Keywords:
Pulmonary vessels, Thorax, Cardiovascular system, CT-Angiography, Catheter arteriography, CT, Diagnostic procedure, Catheters, Surgery, Embolism / Thrombosis, Haemodynamics / Flow dynamics, Hyperplasia / Hypertrophy
Authors:
A. J. Theruvath1, G. Wirth1, T. Bostel2, E. Mayer1, C. Düber1, K.-F. Kreitner1; 1Mainz/DE, 2Heidelberg/DE
Conclusion
CTEPH is a rare disease and misdiagnosis is common because patients often present with nonsepecific or subtle symptoms.
High-quality imaging is needed for setting the accurate diagnosis and planning the adequate therapy.
DSA is still regarded the diagnostic reference standard.
Especially MD-CTA with the currently available generation of CT systems has already reached a level,
which equals or even surpasses that of DSA [11,
13].
In our study summarizing all morphological changes on central and segmental lung arteries there was a tendency towards higher accuracy of MD-CTA compared to DSA displaying the CTEPH typical vascular changes (287 vs.
247 pathologic vascular segments).
However,
on subsegmental level CT angiography was clearly superior to DSA (202 vs.
160 pathologic vascular segments; P=0.0003). IVS curvature correlated strongly with mPAP and sPAP (r=-0,96,
r=-0,91 respectively).
Moreover,
PVR also correlated with the IVS curvature (r=-0,69).
Previous studies have underlined the importance of elevated pulmonary artery pressures and vascular resistance in the clinical outcome of patients with CTEPH [14-16].
Measurement of the IVS curvature in the early diastolic phase is helpful in estimating noninvasively mPAP,
sPAP and PVR.
These measurements may serve as predictors for mortality and clinical outcome in inoperable and operable patients with CTEPH.
Moreover,
the assessment of IVS curvature can be used as a diagnostic tool in everyday clinical practice to identify pulmonary hypertension and quantify its extent.
One major limitation of our study is the limited number of our study population,
which is due to the fact that CTEPH is a rare disease.
In conclusion our results show that CTA is a highly valuable and less invasive diagnostic tool for detection of thromboembolic findings.
The strong correlation of IVS bowing with pulmonary artery pressures and vasuclar resistance detected in our study indicates that measurement of IVS curvature allows for estimation of crucial hemodynamic parameters in CTEPH.