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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 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 (kappa = 0.74) and CACT (kappa = 0.75), while inter-modality agreement was moderate (R1: kappa = 0.46, R2: kappa = 0.47). Compared to the reference standard, the inter-modality agreement for CACT was excellent (kappa = 0.96), whereas it was inferior for DSA (kappa = 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.

  • Hinrichs, J. B.; Marquardt, S.; von Falck, C.; Hoeper, M. M.; Olsson, K. M.; Wacker, F. K.; Meyer, B. C.

Keywords

  • Aged
  • Angiography, Digital Subtraction/*methods
  • Chronic Disease
  • Contrast Media
  • Feasibility Studies
  • Female
  • Humans
  • Hypertension, Pulmonary/complications/*diagnostic imaging
  • Male
  • Middle Aged
  • Pulmonary Artery/diagnostic imaging
  • Pulmonary Embolism/complications/*diagnostic imaging
  • Radiographic Image Enhancement
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed/*methods
  • Balloon pulmonary angioplasty
  • C-arm computed tomography
  • Chronic thromboembolic pulmonary hypertension
  • Cone beam CT
Publication details
DOI: 10.1007/s00270-015-1090-7
Journal: Cardiovascular and interventional radiology
Pages: 53-63 
Number: 1
Work Type: Original
Location: BREATH
Disease Area: PH
Partner / Member: MHH
Access-Number: 25828726
See publication on PubMed
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