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01-03-2012 | Chest

Diagnostic performance of state-of-the-art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH)

Authors: Sebastian Ley, Julia Ley-Zaporozhan, Michael B. Pitton, Jens Schneider, Gesine M. Wirth, Eckhard Mayer, Christoph Düber, Karl-Friedrich Kreitner

Published in: European Radiology | Issue 3/2012

Abstract

Objectives

To determine the most comprehensive imaging technique for the assessment of pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

24 patients with CTEPH were examined by ECG-gated multi-detector CT angiography (MD-CTA), contrast-enhanced MR angiography (ce-MRA) and selective digital subtraction angiography (DSA) within 3 days. Two readers in consensus separately evaluated each imaging technique (48 main, 144 lobar and 449 segmental arteries) for typical changes like complete obstructions, vessel cut-offs, intimal irregularities, incorporated thrombus formations, and bands and webs. A joint interpretation of all three techniques served as a reference standard.

Results

Based on image quality, there was no non-diagnostic examination by either imaging technique. DSA did not sufficiently display 1 main, 3 lobar and 4 segmental arteries. The pulmonary trunk was not assessable by DSA. One patient showed thrombotic material at this level only by MD-CTA and MRA. Sensitivity and specificity of MD-CTA regarding CTEPH-related changes at the main/lobar and at the segmental levels were 100%/100% and 100%/99%, of ce-MRA 83.1%/98.6% and 87.7%/98.1%, and of DSA 65.7%/100% and 75.8%/100%, respectively.

Conclusion

ECG-gated MD-CTA proved the most adequate technique for assessment of the pulmonary arteries in the diagnostic work-up of CTEPH patients.

Key Points

• A prospective single-centre study evaluated ECG-gated MDCTA, ce-MRA and DSA in CTEPH patients.

• ECG-gated MD-CT angiography outperformed DSA and ce-MRA.

• Right heart catheterisation should be reserved only for assessment of pulmonary haemodynamics.

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Title: Diagnostic performance of state-of-the-art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH)
Authors: Sebastian Ley
Julia Ley-Zaporozhan
Michael B. Pitton
Jens Schneider
Gesine M. Wirth
Eckhard Mayer
Christoph Düber
Karl-Friedrich Kreitner
Publication date: 01-03-2012
Publisher: Springer-Verlag
Published in: European Radiology / Issue 3/2012
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-011-2290-4

At a glance: The STEP trials

Springer Medicine

Diagnostic performance of state-of-the-art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH)

Abstract

Objectives

Methods

Results

Conclusion

Key Points

At a glance: The STEP trials

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusion

Key Points

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