, Gustavo A.; Renapurkar, Rahul D.

doi:10.21037/cdt-21-686

Cited by 6 publications

(7 citation statements)

References 21 publications

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“…Currently, that assessment is largely subjective. Our group has developed a DECT-based imaging score that combines an assessment of clot burden and perfusion and that correlates with baseline and postoperative hemodynamics [14]. This score and other methods are necessary to bring some degree of objectivity of CTEPH operability assessment, recognizing that some degree of subjectively will be always present.…”

Section: The Multidisciplinary Discussion For Treatment Planningmentioning

confidence: 99%

Lessons learned in developing a chronic thromboembolic pulmonary hypertension program

Bair

Heresi

2023

Current Opinion in Pulmonary Medicine

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Purpose of review Chronic thromboembolic pulmonary hypertension (CTEPH) is a deadly underdiagnosed form of pulmonary hypertension, traditionally treated with surgical extraction of thrombo-fibrotic lesions via pulmonary thrombendarterectomy (PTE) surgery. More recently, treatment options have expanded to pulmonary vasodilator medical therapy and balloon pulmonary angioplasty (BPA). This has led to increased awareness and detection of CTEPH, as well as growing interest in performing PTE and BPA. This review will describe the steps required to build a successful CTEPH team in the context of the rapidly evolving treatment of CTEPH. Recent findings CTEPH care requires a multidisciplinary team, including a Pulmonologist or Cardiologist expert in Pulmonary Hypertension, a PTE surgeon, a BPA interventionalist, a dedicated radiologist, cardiothoracic anesthesia and Vascular Medicine or Hematology. Careful assessment of precise imaging and hemodynamic data is needed for operability assessment in the context of the experience of the CTEPH team and surgeon. Medical therapy and BPA are indicated for inoperable CTEPH and residual CTEPH after PTE. Increasingly, multimodality approaches, including surgery, BPA and medical therapy are utilized for best outcomes. Summary An expert CTEPH center requires a multidisciplinary team with dedicated specialists, and time to develop the experience and expertise to achieve high volumes and good outcomes.

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Section: The Multidisciplinary Discussion For Treatment Planningmentioning

confidence: 99%

Lessons learned in developing a chronic thromboembolic pulmonary hypertension program

Bair

Heresi

2023

Current Opinion in Pulmonary Medicine

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“…We have developed a combined score that integrates anatomic clot burden and PDs. 17 For the clot burden score, clots that were labeled as chronic on CT imaging included atretic and poorly opacified arteries, bands and webs, and areas of stenosis and luminal narrowing. If these changes involved the pulmonary trunk, a score of 5 was assigned.…”

Section: Dect Scorementioning

confidence: 99%

“…We have previously developed a quantitative DECT score that integrates chronic clot burden and PDs in CTEPH, and that correlates with baseline indices of severity, specifically mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) 17 . In the current study, we test the hypothesis that this preoperative DECT score is associated with postoperative outcomes.…”

mentioning

confidence: 98%

A Novel Dual Energy Computed Tomography Score Correlates With Postoperative Outcomes in Chronic Thromboembolic Pulmonary Hypertension

Renapurkar

Bullen

Rizk

et al. 2023

Journal of Thoracic Imaging

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Purpose: To compare dual-energy computed tomography (DECT) based qualitative and quantitative parameters in chronic thromboembolic pulmonary hypertension with various postoperative primary and secondary endpoints. Materials and Methods: This was a retrospective analysis of 64 patients with chronic thromboembolic pulmonary hypertension who underwent DECT. First, a clot score was calculated by assigning the following score: pulmonary trunk-5, each main pulmonary artery-4, each lobar-3, each segmental-2, and subsegmental-1 per lobe; the sum total was then calculated. The perfusion defect (PD) score was calculated by assigning 1 point to each segmental PD. The combined score was calculated by adding clot and PD scores. For quantitative evaluation, we calculated perfused blood volume (PBV) (%) of each lung and the sum of both lungs. Primary endpoints included testing association between combined score and total PBV with change in mean pulmonary arterial pressure ([mPAP], change calculated as preop minus postop values). Secondary endpoints included explorative analysis of the correlation between combined score and PBV with change in preoperative and postoperative pulmonary vascular resistance, change in preoperative 6-minute walk distance (6MWD), and immediate postoperative complications such as reperfusion edema, ECMO placement, stroke, death and mechanical ventilation for more than 48 hours, all within 1 month of surgery. Results: Higher combined scores were associated with larger decreases in mPAP ( =0.27, P=0.036). On average, the decrease in mPAP (pre mPAP−post mPAP) increased by 2.2 mm Hg (95% CI: −0.6, 5.0) with each 10 unit increase in combined score. The correlation between total PBV and change in mPAP was small and not statistically significant. During an exploratory analysis, higher combined scores were associated with larger increases in 6MWD at 6 months postprocedure ( =0.55, P=0.002). Conclusion: Calculation of DECT-based combined score offers potential in the evaluation of hemodynamic response to surgery. This response can also be objectively quantified.

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“…Quantification of PBV in the lung based on DECT can be assessed, and there has been some research into the association of the severity of PE or PH and the number of perfusion defects [ 16 , 34 , 51 , 52 , 53 , 54 , 55 , 56 , 57 ]. In conventional CT, some CT findings such as dilatation of the PA and the right ventricle (RV), have been observed in patients with PH [ 58 , 59 , 60 , 61 , 62 ].…”

Section: Clinical Application Of Dual-energy Ct For Pulmonary Functio...mentioning

confidence: 99%

Advances for Pulmonary Functional Imaging: Dual-Energy Computed Tomography for Pulmonary Functional Imaging

Ozawa,

Ohno,

Nagata

et al. 2023

Diagnostics

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Dual-energy computed tomography (DECT) can improve the differentiation of material by using two different X-ray energy spectra, and may provide new imaging techniques to diagnostic radiology to overcome the limitations of conventional CT in characterizing tissue. Some techniques have used dual-energy imaging, which mainly includes dual-sourced, rapid kVp switching, dual-layer detectors, and split-filter imaging. In iodine images, images of the lung’s perfused blood volume (PBV) based on DECT have been applied in patients with pulmonary embolism to obtain both images of the PE occluding the pulmonary artery and the consequent perfusion defects in the lung’s parenchyma. PBV images of the lung also have the potential to indicate the severity of PE, including chronic thromboembolic pulmonary hypertension. Virtual monochromatic imaging can improve the accuracy of diagnosing pulmonary vascular diseases by optimizing kiloelectronvolt settings for various purposes. Iodine images also could provide a new approach in the area of thoracic oncology, for example, for the characterization of pulmonary nodules and mediastinal lymph nodes. DECT-based lung ventilation imaging is also available with noble gases with high atomic numbers, such as xenon, which is similar to iodine. A ventilation map of the lung can be used to image various pulmonary diseases such as chronic obstructive pulmonary disease.

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Dual energy CT based scoring in chronic thromboembolic pulmonary hypertension and correlation with clinical and hemodynamic parameters: a retrospective cross-sectional study

Cited by 6 publications

References 21 publications

Lessons learned in developing a chronic thromboembolic pulmonary hypertension program

Lessons learned in developing a chronic thromboembolic pulmonary hypertension program

A Novel Dual Energy Computed Tomography Score Correlates With Postoperative Outcomes in Chronic Thromboembolic Pulmonary Hypertension

Advances for Pulmonary Functional Imaging: Dual-Energy Computed Tomography for Pulmonary Functional Imaging

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