| 1. Raskob GE, Angchaisuksiri P, Blanco AN, et al. Thrombosis: a major contributor to global disease burden. Arterioscler Thromb Vasc Biol 2014;34:2363-71. |
Review/Other-Dx |
8,702 studies |
To review the literature on the global burden of disease caused by venous thromboembolism (VTE). |
We performed a systematic review of the literature on the global disease burden because of VTE in low-, middle-, and high-income countries. Studies from Western Europe, North America, Australia, and Southern Latin America (Argentina) yielded consistent results with annual incidences ranging from 0.75 to 2.69 per 1000 individuals in the population. The incidence increased to between 2 and 7 per 1000 among those aged =70 years. Although the incidence is lower in individuals of Chinese and Korean ethnicity, their disease burden is not low because of population aging. VTE associated with hospitalization was the leading cause of disability-adjusted life-years lost in low- and middle-income countries, and second in high-income countries, responsible for more disability-adjusted life-years lost than nosocomial pneumonia, catheter-related blood stream infections, and adverse drug events. |
4 |
| 2. Ainle FN, Kevane B. Which patients are at high risk of recurrent venous thromboembolism (deep vein thrombosis and pulmonary embolism)? Blood Adv 2020;4:5595-606. |
Review/Other-Tx |
N/A |
In this review, we discuss which patients have the highest predicted venous thromboembolism (VTE; or DVT and pulmonary embolism [PE]) recurrence risk, including an update on emerging personalized strategies. Finally, we will take a deep-dive into VTE recurrence risk in women, with a focus on gender-specific challenges and knowledge gaps. |
No results stated in the abstract. |
4 |
| 3. Sirajuddin A, Mirmomen SM, Henry TS, et al. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update. J Am Coll Radiol 2022;19:S502-S12. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected pulmonary hypertension. |
No results stated in abstract. |
4 |
| 4. Farmakis IT, Keller K, Barco S, Konstantinides SV, Hobohm L. From acute pulmonary embolism to post-pulmonary embolism sequelae. [Review]. Vasa. 52(1):29-37, 2023 Jan. |
Review/Other-Dx |
N/A |
The aim of this narrative review is to summarize the functional and hemodynamic implications of acute pulmonary embolism (PE) and PE sequelae, namely the post-PE syndrome. |
No results stated in the abstract. |
4 |
| 5. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J 2022;43:3618-731. |
Review/Other-Dx |
N/A |
These comprehensive clinical practice guidelines cover the whole spectrum of pulmonary hypertension (PH), with an emphasis on diagnosing and treating pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH). |
No abstract available. |
4 |
| 6. Pepke-Zaba J, Delcroix M, Lang I, et al. Chronic thromboembolic pulmonary hypertension (CTEPH): results from an international prospective registry. Circulation 2011;124:1973-81. |
Observational-Dx |
679 patients |
We describe history and current diagnostic and treatment procedures of newly diagnosed chronic thromboembolic pulmonary hypertension (CTEPH) patients and potential associated conditions |
The international registry included 679 newly diagnosed (6 months) consecutive patients with CTEPH, from February 2007 until January 2009. Diagnosis was confirmed by right heart catheterization, ventilation-perfusion lung scintigraphy, computerized tomography, and/or pulmonary angiography. At diagnosis, a median of 14.1 months had passed since first symptoms; 427 patients (62.9%) were considered operable, 247 (36.4%) nonoperable, and 5 (0.7%) had no operability data; 386 patients (56.8%, ranging from 12.0%– 60.9% across countries) underwent surgery. Operable patients did not differ from nonoperable patients relative to symptoms, New York Heart Association class, and hemodynamics. A history of acute pulmonary embolism was reported for 74.8% of patients (77.5% operable, 70.0% nonoperable). Associated conditions included thrombophilic disorder in 31.9% (37.1% operable, 23.5% nonoperable) and splenectomy in 3.4% of patients (1.9% operable, 5.7% nonoperable). At the time of CTEPH diagnosis, 37.7% of patients initiated at least 1 pulmonary arterial hypertension–targeted therapy (28.3% operable, 53.8% nonoperable). Pulmonary endarterectomy was performed with a 4.7% documented mortality rate. |
3 |
| 7. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). European Heart Journal. 41(4):543-603, 2020 01 21. |
Review/Other-Dx |
N/A |
Evidence-based guidelines from European Society of Cardiology that focus on the diagnosis and management of acute pulmonary embolism (PE) in adult patients developed in collaboration with the European Respiratory Society (ERS). |
No abstract available. |
4 |
| 8. Kirsch J, Wu CC, Bolen MA, et al. ACR Appropriateness Criteria® Suspected Pulmonary Embolism: 2022 Update. J Am Coll Radiol 2022;19:S488-S501. |
Review/Other-Dx |
N/A |
Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected pulmonary embolism. |
No results stated in abstract. |
4 |
| 9. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. |
Review/Other-Dx |
N/A |
Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. |
No abstract available. |
4 |
| 10. Vlahos I, Jacobsen MC, Godoy MC, Stefanidis K, Layman RR. Dual-energy CT in pulmonary vascular disease. [Review]. Br J Radiol. 95(1129):20210699, 2022 Jan 01. |
Review/Other-Dx |
N/A |
This review explores the current application and clinical value of dual-energy CT (DECT) imaging in acute and chronic pulmonary vascular conditions. It should be noted that certain manufacturers and investigators prefer alternative terms, such as spectral or multi energy computed tomography (CT) imaging. In this review, the term dual energy is utilised, although readers can consider these terms synonymous for purposes of the principles explained. |
No results stated in the abstract. |
4 |
| 11. Roach PJ, Schembri GP, Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med. 54(9):1588-96, 2013 Sep. |
Review/Other-Dx |
N/A |
To discuss the ventilation–perfusion (V/Q) scanning using SPECT and SPECT/CT. The objective of this activity is to have participants describe (1) advantages and shortcomings of planar versus SPECT V/Q scanning, (2) advantages and disadvantages of CT pulmonary angiography versus V/Q SPECT in the investigation of pulmonary embolism, and (3) an overview of image acquisition, processing, display, and reporting of V/Q SPECT studies. |
No results stated in the abstract. |
4 |
| 12. Dong ML, Azarine A, Haddad F, et al. 4D flow cardiovascular magnetic resonance recovery profiles following pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension. J Cardiovasc Magn Reson. 24(1):59, 2022 11 14. |
Observational-Dx |
20 patients |
The objective of our study was to investigate novel four-dimensional flow cardiovascular magnetic resonance imaging (4D flow CMR) metrics of the pulmonary arteries (PAs) to characterize recovery and right ventricular (RV) reverse remodeling following a pulmonary endarterectomy (PEA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). |
Mean PA pressures (mPAP), total pulmonary resistance (TPR), and normalized RV end-systolic volume (RVESV) decreased significantly post-PEA (P < 0.002). 4D flow-derived PA volumes decreased (P < 0.001) and stiffness, velocity, and vorticity increased (P < 0.01) post-PEA. Longitudinal improvements from pre- to post-PEA in mPAP were associated with longitudinal decreases in MPA area (r = 0.68, P = 0.002). Longitudinal improvements in TPR were associated with longitudinal increases in the maximum RPA HFI (r=-0.85, P < 0.001). Longitudinal improvements in RVESV were associated with longitudinal decreases in MPA fraction of positive helicity (r = 0.75, P = 0.003) and minimum MPA HFI (r=-0.72, P = 0.005). |
3 |
| 13. Kamada H, Ota H, Nakamura M, et al. Quantification of vortex flow in pulmonary arteries of patients with chronic thromboembolic pulmonary hypertension. Eur J Radiol 2022;148:110142. |
Observational-Tx |
28 patients (7 male, 21 female) |
This study proposes an objective method of quantifying the vortex flow in pulmonary arteries to compare the duration of its presence before and after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). |
Although overall flow patterns after BPA appeared to be the same as the one before BPA, significant decreases in the FWHM, area, and VFR of the backward flow after BPA were found (FWHM: before, 1.88 × 10-1 ± 1.51 × 10-2 [cardiac cycle] vs. after, 1.65 × 10-1 ± 1.86 × 10-2 [cardiac cycle]; area ratio: before, 2.67 × 10-1 ± 1.30 × 10-2 vs. after, 2.38 × 10-1 ± 1.31 × 10-2; VFR: before, 13.6 ± 2.21 [mL/s] vs. after, 11.3 ± 2.36 [mL/s]). |
2 |
| 14. Ende-Verhaar YM, Meijboom LJ, Kroft LJM, et al. Usefulness of standard computed tomography pulmonary angiography performed for acute pulmonary embolism for identification of chronic thromboembolic pulmonary hypertension: results of the InShape III study. J Heart Lung Transplant. 38(7):731-738, 2019 07. |
Observational-Dx |
36 patients |
The primary aim of the study was to assess whether careful reading of computed tomography pulmonary angiogram (CTPA) scans performed for suspected acute pulmonary embolism (PE) could differentiate patients with acute PE without chronic thromboembolic pulmonary hypertension (CTEPH) from those with already existing CTEPH. The secondary aims of the study were to: (1) evaluate the interobserver agreement of the 3 expert radiologists for the diagnosis of CTEPH; and (2) identify the best (set of) predictive radiologic signs of CTEPH on CTPA for acute PE. To avoid misclassification bias, radiologic signs of CTEPH were indicated as predictive for CTEPH diagnosis, as it is impossible to prove that these patients already had CTEPH at that time. |
The overall expert reading yielded a sensitivity of 72% (95% confidence interval [CI] 58%-84%) and a specificity of 94% (95% CI 83%-99%) for CTEPH diagnosis. Multivariate analysis identified 6 radiologic parameters as independent predictors: intravascular webs; pulmonary artery retraction or dilatation; bronchial artery dilatation; right ventricular (RV) hypertrophy; and interventricular septum flattening. The presence of 3 or more these parameters was associated with a sensitivity of 70% (95% CI 55%-82%), a specificity of 96% (95% CI 86%-100%), and a c-statistic of 0.92. |
