Regional Distribution of Pulmonary Blood Volume with Dual-Energy Computed Tomography

Felloni, Paul; Duhamel, Alain; Faivre, J; Giordano, Jessica; Khung, Suonita; Deken, Valérie; Rémy, Jacques; Rémy‐Jardin, Martine

doi:10.1016/j.acra.2017.05.003

Cited by 13 publications

(9 citation statements)

References 39 publications

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“…Therefore, we speculate that these hypo-attenuations in portal venous PBV reconstructions may reflect truly decreased blood supply to these peripherally located regions. This complies with the findings of Felloni et al who reported a median difference of nearly 10 HU between the mean level of attenuation in medullary and cortical lung zones [17].…”

Section: Discussionsupporting

confidence: 93%

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Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

et al. 2021

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Pulmonary arterial dual-energy (aDE) CT is an established technique for evaluating pulmonary perfusion blood volume (PBV). As DECT protocols are increasingly used for thoraco-abdominal CT, this study assessed image quality and clinical findings in portal–venous phase dual-energy (vDE) CT and compared it to aDE. In 95 patients, vDE-CT was performed using a dual-source scanner (70/Sn150 kV, 560/140 ref.mAs). Pulmonary triggered aDE-CT served as reference (n = 94). PBV was reconstructed using a dedicated algorithm. Mean relative attenuation was measured in the pulmonary trunk, aorta, and segmented lung parenchyma. A distribution ratio (DL) between vessels and parenchyma was calculated to assess the iodine uptake of the lung parenchyma. Subjective overall diagnostic image quality was assessed for PBV images on a five-point Likert scale. Image artifacts were classified into five groups based on scale rating and compared between vDE and aDE. Pathological findings were correlated with the anatomical image datasets. Mean relative attenuation of the lung parenchyma was comparable in both groups (vDE: 23 ± 6 HU and aDE: 22 ± 7 HU), but significantly lower in the vessels of vDE. Therefore, iodine uptake of the lung parenchyma was significantly higher in vDE (DL: 10% vs. 8%, p < 0.01). The subjective overall image quality of the PBV images was comparable (p = 0.5). Rotation and streak artifacts were found in most of the patients (>86%, both p > 0.6). Dual-source artifacts were found in only a few patients in both groups (vDE 5%, aDE 7%, p = 0.5). Recess and subpleural artifacts were increased in vDE (vDE 53/27%, aDE 24/7%, both p < 0.001). Pathological findings were found in 19% of the vDE patients and 59% of the aDE patients. Comparable objective and subjective image quality of lung perfusion can be obtained in vDE and aDE. Iodine uptake of the lung parenchyma is increased in vDE compared to aDE, suggesting an interstitial pooling effect. Knowledge of the different appearances of artifacts will aid in the interpretation of the images. Additional clinical information about the lung parenchyma can be provided by PBV evaluation in vDE.

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Section: Discussionsupporting

confidence: 93%

“…Moreover, almost half of these findings could not be detected in the conventional anatomical reconstructions. The lobar or segmental distribution may be explained by restricted arterial supply, and the anterior-posterior gradient is in good agreement with reports about gravity-dependent lung perfusion in supine position [16,17].…”

Section: Discussionsupporting

confidence: 91%

Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

et al. 2021

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“…Third, perfusion changes were analyzed in the absence of control group, starting with perfusion analysis in normal subjects. However, one can highlight the homogeneity of lung perfusion in nonsmokers that has already been reported in the literature [32,33]. In addition, we did not have comparable control group with viral non-COVID-19 pneumonia.…”

Section: Discussionmentioning

confidence: 67%

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

et al. 2021

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Background During COVID-19, the main manifestations of the disease are not only pneumonia but also coagulation disorders. The purpose of this study was to evaluate pulmonary vascular abnormalities 3 months after hospitalization for SARS-CoV-2 pneumonia in patients with persistent respiratory symptoms. Methods Among the 320 patients who participated in a systematic follow-up 3 months after hospitalization, 76 patients had residual symptoms justifying a specialized follow-up in the department of pulmonology. Among them, dual-energy CT angiography (DECTA) was obtained in 55 patients. Findings The 55 patients had partial ( n = 40; 72.7%) or complete ( n = 15; 27.3%) resolution of COVID-19 lung infiltration. DECTA was normal in 52 patients (52/55; 94.6%) and showed endoluminal filling defects in 3 patients (3/55; 5.4%) at the level of one ( n = 1) and two ( n = 1) segmental arteries of a single lobe and within central and peripheral arteries ( n = 1). DECT lung perfusion was rated as non-interpretable ( n = 2;3.6%), normal ( n = 17; 30.9%) and abnormal ( n = 36; 65.5%), the latter group comprising 32 patients with residual COVID-19 opacities (32/36; 89%) and 4 patients with normal lung parenchyma (4/36; 11%). Perfusion abnormalities consisted of (a) patchy defects (30/36; 83%), (b) PE-type defects (6/36; 16.6%) with ( n = 1) or without proximal thrombosis ( n = 5); and (c) focal areas of hypoperfusion (2/36; 5.5%). Increased perfusion was seen in 15 patients, always matching GGOs, bands and/or vascular tree-in- bud patterns. Interpretation DECT depicted proximal arterial thrombosis in 5.4% of patients and perfusion abnormalities suggestive of widespread microangiopathy in 65.5% of patients. Lung microcirculation was abnormal in 4 patients with normal lung parenchyma.

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“…[11] With the development of technology, DECT has introduced into clinical practice in 2006, and it is used maturely to detect physiological gradients of lung perfusion and subtle perfusion defects. [12] DECT is more accurate than angiography at identifying the segmental location of abnormalities. [13] Recent studies have shown that the diagnostic value for DECT was consistent with V/Q Scan excellently.…”

Section: Discussionmentioning

confidence: 99%

CTPA, DECT, MRI, V/Q Scan, and SPECT/CT V/Q for the noninvasive diagnosis of chronic thromboembolic pulmonary hypertension

Yang

Zhu

et al. 2019

Medicine

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Background: To determine the diagnostic accuracy of techniques with chronic thromboembolic pulmonary hypertension (CTEPH) patients via a protocol for systemic review and network meta-analysis. Methods: We will search PubMed, EMBASE, Web of Science, and Google Scholar from inception to October 1, 2018. The reference lists of the retrieved articles are also consulted. Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) will be used to assess the risk of bias in each study. The direct meta-analyses, network meta-analyses, and ranking of competing diagnostic tests will be used by STATA 12.0 and WINBUGS 1.4. Heterogeneity and inconsistency are assessed. Results: This study is ongoing, will be submitted to a peer-reviewed journal publication once completed. Conclusion: This study will provide a comprehensive evidence summary of diagnostic test accuracy in detecting the CTEPH, and can help patients and clinicians to select appropriate or best diagnostic test. Ethics and Communication: No ethical approval and patient consent are required, because it is based on published researches. PROSPERO registration number: CRD42019121279.

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Regional Distribution of Pulmonary Blood Volume with Dual-Energy Computed Tomography

Cited by 13 publications

References 39 publications

Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

Dual-Energy Lung Perfusion in Portal Venous Phase CT—A Comparison with the Pulmonary Arterial Phase

Assessment of pulmonary arterial circulation 3 months after hospitalization for SARS-CoV-2 pneumonia: Dual-energy CT (DECT) angiographic study in 55 patients

CTPA, DECT, MRI, V/Q Scan, and SPECT/CT V/Q for the noninvasive diagnosis of chronic thromboembolic pulmonary hypertension

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