Kurzfassung

Purpose:
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but serious sequela of acute pulmonary thromboembolism (PE). High-quality imaging is needed for diagnosis and planning of therapy. Digital subtraction angiography (DSA) is still regarded the gold standard in the preoperative work-up of the disease. With recent CT scanner development assessment of morphologic and functional parameters of CTEPH has improved. In this study we compare the accuracy of a 256-slice-MDCT (ICT,...Purpose:
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but serious sequela of acute pulmonary thromboembolism (PE). High-quality imaging is needed for diagnosis and planning of therapy. Digital subtraction angiography (DSA) is still regarded the gold standard in the preoperative work-up of the disease. With recent CT scanner development assessment of morphologic and functional parameters of CTEPH has improved. In this study we compare the accuracy of a 256-slice-MDCT (ICT®, Philips, Eindhoven, Netherlands) with selective DSA and right-sided heart catheterization (RHC) in CTEPH.

Material and Methods:
Twelve patients with suspected CTEPH underwent diagnostic workup with retrospectively ECG-gated 256-slice-MDCT angiography, DSA and RHC. Morphologic image analysis of pulmonary arteries with respect to specific findings of CTEPH was performed by two independent, experienced radiologists. Furthermore interventricular septum (IVS) bowing measured on reconstructed short axis images of late systole was compared with pulmonary artery pressures obtained by RHC.

Results:
In contrast to DSA, the entire pulmonary vasculature was accessible on CT angiograms. 256-slice-MDCT showed a tendency towards higher accuracy of displaying typical vascular changes in central and segmental pulmonary arteries of CTEPH. Moreover, on subsegmental level CT angiography was clearly superior to DSA (202 vs. 160 pathologic vascular segments; P=0.0003). Functional analysis revealed that IVS bowing showed a strong correlation with pulmonary artery pressures.
 
Conclusions:
256-slice MDCT angiography is a highly valuable and less invasive diagnostic tool for detection of thromboembolic findings and allows for estimation of hemodynamics in the pulmonary arterial system.
Key Words: CTEPH, MDCT angiography, interventricular septum, DSA, RHC» weiterlesen» einklappen