2 |
| 15. Auger WR, Fedullo PF, Moser KM, Buchbinder M, Peterson KL. Chronic major-vessel thromboembolic pulmonary artery obstruction: appearance at angiography. Radiology 1992;182:393-8. |
Review/Other-Dx |
250 patients |
To describe the angiographic patterns observed in chronic thromboembolic pulmonary hypertension. |
Pulmonary thromboendarterectomy was performed in each of these individuals, and the surgical findings were correlated with abnormal angiographic patterns. The pulmonary angiographic findings suggestive of chronic thromboembolic disease included "pouching" defects, webs or bands, intimal irregularities, abrupt vascular narrowing, and complete vascular obstruction. Pouching is reported by the authors to be a previously undescribed angiographic feature of this disease. Carefully obtained and properly interpreted pulmonary angiograms are necessary to confirm the diagnosis of operable chronic thromboembolic disease. Differential diagnostic possibilities should be considered prior to a decision to perform surgical correction. |
4 |
| 16. Bergin CJ, Sirlin CB, Hauschildt JP, et al. Chronic thromboembolism: diagnosis with helical CT and MR imaging with angiographic and surgical correlation. Radiology 1997;204:695-702. |
Observational-Dx |
55 patients |
To evaluate the accuracy of identification of central and segmental chronic thromboembolic disease on helical computed tomographic (CT) scans and on magnetic resonance (MR) images. |
Central vessel disease was determined more accurately with helical CT scans (accuracy of 0.79 for each of the two readers) than with angiograms (accuracy of 0.74) or with MR images (accuracy of 0.39 and 0.46 for two readers). Segmental vessel disease was also more accurately determined with CT scans (accuracy of 0.75 and 0.76 for two readers) than with MR images (accuracy of 0.61 and 0.57 for two readers). |
3 |
| 17. Bolen MA, Renapurkar RD, Popovic ZB, et al. High-pitch ECG-synchronized pulmonary CT angiography versus standard CT pulmonary angiography: a prospective randomized study. AJR Am J Roentgenol. 201(5):971-6, 2013 Nov. |
Observational-Dx |
55 consecutive outpatients (34 female, 21 male) |
The purpose of this study was to compare high-pitch ECG-synchronized pulmonary CT angiography (CTA) with standard pulmonary CTA with regard to radiation dose and image quality in patients with suspected pulmonary embolism. |
High-pitch ECG-synchronized pulmonary CTA showed higher SI (p < 0.001) for pulmonary arteries. Image quality scores indicated improvement in assessment of cardio-vascular structures (p < 0.001), minimization of motion of central (p < 0.001) pulmonary arteries, and an increase in pulmonary arterial enhancement (p = 0.01) with high-pitch ECG-synchronized pulmonary CTA. Image quality scores for lung assessment were higher for standard pulmonary CTA (p < 0.001). The amount of contrast agent administered was similar between techniques (p = 0.86). Radiation dose was lower for high-pitch ECG-synchronized pulmonary CTA (p < 0.001). |
2 |
| 18. Thakur R, Singhal M, Aggrawal AN, et al. Comparison of high-pitch prospective electrocardiogram-gated pulmonary CT angiography with standard CT pulmonary angiography on dual-source CT for detection of subsegmental pulmonary embolism in patients suspected of acute pulmonary embolism. Pol J Radiol 2022;87:e296-e303. |
Observational-Dx |
87 patients |
Objective of this study was to compare high-pitch prospective electrocardiogram (ECG)-gated computed tomography (CT) pulmonary angiography (HP-PECG-gated CTPA) with standard-pitch non-ECG-gated CT pulmonary angiography (SP-NECG-gated CTPA) on 128-slice dual-source CT (DSCT) for the detection of subsegmental pulmonary embolism (SSPE) in patients suspected of acute pulmonary embolism (APE) with radiation and contrastoptimized protocols. Cardiac-related motion artefacts, lung image quality, and quantitative parameter (pulmonary arterial enhancement, radiation exposure, and contrast) volumes were also compared. |
SSPE was diagnosed in 15/44 (34.09%) patients in HP-PECG-gated CTPA, in comparison to 8/43 (18.60%) patients in SP-NECG-gated CTPA. Cardiac motion-related artefacts (blurring of bronchovascular structures and double-line artefacts) were statistically significantly less, with p-value < 0.05. Lung image quality was also better, with p-value < 0.001. Effective radiation dose and contrast volume in HP-PECG-gated CTPA were (2.54 ± 0.80 mSv, 45.05 ± 6 ml) versus SP-NECG-gated CTPA (3.17 ± 1.20 mSv, 74.19 ± 7.63 ml) with p-values of 0.007 and 0.001, respectively. |
2 |
| 19. Okada M, Kunihiro Y, Nakashima Y, et al. Added value of lung perfused blood volume images using dual-energy CT for assessment of acute pulmonary embolism. Eur J Radiol. 84(1):172-177, 2015 Jan. |
Observational-Dx |
83 patients |
To investigate the added value of lung perfused blood volume (LPBV) using dual-energy CT for the evaluation of intrapulmonary clot (IPC) in patients suspected of having acute pulmonary embolism (PE). |
Values for inter- and intraobserver agreement, respectively, were better for CTPA combined with LPBV (ICC=0.847 and 0.937) than CTPA alone (ICC=0.748 and 0.861). For both readers, diagnostic accuracy (area under the ROC curve [Az]) were also superior, when CTPA alone (Az=0.888 [reader 1] and 0.912 [reader 2]) was compared with that after the combination with LPBV images (Az=0.966 [reader 1] and 0.959 [reader 2]) (p<0.001). However, Az values of both images might not have significant difference in statistics, because Az value of CTPA alone was high and 95% confidence intervals overlapped in both images. |
2 |
| 20. Farag A, Fielding J, Catanzano T. Role of Dual-energy Computed Tomography in Diagnosis of Acute Pulmonary Emboli, a Review. [Review]. Semin Ultrasound CT MR. 43(4):333-343, 2022 Aug. |
Review/Other-Dx |
N/A |
To discuss the role of dual-energy computed tomography in diagnosis of acute pulmonary emboli. |
No results stated in the abstract. |
4 |
| 21. Masy M, Giordano J, Petyt G, et al. Dual-energy CT (DECT) lung perfusion in pulmonary hypertension: concordance rate with V/Q scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol. 28(12):5100-5110, 2018 Dec. |
Observational-Dx |
80 patients |
To evaluate the concordance between DECT perfusion and ventilation/perfusion (V/Q) scintigraphy in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). |
Based on multidisciplinary expert decisions that did not include DECT perfusion, 36 patients were diagnosed with CTEPH and 44 patients with other aetiologies of PH. On DECT perfusion studies, there were 35 true positives, 6 false positives and 1 false negative (sensitivity 0.97, specificity 0.86, PPV 0.85, NPV 0.97). On V/Q scans, there were 35 true positives and 1 false negative (sensitivity 0.97, specificity 1, PPV 1, NPV 0.98). There was excellent agreement between CT perfusion and scintigraphy in diagnosing CTEPH (kappa value 0.80). Combined information from DECT perfusion and CT angiographic images enabled correct reclassification of the 6 false positives and the unique false negative case of DECT perfusion. |
2 |
| 22. Oudkerk M, van Beek EJ, Wielopolski P, et al. Comparison of contrast-enhanced magnetic resonance angiography and conventional pulmonary angiography for the diagnosis of pulmonary embolism: a prospective study. Lancet. 2002;359(9318):1643-1647. |
Observational-Dx |
141 patients: 61 men, 80 women (median age of 53 years: range 16-87), 2 reviewers |
Prospectively evaluate MRA compared to conventional pulmonary angiography (reference standard) for the diagnosis of PE. |
MRA identified 27/35 patients with proven PE (sensitivity 77%, 95% CI, 61-90). Sensitivity of MRA for isolated subsegmental, segmental, and central or lobar PE was 40%, 84%, and 100%, respectively (P<0.01 for isolated subsegmental vs segmental or larger PE). MRA is sensitive and specific for central/lobar and segmental PE, similar to data for CTA, though diagnostic value diminishes more peripherally. |
1 |
| 23. Stein PD, Chenevert TL, Fowler SE, et al. Gadolinium-enhanced magnetic resonance angiography for pulmonary embolism: a multicenter prospective study (PIOPED III). Ann Intern Med. 152(7):434-43, W142-3, 2010 Apr 06. |
Experimental-Dx |
371 patients |
Prospective multicenter study to investigate performance characteristics of MRA, with or without MR venography, for diagnosing PE. Reference standard diagnosis or exclusion was made by using various tests, including CTA and venography, V/Q, venous US, d-dimer assay, and clinical assessment. |
MRA averaged across centers, was technically inadequate in 25% of patients (92/371). The proportion of technically inadequate images ranged from 11% to 52% at various centers. Including patients with technically inadequate images, MRA identified 57% (59/104) with PE. Technically adequate MRA had a sensitivity of 78% and a specificity of 99%. Technically adequate MRA and venography had a sensitivity of 92% and a specificity of 96%, but 52% of patients (194/370) had technically inadequate results. MRA should be considered only at centers that routinely perform it well and only for patients for whom standard tests are contraindicated. MRA and MR venography combined have a higher sensitivity than MRA alone in patients with technically adequate images, but it is more difficult to obtain technically adequate images with the 2 procedures. |
2 |
| 24. Schiebler ML, Nagle SK, Francois CJ, et al. Effectiveness of MR angiography for the primary diagnosis of acute pulmonary embolism: clinical outcomes at 3 months and 1 year. J Magn Reson Imaging. 38(4):914-25, 2013 Oct. |
Observational-Dx |
190 patients |
To determine the effectiveness of MR angiography for pulmonary embolism (MRA-PE) in symptomatic patients. |
