Comparison of C-arm Computed Tomography and Digital Subtraction Angiography in Patients with Chronic Thromboembolic Pulmonary Hypertension

Purpose To assess the feasibility and diagnostic performance of contrast-enhanced, C-arm computed tomography (CACT) of the pulmonary arteries compared to digital subtraction angiography (DSA) in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH). Materials Fifty-two patien...

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Vydáno v:Cardiovascular and interventional radiology Ročník 39; číslo 1; s. 53 - 63
Hlavní autoři: Hinrichs, Jan B., Marquardt, Steffen, von Falck, Christian, Hoeper, Marius M., Olsson, Karen M., Wacker, Frank K., Meyer, Bernhard C.
Médium: Journal Article
Jazyk:angličtina
Vydáno: New York Springer US 01.01.2016
Springer Nature B.V
Témata:
Aged
Angiography, Digital Subtraction - methods
ARTERIES
BIOMEDICAL RADIOGRAPHY
BRANCHING RATIO
Cardiology
Chronic Disease
Clinical Investigation
COMPARATIVE EVALUATIONS
COMPUTERIZED TOMOGRAPHY
Contrast Media
DIAGNOSIS
Feasibility Studies
Female
Humans
HYPERTENSION
Hypertension, Pulmonary - complications
Hypertension, Pulmonary - diagnostic imaging
Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Nuclear Medicine
PATIENTS
Pulmonary Artery - diagnostic imaging
Pulmonary Embolism - complications
Pulmonary Embolism - diagnostic imaging
Radiographic Image Enhancement
Radiology
RADIOLOGY AND NUCLEAR MEDICINE
Reproducibility of Results
Sensitivity and Specificity
SURGERY
Tomography, X-Ray Computed - methods
Ultrasound
Chronic thromboembolic pulmonary hypertension
C-arm computed tomography
Cone beam CT
Balloon pulmonary angioplasty
ISSN:0174-1551, 1432-086X, 1432-086X
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Shrnutí:Purpose To assess the feasibility and diagnostic performance of contrast-enhanced, C-arm computed tomography (CACT) of the pulmonary arteries compared to digital subtraction angiography (DSA) in patients suffering from chronic thromboembolic pulmonary hypertension (CTEPH). Materials Fifty-two patients with CTEPH underwent ECG-gated DSA and contrast-enhanced CACT. Two readers (R1, R2) independently evaluated pulmonary artery segments and their sub-segmental branching using DSA and CACT for optimal image quality. Afterwards, the diagnostic findings, i.e., intraluminal filling defects, stenosis, and occlusion, were compared. Inter-modality and inter-observer agreement was calculated, and subsequently consensus reading was done and correlated to a reference standard representing the overall consensus of both modalities. Fisher’s exact test and Cohen’s Kappa were applied. Results A total of 1352 pulmonary segments were evaluated, of which 1255 (92.8 %) on DSA and 1256 (92.9 %) on CACT were rated to be fully diagnostic. The main causes of the non-diagnostic image quality were motion artifacts on CACT (R1:37, R2:78) and insufficient contrast enhancement on DSA (R1:59, R2:38). Inter-observer agreement was good for DSA ( κ  = 0.74) and CACT ( κ  = 0.75), while inter-modality agreement was moderate (R1: κ  = 0.46, R2: κ  = 0.47). Compared to the reference standard, the inter-modality agreement for CACT was excellent ( κ  = 0.96), whereas it was inferior for DSA ( κ  = 0.61) due to the higher number of abnormal consensus findings read as normal on DSA. Conclusion CACT of the pulmonary arteries is feasible and provides additional information to DSA. CACT has the potential to improve the diagnostic work-up of patients with CTEPH and may be particularly useful prior to surgical or interventional treatment.
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ISSN:0174-1551
1432-086X
1432-086X
DOI:10.1007/s00270-015-1090-7