Microvasculopathy Evaluated by Dual-Energy Computed Tomography in Patients with Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Arterial Hypertension.
Keisuke MiwaYu TaniguchiHiroyuki FujiiYoichiro MatsuokaHiroyuki OnishiKenichi YanakaYu IzawaYasunori TsuboiAtsushi K KonoNoriaki EmotoKenichi HirataPublished in: Life (Basel, Switzerland) (2022)
Background: Poor subpleural perfusion (PSP) on dual-energy computed tomography (DE-CT) suggests microvasculopathy in chronic thromboembolic pulmonary hypertension (CTEPH). However, whether the microvasculopathy findings are equivalent to those in pulmonary arterial hypertension (PAH) remains unclear. The aim of this study was to elucidate the characteristics of microvasculopathy in CTEPH compared to those of that in PAH. Methods: We retrospectively reviewed subpleural perfusion on DE-CT and the hemodynamics of 23 patients with PAH and 113 with inoperable CTEPH. Subpleural perfusion on DE-CT was classified as poor (subpleural spaces in all segments with little or no perfusion) or normal. Results: PSP was observed in 51% of patients with CTEPH and in 4% of those with PAH ( p < 0.01). CTEPH patients with PSP had poorer baseline hemodynamics and lower diffusing capacity for carbon monoxide divided by the alveolar volume (DLCO/VA) than those with CTEPH with normal perfusion (pulmonary vascular resistance [PVR]: 768 ± 445 dynes-sec/cm 5 vs. 463 ± 284 dynes-sec/cm 5 , p < 0.01; DLCO/VA, 60.4 ± 16.8% vs. 75.9 ± 15.7%, p < 0.001). Despite the existence of PSP, hemodynamics improved to nearly normal in both groups after balloon pulmonary angioplasty. Conclusions: PSP on DE-CT, which is one of the specific imaging findings in CTEPH, might suggest a different mechanism of microvasculopathy from that in PAH.
Keyphrases
- dual energy
- pulmonary hypertension
- pulmonary arterial hypertension
- contrast enhanced
- computed tomography
- pulmonary artery
- image quality
- magnetic resonance imaging
- polycyclic aromatic hydrocarbons
- positron emission tomography
- magnetic resonance
- high resolution
- atrial fibrillation
- squamous cell carcinoma
- coronary artery
- rectal cancer
- photodynamic therapy
- mass spectrometry