There were 190 MRA-PE exams performed with 97.4% (185/190) of diagnostic quality. There were 148 patients (120 F: 28 M) that had both a diagnostic MRA-PE exam and 1 complete year of EMR follow-up. There were 167 patients (137 F: 30 M) with 3 months or greater follow-up. We found 83% (139/167) and 81% (120/148) MRA-PE exams negative for PE at 3 months and 1 year, respectively. Positive exams for PE were seen in 14% (23/167). During the 1-year follow-up period, five patients (false negative) were diagnosed with DVT (5/148 = 3.4 %), and one of these patients also experienced a non-life-threatening PE. The negative predictive value (NPV) for MRA-PE was 97% (92-99; 95% CI) at 3 months and 96% (90-98; 95% CI) with 1 year of follow-up. |
3 |
| 25. Sostman HD, Jablonski KA, Woodard PK, et al. Factors in the technical quality of gadolinium enhanced magnetic resonance angiography for pulmonary embolism in PIOPED III. Int J Cardiovasc Imaging. 28(2):303-12, 2012 Feb. |
Review/Other-Dx |
N/A |
To perform a retrospective analysis of the data collected in the PIOPED III study by assessing the relationship to the proportion of examinations deemed "uninterpretable" by central readers to the clinical centers, MR equipment platform and vendors, degree of vascular opacification in different orders of pulmonary arteries; type, frequency and severity of image artifacts; patient co-morbidities, symptoms and signs; and reader characteristics. |
Centers, MR equipment vendor and platform, degree of vascular opacification, and motion artifacts influenced the likelihood of central reader determinations that images were "uninterpretable". Neither the reader nor patient characteristics (age, body mass index, respiratory rate, heart rate) correlated with the likelihood of determining examinations "uninterpretable". Vascular opacification and motion artifact are the principal factors influencing MRA interpretability. Some centers obtain better images more consistently, but the reasons for differences between centers are unclear. |
4 |
| 26. Rajaram S, Swift AJ, Capener D, et al. Diagnostic accuracy of contrast-enhanced MR angiography and unenhanced proton MR imaging compared with CT pulmonary angiography in chronic thromboembolic pulmonary hypertension. Eur Radiol. 22(2):310-7, 2012 Feb. |
Observational-Dx |
89 patients |
To evaluate the diagnostic accuracy of contrast-enhanced MR angiography (CE-MRA) and the added benefit of unenhanced proton MR angiography compared with CT pulmonary angiography (CTPA) in patients with chronic thromboembolic disease (CTE) |
The overall sensitivity and specificity of CE-MRA in diagnosing proximal and distal CTE were 98% and 94%, respectively. The sensitivity improved from 50% to 88% for central vessel disease when CE-MRA images were analysed with unenhanced proton MRA. The CE-MRA identified more stenoses (29/18), post-stenosis dilatation (23/7) and occlusions (37/29) compared with CTPA. The CE-MRA perfusion images showed a sensitivity of 92% for diagnosing CTE. |
3 |
| 27. Ley S, Ley-Zaporozhan J, Pitton MB, et al. Diagnostic performance of state-of-the-art imaging techniques for morphological assessment of vascular abnormalities in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Eur Radiol. 22(3):607-16, 2012 Mar. |
Observational-Dx |
24 patients |
To determine the most comprehensive imaging technique for the assessment of pulmonary arteries in patients with chronic thromboembolic pulmonary hypertension (CTEPH). |
Based on image quality, there was no non-diagnostic examination by either imaging technique. DSA did not sufficiently display 1 main, 3 lobar and 4 segmental arteries. The pulmonary trunk was not assessable by DSA. One patient showed thrombotic material at this level only by MD-CTA and MRA. Sensitivity and specificity of MD-CTA regarding CTEPH-related changes at the main/lobar and at the segmental levels were 100%/100% and 100%/99%, of ce-MRA 83.1%/98.6% and 87.7%/98.1%, and of DSA 65.7%/100% and 75.8%/100%, respectively. ECG-gated MD-CTA proved the most adequate technique for assessment of the pulmonary arteries in the diagnostic work-up of CTEPH patients. |
3 |
| 28. Pasin L, Zanon M, Moreira J, et al. Magnetic Resonance Imaging of Pulmonary Embolism: Diagnostic Accuracy of Unenhanced MR and Influence in Mortality Rates. Lung. 195(2):193-199, 2017 04. |
Observational-Dx |
93 patients |
To evaluate the diagnostic value for pulmonary embolism (PE) of the True fast imaging with steady-state precession (TrueFISP) mangetic resonance imaging (MRI), a method that allows the visualization of pulmonary vasculature without breath holding or intravenous contrast. |
Two patients could not undergo the real-time MRI and were excluded from the study. PE prevalence was 22%. During the 1-year follow-up period, eight patients died, whereas PE was responsible for 12.5% of cases. Between patients who developed PE, only 5% died due to this condition. There were no differences between MR and CT embolism detection in these subjects. MR sequences had a sensitivity of 85%, specificity was 98.6% and accuracy was 95.6%. Agreement between readers was high (?= 0.87). |
2 |
| 29. Leong K, Howard L, Giudice FL, et al. Utility of cardiac magnetic resonance feature tracking strain assessment in chronic thromboembolic pulmonary hypertension for prediction of REVEAL 2.0 high risk status. Pulm Circ 2023;13:e12116. |
Observational-Dx |
57 patients |
To characterize biatrial and biventricular cardiac MRI (CMR) feature tracking (FT) strain parameters following pulmonary endarterectomy (PEA) and tested the ability of cardiac MRI (CMR) feature tracking (FT) to identify REVEAL 2.0 high-risk status. |
We undertook a retrospective single-center cross-sectional study of patients (n?=?57) who underwent PEA (2015–2020). All underwent pre and postoperative catheterization and CMR. Pulmonary arterial hypertension validated risk scores were calculated. Significant postoperative improvements were observed in mean pulmonary artery pressure (mPAP) (pre-op 45?±?11?mmHg vs. post-op 26?±?11?mmHg; p?<?0.001) and PVR however a large proportion had residual pulmonary hypertension (45%; mPAP =25?mmHg). PEA augmented left heart filling with left ventricular end diastolic volume index and left atrial volume index increment. Left ventricular ejection fraction was unchanged postoperatively but LV global longitudinal strain improved (pre-op median -14.2% vs. post-op -16.0%; p?<?0.001). Right ventricular (RV) geometry and function also improved with reduction in RV mass. Most had uncoupled RV-PA relationships which recovered (pre-op right ventricular free wall longitudinal strain -13.2?±?4.8%, RV stroke volume/right ventricular end systolic volume ratio 0.78?±?0.53 vs. post-op -16.8?±?4.2%, 1.32?±?0.55; both p?<?0.001). Postoperatively, there were six REVEAL 2.0 high-risk patients, best predicted by impaired RA strain which was superior to traditional volumetric parameters (area under the curve [AUC] 0.99 vs. RVEF AUC 0.88). CMR deformation/strain evaluation can offer insights into coupling recovery; RA strain may be an expeditious surrogate for the more laborious REVEAL 2.0 score. |
3 |
| 30. Renapurkar RD, Shrikanthan S, Heresi GA, Lau CT, Gopalan D. Imaging in Chronic Thromboembolic Pulmonary Hypertension. [Review]. J Thorac Imaging. 32(2):71-88, 2017 Mar. |
Review/Other-Dx |
NA |
To discuss the roles of various imaging techniques and discuss their merits, limitations, and relative strengths in depicting the structural and functional changes of CTEPH.To explore newer imaging techniques and the potential value they may offer. |
No results stated in the abstract. |
4 |
| 31. McConnell MV, Solomon SD, Rayan ME, Come PC, Goldhaber SZ, Lee RT. Regional right ventricular dysfunction detected by echocardiography in acute pulmonary embolism. Am J Cardiol 1996;78:469-73. |
Observational-Dx |
126 patients |
To analyze the regional pattern of right ventricular (RV) dysfunction on transthoracic echocardiograms in patients with and without acute pulmonary embolism. |
Patients with acute pulmonary embolism had a distinct regional pattern of RV dysfunction, with akinesia of the mid-free wall (centerline excursion: -0.2 +/- 0.8 mm, p = 0.0001 vs normal) but normal motion at the apex (centerline excursion: 5.7 +/- 0.8 mm, p = NS vs normal). In contrast, patients with primary pulmonary hypertension had abnormal wall motion in all regions (p <0.03 vs normal). This echocardiographic finding of normal wall motion at the apex and abnormal wall motion in the mid-free wall in acute pulmonary embolism was then tested in a "validation" cohort of 85 patients (group 2), consisting of hospitalized patients with RV dysfunction from any cause, including 13 patients with acute pulmonary embolism. The finding had a 77% sensitivity and a 94% specificity for the diagnosis of acute pulmonary embolism, with a positive predictive value of 71% and a negative predictive value of 96%. |
2 |
| 32. Mediratta A, Addetia K, Medvedofsky D, Gomberg-Maitland M, Mor-Avi V, Lang RM. Echocardiographic Diagnosis of Acute Pulmonary Embolism in Patients with McConnell's Sign. Echocardiography. 33(5):696-702, 2016 May. |
Observational-Dx |
161 patients |
To evaluate in patients with "McConnell's sign" (McCS), whether echocardiographic parameters of global and regional RV function could differentiate between patients with and without acute pulmonary embolism (aPE). |
Fifty-five of eighty-one (68%) had PE (McCS + PE), while 26 of 81 (32%) did not (McCS - PE). Compared to NL, global and segmental RV strain were lower in patients with McCS, contrary to the notion of normal apical function. In McCS + PE, compared to McCS - PE: (1) PASP, fractional area change and TR were significantly lower; (2) strain magnitude was significantly lower globally and in basal and apical segments. Individual parameters had similar diagnostic accuracy by ROC analysis, which further improved by combining parameters. In McCS - PE, 69% of patients had pulmonary hypertension (PH). |
3 |
| 33. Klok FA, Ageno W, Ay C, et al. Optimal follow-up after acute pulmonary embolism: a position paper of the European Society of Cardiology Working Group on Pulmonary Circulation and Right Ventricular Function, in collaboration with the European Society of Cardiology Working Group on Atherosclerosis and Vascular Biology, endorsed by the European Respiratory Society. Eur Heart J 2022;43:183-89. |
Review/Other-Dx |
N/A |
This position paper provides a comprehensive guide for optimal follow-up of patients with acute pulmonary embolism (PE), covering multiple relevant aspects of patient counselling. It serves as a practical guide to treating patients with acute PE complementary to the formal 2019 European Society of Cardiology guidelines developed with the European Respiratory Society. |
No results stated in the abstract. |
4 |
| 34. Anderson DR, Barnes DC. Computerized tomographic pulmonary angiography versus ventilation perfusion lung scanning for the diagnosis of pulmonary embolism. Curr Opin Pulm Med 2009;15:425-9. |
Review/Other-Dx |
N/A |
The purpose of this review is to focus on recent research that has addressed the relative merits of computed tomographic pulmonary angiography (CTPA) and ventilation perfusion (V/Q) scanning for the diagnosis of pulmonary embolism. |
No results stated in the abstract. |
4 |
| 35. Anderson DR, Kahn SR, Rodger MA, et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. JAMA 2007;298:2743-53. |
Experimental-Tx |
1417 patients |
To determine whether the widely adopted new technology of uncertain sensitivity (CTPA) was at least as safe as the standard technology V(dot)Q(dot ) scanning at not missing the detection of clinically important pulmonary embolism. |
Seven hundred one patients were randomized to CTPA and 716 to V(dot)Q(dot scanning. Of these, 133 patients (19.2%) in the CTPA group vs 101 (14.2%) in the V(dot)Q(dot scan group were diagnosed as having pulmonary embolism in the initial evaluation period (difference, 5.0%; 95% confidence interval [CI], 1.1% to 8.9%) and were treated with anticoagulant therapy. Of those in whom pulmonary embolism was considered excluded, 2 of 561 patients (0.4%) randomized to CTPA vs 6 of 611 patients (1.0%) undergoing V(dot)Q(dot scanning developed venous thromboembolism in follow-up (difference, -0.6%; 95% CI, -1.6% to 0.3%) including one patient with fatal pulmonary embolism in the V(dot)Q(dot group. In this study, CTPA was not inferior to V(dot)Q(dot scanning in ruling out pulmonary embolism. However, significantly more patients were diagnosed with pulmonary embolism using the CTPA approach. Further research is required to determine whether all pulmonary emboli detected by CTPA should be managed with anticoagulant therapy. |
1 |
| 36. Sostman HD, Stein PD, Gottschalk A, Matta F, Hull R, Goodman L. Acute pulmonary embolism: sensitivity and specificity of ventilation-perfusion scintigraphy in PIOPED II study. Radiology 2008;246:941-6. |
Observational-Dx |
910 patients |
To use Prospective Investigation of Pulmonary Embolism Diagnosis (PIOPED) II data to retrospectively determine sensitivity and specificity of ventilation-perfusion (V/Q) scintigraphic studies categorized as pulmonary embolism (PE) present or PE absent and the proportion of patients for whom these categories applied. |
With the exclusion of patients with intermediate or low probability, the sensitivity of a high probability (PE present) scan finding was 77.4% (95% confidence interval [CI]: 69.7%, 85.0%), while the specificity of very low probability or normal (PE absent) scan finding was 97.7% (95% CI: 96.4%, 98.9%). The percentage of patients with a PE present or PE absent scan finding was 73.5% (95% CI: 70.7%, 76.4%). |
3 |
| 37. Tunariu N, Gibbs SJ, Win Z, et al. Ventilation-perfusion scintigraphy is more sensitive than multidetector CTPA in detecting chronic thromboembolic pulmonary disease as a treatable cause of pulmonary hypertension. J Nucl Med. 2007; 48(5):680-684. |
Observational-Dx |
227 patients |
Retrospective study to compare the value of ventilation-perfusion (V/Q) scintigraphy with CT pulmonary angiography (CTPA) in detecting chronic thromboembolic pulmonary disease. |
78 patients (group A) had a final diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) and 149 (group B) had non-CTEPH etiology. Among group A, V/Q scintigraphy was reported as high probability in 75 patients, intermediate probability in 1 patient, and low probability in 2 patients. CTPA was positive in 40 patients and negative in 38 patients. Among group B, V/Q scintigraphy was reported as low probability in 134, intermediate probability in 7, and high probability in 8 patients. CTPA was negative in 148 patients and false-positive in 1 patient. Statistical analysis showed V/Q scintigraphy to have a sensitivity of 96%-97.4% and a specificity of 90%-95%. CTPA showed a sensitivity of 51% and a specificity of 99%. Results demonstrate that V/Q scintigraphy has a higher sensitivity than CTPA in detecting CTEPH as a potential curable cause of PH. |
4 |
| 38. Gruning T, Drake BE, Farrell SL, Nokes T. Three-year clinical experience with VQ SPECT for diagnosing pulmonary embolism: diagnostic performance. Clin Imaging. 38(6):831-5, 2014 Nov-Dec. |
Observational-Dx |
1,950 patients |
To present a retrospective analysis of ventilation–perfusion (VQ) SPECT for the diagnosis of pulmonary embolism (PE) in just under two thousand patients over more than 3 years. |
Ventilation–perfusion (VQ) single-photon emission computed tomography (SPECT) comprised the administration of SmartVent (n=386) or Technegas (n=1564) and 200 MBq 99mTc-MAA. 1406 scans were normal, 462 showed PE, 61 showed a singular subsegmental mismatched defect, 21 scans were non-diagnostic. 26% of scans performed with Technegas showed PE, compared to 15% with SmartVent. VQ SPECT had a sensitivity of 95.7%, specificity 98.6%, positive predictive value 95.7%, negative predictive value 98.6%. A normal VQ SPECT scan implied a more than ten-fold lower cause-specific mortality (1 in 1406) than a scan showing PE (1 in 116). NPV of a negative D-dimer was 94.3% |
2 |
| 39. Leblanc M, Leveillee F, Turcotte E. Prospective evaluation of the negative predictive value of V/Q SPECT using 99mTc-Technegas. Nucl Med Commun 2007;28:667-72. |
Observational-Dx |
584 patients |
To verify the negative predictive value of pulmonary ventilation/perfusion scintigraphy with single photon emission computed tomography (V/Q SPECT) in ruling out pulmonary thromboembolism. |
One hundred and eight patients (19%) had a positive pulmonary thromboembolism reading, 18 (3%) an indeterminate study, and 458 (78%) patients had a negative reading for pulmonary thromboembolism. There were 189 patients with an abnormal chest X-ray. The mean follow-up time was 165 days. Of the 458 patients classified as negative for pulmonary thromboembolism, patients receiving chronic anticoagulation for other causes were excluded from follow-up (n=53), which left 405 patients for final analysis. There were no pulmonary thromboembolism-related deaths in the negative group. Six patients were identified as false negatives. The negative predictive value is estimated at 98.5%. |
2 |
| 40. Iftikhar IH, Iftikhar NH, Naeem M, BaHammam A. SPECT Ventilation/Perfusion Imaging for Acute Pulmonary Embolism: Meta-analysis of Diagnostic Test Accuracy. Acad Radiol 2023. |
Meta-analysis |
24 studies |
To evaluate the diagnostic accuracies of ventilation/perfusion-single photon emission computed tomography (V/Q-SPECT) imaging modalities for acute pulmonary embolism (PE). These included, in addition to V/Q-SPECT, V/Q-SPECT with low-dose computed tomography (CT; V/Q-SPECT-CT), Q-SPECT with low-dose CT (Q-SPECT-CT), and Q-SPECT. |
Data from participants totaling 4146 from 11 V/Q-SPECT studies, 785 from 7 V/Q-SPECT-CT studies, 1196 from 7 Q-SPECT-CT studies, and 728 from five Q-SPECT studies were separately meta-analyzed. The bivariate weighted mean sensitivity and specificity were 0.94 (95% confidence interval [CI]: 0.88-0.97) and 0.95 (95% CI: 0.87-0.98) for V/Q-SPECT, 0.95 (95% CI: 0.88-0.98) and 0.99 (95% CI: 0.92-1.00) for V/Q-SPECT-CT, 0.92 (95% CI: 0.79-0.97) and 0.92 (95% CI: 0.83-0.96) for Q-SPECT-CT, and 0.89 (95% CI: 0.76-0.95) and 0.86 (95% CI: 0.67-0.95) for Q-SPECT studies. The positive and negative likelihood ratios (+LRs and -LRs) were 17.4 (6.9-44.0) and 0.06 (0.03-0.13), 76.7 (11.8-498.0) and 0.06 (0.02-0.13), 11.0 (5.3-22.9) and 0.09 (0.04-0.23), and 6.4 (2.6-15.8) and 0.13 (0.07-0.27) for V/Q-SPECT, V/Q-SPECT-CT, Q-SPECT-CT, and Q-SPECTs, respectively. |
Good |
| 41. Miles S, Rogers KM, Thomas P, et al. A comparison of single-photon emission CT lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism. Chest. 136(6):1546-1553, 2009 Dec. |
Observational-Dx |
100 patients |
This study compared single-photon emission CT (SPECT) ventilation/perfusion (V/Q) scintigraphy with multislice CT pulmonary angiography (CTPA). |
The observed percentage of agreement between SPECT V/Q scintigraphy and CTPA data for the diagnosis of PE was 95%. When calculated against the respiratory physicians' reference diagnosis, SPECT V/Q scintigraphy had a sensitivity of 83% and a specificity of 98%. |
2 |
| 42. Le Roux PY, Robin P, Tromeur C, et al. Ventilation/perfusion SPECT for the diagnosis of pulmonary embolism: A systematic review. J Thromb Haemost. 18(11):2910-2920, 2020 11. |
Meta-analysis |
13 studies |
The primary aim was to establish the diagnostic accuracy (sensitivity, specificity) of ventilation/perfusion (V/Q) single-photon emission computed tomography (SPECT) for pulmonary embolism (PE) diagnosis. The secondary aim was to review the clinical outcomes of patients investigated for PE suspicion with a standardized algorithm based on V/Q SPECT. |
We identified 13 accuracy studies and one prospective outcome study. Eleven diagnostic accuracy studies were deemed at high risk of bias in at least two of the four domains of QUADAS-2 evaluation and a further two studies raised concerns regarding the applicability of results, precluding the meta-analysis for accuracy indices. The only prospective cohort study demonstrated critical risk of bias. |
Good |
| 43. Wang L, Wang M, Yang T, Wu D, Xiong C, Fang W. A Prospective, Comparative Study of Ventilation-Perfusion Planar Imaging and Ventilation-Perfusion SPECT for Chronic Thromboembolic Pulmonary Hypertension. J Nucl Med. 61(12):1832-1838, 2020 12. |
Observational-Dx |
208 patients |
This study compared the diagnostic performance of ventilation-perfusion (V/Q) planar imaging and V/Q SPECT and determined whether combining perfusion SPECT with low-dose CT (Q-LDCT) may be equally effective in a prospective study of patients with chronic thromboembolic pulmonary hypertension (CTEPH). V/Q scanning is recommended for excluding CTEPH during the diagnosis of pulmonary hypertension (PH). However, V/Q planar imaging and V/Q SPECT have yet to be compared in patients with CTEPH. |
A total of 208 patients completed the study, including 69 with CTEPH confirmed by pulmonary angiography. V/Q planar imaging, V/Q SPECT, and Q-LDCT were all highly effective for diagnosing CTEPH, with no significant differences in sensitivity or specificity observed among the 3 techniques (respective sensitivity and specificity: 94.20% and 92.81% for V/Q planar imaging, 97.10% and 91.37% for V/Q SPECT, and 95.65% and 90.65% for Q-LCDT). However, V/Q SPECT was significantly more sensitive (V/Q SPECT, 79.21%; V/Q planar imaging, 75.84% [P = 0.012]; Q-LDCT, 74.91% [P < 0.001]), and V/Q planar imaging was significantly more specific (V/Q planar imaging, 54.14%; V/Q SPECT, 46.05% [P < 0.001]; Q-LDCT, 46.05% [P = 0.001]) than the other 2 techniques for identifying perfusion defects in individual lung segments. |
2 |
| 44. Kawakami T, Ogawa A, Miyaji K, et al. Novel Angiographic Classification of Each Vascular Lesion in Chronic Thromboembolic Pulmonary Hypertension Based on Selective Angiogram and Results of Balloon Pulmonary Angioplasty. Circ., Cardiovasc. interv.. 9(10), 2016 10. |
Observational-Tx |
97 patients |
To evaluate the success and complication rate of balloon pulmonary angioplasty (BPA) in accordance with the location and morphology of thromboembolic lesions. |
We reviewed 500 consecutive procedures (1936 lesions) of BPA in 97 patients with chronic thromboembolic pulmonary hypertension and investigated the outcomes of BPA based on the lesion distribution and the angiographic characteristics of the thromboembolic lesions, as follows: type A, ring-like stenosis lesion; type B, web lesion; type C, subtotal lesion; type D, total occlusion lesion, and type E, tortuous lesion. The success rate was higher, and the complication rate was lower in ring-like stenosis and web lesions. The total occlusion lesions had the lowest success rate. Tortuous lesions were associated with a high complication rate and should be treated only by operators with extensive experience with BPA. |
2 |
| 45. Hinrichs JB, Marquardt S, von Falck C, et al. Comparison of C-arm Computed Tomography and Digital Subtraction Angiography in Patients with Chronic Thromboembolic Pulmonary Hypertension. Cardiovasc Intervent Radiol. 39(1):53-63, 2016 Jan. |
Observational-Dx |
52 patients |
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). |
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 (? = 0.74) and CACT (? = 0.75), while inter-modality agreement was moderate (R1: ? = 0.46, R2: ? = 0.47). Compared to the reference standard, the inter-modality agreement for CACT was excellent (? = 0.96), whereas it was inferior for DSA (? = 0.61) due to the higher number of abnormal consensus findings read as normal on DSA. |
3 |
| 46. Lang IM, Andreassen AK, Andersen A, et al. Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension: a clinical consensus statement of the ESC working group on pulmonary circulation and right ventricular function. Eur Heart J 2023;44:2659-71. |
Review/Other-Dx |
N/A |
A clinical consensus statement of the European Society of Cardiology (ESC) working group on pulmonary circulation and right ventricular function. The present document serves as a practical guide to performing balloon pulmonary angioplasty (BPA) in Europe, according to the refinement of the technique by Japanese interventionists. |
No results stated in the abstract. |
4 |
| 47. Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. [Review]. Eur Respir J. 53(1), 2019 01. |
Review/Other-Dx |
NA |
To discuss the classification of pulmonary hypertension. |
No results state din the abstract |
4 |
| 48. Held M, Kolb P, Grun M, et al. Functional Characterization of Patients with Chronic Thromboembolic Disease. Respiration 2016;91:503-9. |
Observational-Dx |
79 patients |
This study aimed to analyze the exercise capacity and limiting factors in chronic thromboembolic pulmonary disease (CTED). |
Subjects with CTED show a reduced oxygen uptake [median 76/interquartile range (IQR) 22% pred.] and work rate (median 76/IQR 21 W). The work rate was significantly lower compared to control subjects (p = 0.04) but not significantly different from CTEPH patients (p = 0.66). Oxygen pulse and breathing reserve were normal. CTED subjects showed decreased end-tidal CO2 at anaerobic threshold (28.4/4.3 mm Hg), an elevated VE/VCO2 slope (42.5/23.5), breathing equivalents (EQO2 32.0/8.7, EQCO2 39.5/8.8), alveolar-capillary oxygen gradient (34.7/15.5 mm Hg) and capillary end-tidal carbon dioxide gradient (8.8/5.7 mm Hg) compared to control subjects (p < 0.001). The degree of limitation was similar to that in CTEPH. |
3 |
| 49. Delcroix M, Torbicki A, Gopalan D, et al. ERS statement on chronic thromboembolic pulmonary hypertension. Eur Respir J 2021;57. |
Review/Other-Dx |
N/A |
This statement outlines a review of the literature and current practice concerning diagnosis and management of chronic thromboembolic pulmonary hypertension (CTEPH). It covers the definitions, diagnosis, epidemiology, follow-up after acute pulmonary embolism, pathophysiology, treatment by pulmonary endarterectomy, balloon pulmonary angioplasty, drugs and their combination, rehabilitation and new lines of research in CTEPH. It represents the first collaboration of the European Respiratory Society, the International CTEPH Association and the European Reference Network-Lung in the pulmonary hypertension domain. The statement summarises current knowledge, but does not make formal recommendations for clinical practice. |
No results stated in the abstract. |
4 |
| 50. Abel E, Jankowski A, Pison C, Luc Bosson J, Bouvaist H, Ferretti GR. Pulmonary artery and right ventricle assessment in pulmonary hypertension: correlation between functional parameters of ECG-gated CT and right-side heart catheterization. Acta Radiol 2012;53:720-7. |
Observational-Dx |
27 patients |
To evaluate whether pulmonary hypertension (PH) severity could be assessed using electrocardiography-gated CT (ECG-gated CT) functional parameters. A further objective was to evaluate cardiac output (CO) using two ECG-gated CT methods: the reference Simpson technique and the fully automatic technique generated by commercially available cardiac software. |
Inter-observer agreement was good for all measurements (r > 0.7) except for CT-RVCO calculated with Simpson’s technique (r = 0.63). Pulmonary artery (PA) distensibility was significantly correlated to mPAP (r =-0.426, P =0.027). CT-RVEF was correlated with mPAP only when issued from Simpson technique (r =-0.417, P = 0.034). CT-RVEF was not significantly correlated to RHC-CO (P > 0.2). CT-RVCO measured with Simpson technique (r = 0.487, P = 0.010) and automatic segmentation (r = 0.549, P = 0.005) correlated equally with RHC-CO. |
3 |
| 51. Roller FC, Yildiz SM, Kriechbaum SD, et al. Noninvasive prediction of pulmonary hemodynamics in chronic thromboembolic pulmonary hypertension by electrocardiogram-gated computed tomography. Eur J Radiol Open 2021;8:100384. |
Observational-Dx |
45 patients |
The aim of the study was to investigate the potential of electrocardiogram (ECG)-gated computed tomography pulmonary angiography (CTPA) as a predictor of disease severity in patients with chronic thromboembolic pulmonary hypertension (CTEPH). |
RVD4CH/LVD4CH revealed the strongest correlation to mPAP before (r = 0.6507) and after (r = 0.7650; p < 0.0001) PT/A adjustment. The AUCs for predicting pH with mPAP over 40 mmHg and 30 mmHg were 0.9229 and 0.864, respectively. A cutoff value of 1.298 enabled prediction of pH with mPAP over 40 mmHg with a sensitivity, specificity, positive predictive, and negative predictive value of 80.00 %, 95.83 %, 88.46 %, and 94.12 %, respectively. Intra- and interobserver variability were excellent for all parameters. |
2 |
| 52. Rogberg AN, Gopalan D, Westerlund E, Lindholm P. Do radiologists detect chronic thromboembolic disease on computed tomography? Acta Radiol 2019;60:1576-83. |
Observational-Dx |
35 patients |
To evaluate the extent of misdiagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) on computed tomography (CT). |
The expert reading identified all CTEPH cases. However, in the original reports, the terminology “CTEPH” was only used in two patients. Another seven descriptive reports picked up the combination of PH and vascular signs of CTEPH without making a definitive diagnosis. Taking these nine cases as positive for CTEPH, the overall sensitivity on a diagnostic level was 26%. Pulmonary arterial abnormalities were described in isolation in 63% with no mention of PH or CTEPH. Signs of PH and mosaic attenuation were documented in 53% and 6% of the original reports, respectively, where it could be seen on the CT examination. |
2 |
| 53. Kauczor HU, Schwickert HC, Mayer E, Schweden F, Schild HH, Thelen M. Spiral CT of bronchial arteries in chronic thromboembolism. J Comput Assist Tomogr 1994;18:855-61. |
Observational-Dx |
39 patients |
To describe the computed tomography (CT) appearance of bronchial arteries in chronic thromboembolism and to determine whether depiction, dilatation, and tortuosity have any predictive value indicating pulmonary hypertension or postoperative mortality. |
In the pulmonary hypertension group, 50 bronchial arteries were observed in 30 of 39 patients. Their prevalence was significantly higher than in the control group (p < 0.0001). Their proximal diameter measured > or = 1.5 mm in 20 patients (51%); a tortuous course was found in 14 (36%). The correlation between total bronchial artery diameter and mean PA pressure was poor (r = 0.2). Patients with dilated bronchial arteries had a significantly lower risk for postoperative death than patients without (p < 0.05); positive predictive value was 100% and confidence interval 0.79-1.0. Despite normal postoperative PA pressures, bronchial arteries were still visible on follow-up studies. |
3 |
| 54. Takagi H, Ota H, Sugimura K, et al. Dual-energy CT to estimate clinical severity of chronic thromboembolic pulmonary hypertension: Comparison with invasive right heart catheterization. Eur J Radiol. 85(9):1574-80, 2016 Sep. |
Observational-Dx |
46 patients (10 male, 36 female) |
To evaluate whether the extent of perfusion defects assessed by examining lung perfused blood volume (PBV) images is a stronger estimator of the clinical severity of chronic thromboembolic pulmonary hypertension (CTEPH) compared with other computed tomography (CT) findings and noninvasive parameters. |
Interobserver agreement in terms of the scoring of perfusion defects was excellent (?=0.88, 95% CIs: 0.85, 0.91). The lung PBV score was significantly correlated with the PAP (mean, rho=0.48; systolic, rho=0.47; diastolic, rho=0.39), PVR (rho=0.47), and RVP (rho=0.48) (all p values<0.01). Multivariable linear regression analyses showed that only the lung PBV score was significantly associated with both the mean PAP (coefficient, 0.84, p<0.01) and the PVR (coefficient, 28.83, p<0.01). |
2 |
| 55. Abozeed M, Conic S, Bullen J, et al. Dual energy CT based scoring in chronic thromboembolic pulmonary hypertension and correlation with clinical and hemodynamic parameters: a retrospective cross-sectional study. Cardiovasc Diagn Ther 2022;12:305-13. |
Observational-Dx |
78 patients |
To use a simple dual energy computed tomography (DECT) based scoring system to noninvasively assess the functional and hemodynamic status in patients with chronic thromboembolic pulmonary hypertension (CTEPH). |
Clot burden score, PD score, and combined score all positively correlated with sPAP (0.25, 0.34, 0.34), PVR (0.27, 0.30, 0.34), and mPAP (0.28, 0.31, 0.36). There was no statistically significant correlation of clot burden score, PD score and combined score with 6MWT, % predicted 6MWT, FEV1, FEV1%, FVC, FVC%, DLCO% and NYHA functional class. |
3 |
| 56. Renapurkar RD, Bullen J, Rizk A, et al. A Novel Dual Energy Computed Tomography Score Correlates With Postoperative Outcomes in Chronic Thromboembolic Pulmonary Hypertension. J Thorac Imaging 2023. |
Observational-Dx |
64 patients |
To compare dual-energy computed tomography (DECT) based qualitative and quantitative parameters in chronic thromboembolic pulmonary hypertension with various postoperative primary and secondary endpoints. |
Higher combined scores were associated with larger decreases in mPAP (=0.27, P=0.036). On average, the decrease in mPAP (pre mPAP-post mPAP) increased by 2.2 mm Hg (95% CI: -0.6, 5.0) with each 10 unit increase in combined score. The correlation between total PBV and change in mPAP was small and not statistically significant. During an exploratory analysis, higher combined scores were associated with larger increases in 6MWD at 6 months postprocedure (=0.55, P=0.002). |
3 |
| 57. Onishi H, Taniguchi Y, Matsuoka Y, et al. Evaluation of microvasculopathy using dual-energy computed tomography in patients with chronic thromboembolic pulmonary hypertension. Pulm Circ 2021;11:2045894020983162. |
Observational-Dx |
93 patients |
To assess the association between pulmonary vascular perfusion and hemodynamic status in patients with chronic thromboembolic pulmonary hypertension (CTEPH). |
According to the extent of poor subpleural perfusion, ninety-three interventional treatment-naïve patients were divided into poorly perfused (n = 49) or normally perfused group (n = 44). We assessed cardiopulmonary exercise test, right heart catheterization, and dual-energy computed tomography parameters for quantitative evaluation of lung perfusion of blood volume score. Lung perfusion of blood volume score in normally perfused group was significantly inversely correlated with pulmonary vascular resistance (pulmonary vascular resistance = 6816.1 × lung perfusion of blood volume score-0.793, R2 = 0.225, p < 0.01), but lung perfusion of blood volume score in poorly perfused group was not. Poorly perfused group had higher pulmonary vascular resistance (879 ± 409 dynes-s/cm5 vs. 574 ± 279 dynes-s/cm5, p < 0.01) and lower lung perfusion of blood volume score (22.1 ± 5.4 vs. 26.4 ± 6.6, p < 0.01) and % diffusing capacity for carbon monoxide divided by the alveolar volume (59.9 ± 15.4% vs. 78.8 ± 14.2%, p < 0.01). Perfusion of blood volume score in the normally perfused group showed an inverse correlation with pulmonary vascular resistance; however, that in poorly perfused group did not. Microvasculopathy might contribute to severe hemodynamics, apart from pulmonary vascular obstruction. In our experience, more than half of treatment-naïve chronic thromboembolic pulmonary hypertension patients have microvasculopathy. |
3 |
| 58. Saeedan MB, Bullen J, Heresi GA, Rizk A, Karim W, Renapurkar RD. Morphologic and Functional Dual-Energy CT Parameters in Patients With Chronic Thromboembolic Pulmonary Hypertension and Chronic Thromboembolic Disease. AJR Am J Roentgenol. 215(6):1335-1341, 2020 12. |
Observational-Dx |
28 patients with CTED, 72 patients with CTEPH |
The objective of our study was to compare morphologic and functional dual-energy CT (DECT) parameters in patients with chronic thromboembolic disease (CTED) and chronic thromboembolic pulmonary hypertension (CTEPH). |
After matching, the CTEPH group showed a higher PD score than the CTED group and unilateral disease was more common in the CTED group than in the CTEPH group. In the unmatched sample, patients with CTED showed increased percentages of PBV for both lungs (PBV total) and for the right lung as compared with the CTEPH group (adjusted p = 0.040 and 0.028, respectively); after adjustment for clot burden, the difference between groups was still noted but was not statistically significant. No statistically significant differences were noted in the various functional DECT parameters after propensity score matching. |
3 |
| 59. Koike H, Sueyoshi E, Nishimura T, et al. Effect of Balloon Pulmonary Angioplasty on Homogenization of Lung Perfusion Blood Volume by Dual-Energy Computed Tomography in Patients with Chronic Thromboembolic Pulmonary Hypertension. Lung. 199(5):475-483, 2021 10. |
Observational-Dx |
33 patients (5 male, 28 female) |
To evaluate lung perfusion blood volume (PBV) with haemodynamic and exercise-capacity parameters to assess the efficacy of balloon pulmonary angioplasty (BPA) in the treatment of chronic thromboembolic pulmonary hypertension (CTEPH). |
Lung perfusion images showed decreased heterogeneity after BPA. There was a significant difference before and after BPA in the whole-lung PBV and in the regional standard deviation for pulmonary arterial pressure (R = 0.37, p = 0.032 and R = 0.57, p = 0.006), pulmonary vascular resistance (R = 0.51, p = 0.023 and R = 0.60, p = 0.002), transtricuspid pressure gradient (R = 0.50, p = 0.0028 and R = 0.61, p = 0.0001), brain natriuretic peptide (R = 0.54, p = 0.0012 and R = 0.46, p = 0.0078), and 6-min walking distance (R = 0.59, p = 0.003 and R = 0.26, p = 0.14). The effects were especially pronounced after the first BPA procedure. |
2 |
| 60. Koike H, Sueyoshi E, Sakamoto I, Uetani M, Nakata T, Maemura K. Quantification of lung perfusion blood volume (lung PBV) by dual-energy CT in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after balloon pulmonary angioplasty (BPA): Preliminary results. Eur J Radiol. 85(9):1607-12, 2016 Sep. |
Observational-Dx |
8 patients (female) |
The objective of this study was to evaluate and quantify the effect of balloon pulmonary angioplasty (BPA) on pulmonary perfusion in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after BPA. |
Pre- and post-BPA 6-segment lung PBV/PAenh were 0.067±0.021 and 0.077±0.019, respectively, in the treated segment (p<0.0001). There were significant positive correlations between pre- to post-BPA improvements in both-lung PBV/PAenh and PAP (R=0.69, p=0.005), PVR (R=0.56, p=0.03), and 6-min walking distance (R=0.67, p=0.01). |
2 |
| 61. Ohno Y, Hatabu H, Murase K, et al. Quantitative assessment of regional pulmonary perfusion in the entire lung using three-dimensional ultrafast dynamic contrast-enhanced magnetic resonance imaging: Preliminary experience in 40 subjects. J Magn Reson Imaging 2004;20:353-65. |
Observational-Dx |
15 normal volunteers, and 25 patients with pulmonary hypertension |
To assess regional differences in quantitative pulmonary perfusion parameters, i.e., pulmonary blood flow (PBF), mean transit time (MTT), and pulmonary blood volume (PBV) in the entire lung on a pixel-by-pixel basis in normal volunteers and pulmonary hypertension patients. |
Regional PBF, MTT, and PBV showed significant differences in the gravitational and isogravitational directions (P < 0.05). The quantitative pulmonary perfusion parameter maps demonstrated significant differences between normal volunteers and pulmonary hypertension patients (P < 0.05). |
3 |
| 62. Pohler GH, Klimes F, Voskrebenzev A, et al. Chronic Thromboembolic Pulmonary Hypertension Perioperative Monitoring Using Phase-Resolved Functional Lung (PREFUL)-MRI. J Magn Reson Imaging. 52(2):610-619, 2020 08. |
Observational-Dx |
30 patients with CTEPH (11 female, 19 males) and 12 healthy patients in control group (6 females, 6 males) |
To evaluate successful pulmonary endarterectomy (PEA) via phase-resolved functional lung (PREFUL)-MRI with pulmonary pulse wave transit time (pPTT). |
Median pPTT was significantly lower post PEA (139 msec) compared to pre PEA (193 msec), P = 0.0002. Median pPTT correlated significantly with the mPAP post PEA (r = 0.52, P < 0.008). Median pPTT was distributed more homogeneously after PEA: IQR pPTT decreased from 336 to 281 msec (P < 0.004). Median PREFULQ (P < 0.0002), QDPpPTT (P < 0.0478), QDPPREFUL (P < 0.0001) and V/Q match (P < 0.0001) improved significantly after PEA. Percentage change of PREFULQ correlated significantly with percentage change of 6-minute walking distance (? = 0.61; P = 0.0031) 5 months post PEA. |
3 |
| 63. Schoenfeld C, Cebotari S, Hinrichs J, et al. MR Imaging-derived Regional Pulmonary Parenchymal Perfusion and Cardiac Function for Monitoring Patients with Chronic Thromboembolic Pulmonary Hypertension before and after Pulmonary Endarterectomy. Radiology. 279(3):925-34, 2016 Jun. |
Observational-Dx |
20 patients |
To evaluate surgical success after pulmonary endarterectomy (PEA) by means of cardiopulmonary magnetic resonance (MR) imaging. |
Two weeks after PEA, regional PBF increased 66% in the total lung from 32.7 to 54.2 mL/min/100 mL (P = .0002). However, after adjustment for cardiac output, this change was not evident anymore (increase of 7% from 7.03 to 7.54 mL/min/100 mL/L/min, P = .1). Only in the lower lobes, a significant increase in PBF after cardiac output adjustment remained: a 16% increase in the right lower lobe from 7.53 to 8.71 mL/min/100 mL (P = .01) and a 14% increase in the left lower lobe from 7.42 to 8.47 mL/min/100 mL/L/min (P < .05). Right ventricular mass and function also improved. mPAP decreased from 46 to 24 mm Hg (P < .0001). Six-minute walking distance increased from 390 to 467 m (P = .02) 5 months after PEA. Percentage change of mPAP and PBF in the lower lobe tended to be significant predictors of percentage change in 6-minute walking distance (ß = -1.79 [P = .054] and ß = 0.45 [P = .076], respectively) in multiple linear regression analysis. |
3 |
| 64. Schoenfeld C, Hinrichs JB, Olsson KM, et al. Cardio-pulmonary MRI for detection of treatment response after a single BPA treatment session in CTEPH patients. Eur Radiol. 29(4):1693-1702, 2019 Apr. |
Observational-Dx |
29 patients |
The aim of this study was to measure treatment response after a single balloon pulmonary angioplasty (BPA) session using cardio-pulmonary MRI. |
After BPA regional PBF increased in the treated lobe (p < 0.0001) as well as in non-treated lobes (p = 0.015). PBF treatment changes in the treated lobe were significantly larger compared with the non-treated lobes (p = 0.0049). Change in NT proBNP, MRI-derived mean pulmonary artery pressure (mPAP), PTT, FWHM, right ventricular (RV) ejection fraction, RV stroke volume, CO, VMI and PBF in the non-treated lobes correlated with PBF change in the treated lobe (p < 0.05). PBF changes in the treated lobe were independently predicted by PTT as well as PBF change in the non-treated lobes. |
2 |
| 65. Wild JM, Fichele S, Woodhouse N, Paley MN, Kasuboski L, van Beek EJ. 3D volume-localized pO2 measurement in the human lung with 3He MRI. Magn Reson Med 2005;53:1055-64. |
Observational-Dx |
3 patients |
To test a method for 3D volume-localized quantification of pO2 in the lungs is presented that uses repetitive frame 3D gradient-echo imaging of (3)He. |
The results were compared with those obtained by equivalent 2D thin-slice and 2D projection methodologies, and were found to be consistent with published results from the 2D projection methodologies (pO(2) = 0.09-0.18 bar). Studies performed on the same subject, on three separate occasions, demonstrated a repeatability of pO(2) measurement to within 14% using the 3D technique. Experimental differences between the 2D and 3D methods were substantiated with theoretical and numerical analyses of the signal decay, which took into account the effects of out-of-slice diffusion as a source of error in the thin-slice 2D experiments. It is shown that the 2D thin-slice technique systematically underestimates pO2 when there is significant gas diffusion (factor of 4 underestimate for D = 0.9 cm(2)s(-1) representative of free (3)He in air). |
3 |
| 66. Grothues F, Moon JC, Bellenger NG, Smith GS, Klein HU, Pennell DJ. Interstudy reproducibility of right ventricular volumes, function, and mass with cardiovascular magnetic resonance. Am Heart J 2004;147:218-23. |
Observational-Dx |
60 patients (47 men; 20 healthy volunteers, 20 patients with heart failure, 20 patients with ventricular hypertrophy) |
To determine the interstudy reproducibility of measurements of right ventricular (RV) volumes, function, and mass with cardiovascular magnetic resonance (CMR) and compare it with correspondent left ventricular (LV) values. |
The overall interstudy reproducibility (range between groups) for the RV was 6.2% (4.2%-7.8%) for end-diastolic volume, 14.1% (8.1%-18.1%) for end-systolic volume, 8.3% (4.3%-10.4%) for ejection fraction (EF), and 8.7% (7.8%-9.4%) for RV mass. RV reproducibility was not as good as for the LV for all measures in all 3 groups, but this was only statistically significant for EF (P <.01). |
3 |
| 67. Zhang L, Dai J, Zhang P, et al. Right ventricular end-systolic remodeling index on cardiac magnetic resonance imaging: comparison with other functional markers in patients with chronic thromboembolic pulmonary hypertension. Quant Imaging Med Surg 2022;12:894-905. |
Observational-Dx |
64 patients |
To investigate whether the cardiac magnetic resonance imaging (CMR)-derived right ventricular end-systolic remodeling index (RVESRI) could be a metric in assessing the function and hemodynamics of chronic thromboembolic pulmonary hypertension (CTEPH). |
RVESRI of all patients was 1.50 (IQR, 1.26-1.90). Compared with CTE patients, RVESRI in patients with CTEPH was significantly increased (U=27.5, P<0.001). The interclass correlation coefficients of intra-observer reproducibility and inter-observer reproducibility for RVESRI measurement were 0.96 (95% CI, 0.93-0.97) and 0.99 (95% CI, 0.98-0.99), respectively. RVESRI positively correlated with right ventricular end-diastolic and end-systolic volume index and right ventricular global longitudinal strain (r=0.79, 0.83, 0.62, P<0.001), while it was negatively correlated with right ventricular ejection fraction (r=-0.64, P<0.001), right ventricular cardiac output (r=-0.50, P<0.001), and right ventricular eccentricity index (r=-0.81, P<0.001). RVESRI had a positive correlation with mean pulmonary arterial pressure (r=0.65, P<0.001) and pulmonary vascular resistance (r=0.69, P<0.001), while it was negatively correlated with cardiac output (r=-0.64, P<0.001). The receiver operating characteristic curve indicated that RVESRI >1.35 had a sensitivity of 97.8% and specificity of 83.3% in predicting mean pulmonary arterial pressure =25 mmHg, and its area under the curve (AUC) was 0.96±0.02. Meanwhile, the AUC of RVESRI was similar to RVEI (Z=1.635, P=0.102) and was more than the diameter of the main pulmonary artery (MPA) (Z=2.26, P=0.02) and the ratio of the MPA and ascending aorta diameter (MPA/AAo) (Z=3.826, P<0.001) in predicting mean pulmonary arterial pressure =25 mmHg. |
3 |
| 68. Kawakubo M, Yamasaki Y, Kamitani T, et al. Clinical usefulness of right ventricular 3D area strain in the assessment of treatment effects of balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: comparison with 2D feature-tracking MRI. Eur Radiol. 29(9):4583-4592, 2019 Sep. |
Observational-Dx |
21 patients |
To evaluate the usefulness of right ventricular (RV) area strain analysis via cardiac MRI (CMRI) as a tool for assessing the treatment effects of balloon pulmonary angioplasty (BPA) in inoperable chronic thromboembolic pulmonary hypertension (CTEPH), RV area strain was compared to two-dimensional (2D) strain with feature-tracking MRI (FTMRI) before and after BPA. |
ROC analysis revealed the optimal cutoffs of strains (GAS, LS, CS, and RS) for identifying improved patients with mPAP < 30 mmHg (cutoff (%) = - 41.2, - 13.8, - 16.7, and 14.4: area under the curve, 0.75, 0.56, 0.65, and 0.75) and patients with RVEF > 50% (cutoff (%) = - 37.2, - 29.5, - 2.9, and 14.4: area under the curve, 0.81, 0.60, 0.56, and 0.56). |
2 |
| 69. Roller FC, Kriechbaum S, Breithecker A, et al. Correlation of native T1 mapping with right ventricular function and pulmonary haemodynamics in patients with chronic thromboembolic pulmonary hypertension before and after balloon pulmonary angioplasty. Eur Radiol. 29(3):1565-1573, 2019 Mar. |
Observational-Dx |
21 patients |
The aim of this study was to assess native T1 mapping in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) before and 6 months after balloon pulmonary angioplasty (BPA) and compare the results with right heart function and pulmonary haemodynamics. |
The mean AA-T1 value decreased significantly after BPA (1,045.8 ± 44.3 ms to 1,012.5 ± 50.4 ms; p < 0.001). Before BPA, native T1 values showed a moderate negative correlation with RVEF (r = -0.61; p = 0.0036) and moderate positive correlations with mPAP (r = 0.59; p < 0.01) and PVR (r = 0.53; p < 0.05); after BPA correlation trends were present (r = -0.21, r = 0.30 and r = 0.35, respectively). |
2 |
| 70. Mousseaux E, Tasu JP, Jolivet O, Simonneau G, Bittoun J, Gaux JC. Pulmonary arterial resistance: noninvasive measurement with indexes of pulmonary flow estimated at velocity-encoded MR imaging--preliminary experience. Radiology 1999;212:896-902. |
Observational-Dx |
19 patients |
To describe and assess the accuracy of indexes of pulmonary vascular resistance (PVR) measurements obtained at velocity-encoded magnetic resonance imaging (MRI) on the basis of estimations of that instantaneous main pulmonary arterial blood flow and wave form morphology. |
Results were compared with the cardiac output and indexes of pulmonary arterial blood flow estimated with velocity-encoded magnetic resonance (MR) imaging. Correlations were good between estimates with right-sided heart catheterization and those with velocity-encoded MR imaging. By providing accurate pulmonary arterial blood flow measurements, velocity-encoded MR imaging allowed distinction of patients with high PVR from subjects with normal PVR. |
3 |
| 71. Ota H, Kamada H, Higuchi S, Takase K. Clinical Application of 4D Flow MR Imaging to Pulmonary Hypertension. Magn Reson Med Sci 2022;21:309-18. |
Observational-Dx |
N/A |
To discuss the clinical definition of pulmonary hypertension (PH), summary of conventional imaging tests, characteristics of pulmonary arterial flow as shown by 4D flow magnetic resonance imaging (MRI), and clinical application of 4D flow MRI in the management of patients with PH. |
Right heart catheterization is the gold standard method for the diagnosis of PH by definition, various less-invasive imaging tests have been used for screening, detection of underlying diseases-causing PH, and monitoring of diseases. Among them, 4D flow MRI is an emerging and unique imaging test that allows for comprehensive visualization of blood flow in the right heart and proximal pulmonary arteries. The characteristic blood flow pattern observed in patients with PH is vortical flow formation in the main pulmonary artery. Recent studies have proposed the use of these findings to determine not only the presence of PH but also estimate the mean PAP. Other applications of 4D flow MRI for PH include measurement of wall shear stress, helicity, and 3D flow balance in the pulmonary arteries. It is worth noting that 4D flow has also the potential for longitudinal follow-ups. In this review, the clinical definition of PH, summary of conventional imaging tests, characteristics of pulmonary arterial flow as shown by 4D flow MRI, and clinical application of 4D flow MRI in the management of patients with PH will be discussed. |
4 |
| 72. Broch K, Murbraech K, Ragnarsson A, et al. Echocardiographic evidence of right ventricular functional improvement after balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension. J Heart Lung Transplant. 35(1):80-86, 2016 Jan. |
Observational-Dx |
26 patients |
To hypothesize that right ventricular (RV) reverse remodeling and improved RV function would occur after balloon pulmonary angioplasty (BPA) in patients with chronic thromboembolic pulmonary hypertension (CTEPH). |
Significant improvements in hemodynamics, peak oxygen consumption, and levels of N-terminal pro-B-type natriuretic peptide were detected after BPA. All measures of RV function improved considerably, including fractional area change (+6%; p = 0.003), tricuspid annular plane systolic excursion (+3 mm; p < 0.001), and RV free wall peak strain (-4.4; p = 0.002). RV end-diastolic diameter, area, and free wall thickness decreased significantly, whereas left ventricular diameter and stroke volume increased. |
2 |
| 73. Moceri P, Duchateau N, Baudouy D, et al. Additional prognostic value of echocardiographic follow-up in pulmonary hypertension-role of 3D right ventricular area strain. Eur Heart J Cardiovasc Imaging 2022;23:1562-72. |
Observational-Dx |
95 patients |
To assess right ventricular (RV) function changes between baseline and 6-month follow-up and evaluate their prognostic value for pulmonary hypertension (PH) patients using 3D echocardiography. |
Ninety-five PH patients underwent a prospective longitudinal study including ESC/ERS guidelines prognostic assessment and 3D RV echocardiographic imaging at baseline and 6-month follow-up. Semi-automatic software tracked the RV along the cycle, and its output was post-processed to extract 3D deformation patterns. Over a median follow-up of 24.8 (22.1-25.7) months, 21 patients died from PH or were transplanted. Improvements in RV global AS were associated with stable or improving clinical condition as well as survival free from transplant (P < 0.001). The 3D deformation patterns confirmed that the most significant regional changes occurred within the septum. RV global AS change over 6-month by +3.5% identifies patients with a 3.7-fold increased risk of death or transplant. On multivariate COX analysis, changes in WHO class, BNP, and RV global AS were independent predictors of outcomes. Besides, the combination of these three parameters was of special interest to identify high-risk patients [HR 11.5 (1.55-86.06)]. |
1 |
| 74. Wang L, Han X, Wang M, et al. Ventilation/perfusion imaging predicts response to balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Ann Nucl Med. 36(6):515-522, 2022 Jun. |
Observational-Dx |
120 patients |
To study the efficacy of balloon pulmonary angioplasty (BPA) on pulmonary blood flow and the predictive value of ventilation/perfusion (V/Q) scanning. |
BPA significantly alleviated mean pulmonary arterial pressure (mPAP: 48.0 ± 12.9 mmHg vs 34.7 ± 10.3 mmHg, P < 0.001) and pulmonary vascular resistance (PVR: 8.8 ± 4.1 Wood units vs 5.2 ± 3.0 Wood units, P < 0.001), and improved cardiac function (N-terminal pro B-type natriuretic peptide: 1628.7 ± 2887.2 pg/mL vs 400.4 ± 669.3 pg/mL, P < 0.001) and exercise capacity (6-minute walking distance: 386 ± 122 m vs 461 ± 86 m, P < 0.001). The extent of pulmonary perfusion abnormality represented by the percentage of perfusion defects (PPDs%) was improved after BPA (50.1 ± 13.6 vs 35.6 ± 14.2, P < 0.001), with the right and inferior lung lobes benefitting the most. PPDs% < 35.5 at baseline and greater restoration of PPDs% after BPA (?PPDs% > 20.6) were associated with a better response to BPA (PPDs% < 35.5: odds ratio [OR] 10.857, 95% confidence interval [95%CI] 1.393-84.635, P = 0.023; ?PPDs% > 20.6: OR 1.035, 95% CI 1.002-1.068, P = 0.036). |
3 |
| 75. Nachand D, Huang S, Bullen J, Heresi GA, Renapurkar RD. Assessment of ventilation-perfusion scans in patients with chronic thromboembolic pulmonary hypertension before and after surgery and correlation with clinical parameters. Clin Imaging. 66:147-152, 2020 Oct. |
Observational-Dx |
27 patients |
To discuss the comparative analysis of matched and mismatched defects in pre- and post-operative V/Q scans in CTEPH patients. |
On a segmental basis, 176 mismatched defects were noted in 27 patients, of which 111 improved post-surgery (63%). 22 of the 34 matched defects improved following surgery (64%). 31 new mismatched defects were observed. The number of pre-operative matched defects per patient ranged from 0 to 6. No statistically significant associations were observed between the number of pre-operative matched defects and pre-operative clinical parameters. No statistically significant associations were observed between the number of improved matched defects and the change in clinical parameters (pre- to post-surgery). |
2 |
| 76. Olman MA, Auger WR, Fedullo PF, Moser KM. Pulmonary vascular steal in chronic thromboembolic pulmonary hypertension. Chest 1990;98:1430-4. |
Observational-Dx |
33 patients |
To study the frequent occurrence of new postoperative, segmental, perfusion scan abnormalities in lung zones served by angiographically patent, undissected pulmonary arteries. |
We retrospectively reviewed the preoperative and postoperative perfusion scans of 33 consecutive patients undergoing pulmonary thromboendarterectomy. New postoperative perfusion defects were noted in 23 of 33 patients. The incidence of new defects was increased tenfold in segments that had (1) normal preoperative angiographic findings, (2) normal preoperative radionuclide perfusion, and (3) not been entered at the time of surgery. Postoperative angiograms, available in 15 of 33 patients, documented the nonembolic, nonocclusive nature of the new perfusion scan defects. The most plausible alternate explanation for this previously undescribed finding is a redistribution of pulmonary arterial resistance induced by the thromboendarterectomy, namely, a pulmonary vascular "steal." |
2 |
| 77. Eyharts D, Pascal P, Lavie-Badie Y, et al. Impact of pulmonary perfusion defects by scintigraphy on pulmonary vascular resistances, functional capacity and right ventricular systolic function in patients with chronic thromboembolic pulmonary hypertension. Am J Nucl Med Mol Imaging 2021;11:20-26. |
Observational-Dx |
46 patients |
The aim of our study was to investigate the relationship between the extent of pulmonary perfusion defects by Ventilation/perfusion lung single photon emission computed tomography (V/Q lung SPECT) and hemodynamic, echocardiographic, biological and functional parameters. |
Between 2012 and 2019, 46 patients with CTEPH were retrospectively enrolled in the study. The diagnosis of pulmonary hypertension was made by the referral team of the expert center according to the European guidelines. All patients underwent pulmonary V/Q SPECT, right heart catheterization, transthoracic echocardiography (TTE), functional tests and natriuretic peptides assays. There was a slight correlation between the extent of pulmonary perfusion defects and pulmonary vascular resistances (R=0.510, P < 0.001). However, there was no correlation between the extent of pulmonary perfusion defects and NYHA stage, NT-proBNP level, functional parameters (6 minutes-walk distance-6 MWD), right ventricular function assessed by TTE. Pulmonary perfusion defects extension by V/Q lung SPECT are correlated with pulmonary vascular resistances in CTEPH. However, it is not correlated with right ventricular function and functional parameters. |
2 |
| 78. Ma RZ, Han PP, Tao XC, et al. A Feasibility Study on Using Single-Photon Emission Computed Tomography Pulmonary Perfusion/Ventilation Imaging for the Diagnosis of Chronic Thromboembolic Pulmonary Hypertension and Patient Risk Assessment. Int J Gen Med 2021;14:8029-38. |
Observational-Dx |
83 patients |
To evaluate the diagnostic ability of single-photon emission computed tomography (SPECT) pulmonary ventilation/perfusion (V/Q) imaging in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and investigate its feasibility in assessing patient risk. |
For the 1494 pulmonary segments of the 83 patients, the sensitivity, specificity, and accuracy of identifying pulmonary segments with defects using V/Q imaging was 87.05%, 82.78% (668/807), and 84.74% (1266/1494), respectively. The average PPDs% (58.8 ± 12.6%) was positively correlated with the mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), and right ventricular pressure (RVP; r =0.316, 0.318, and 0.432, respectively; P < 0.05) and negatively correlated with the six-minute walk distance (6MWD; r = -0.309; P < 0.05). There were 37 patients in the low-risk group and 46 in the medium-high-risk group. The number of pulmonary segments with perfusion defects (NPSPDs) and PPDs% were higher in the medium-high risk than in the low-risk group (t = -6.721, -5.032; P < 0.05). In the low- and medium-high-risk groups, the cut-off values for the NPSPDs (7.2 ± 2.1 and 10.2 ± 2.0) and PPDs% (51.9 ± 11.1% and 64.3 ± 11.1%,) were 8.5 and 61.25%, respectively. |
2 |
| 79. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. |
Review/Other-Dx |
N/A |
Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. |
No abstract available. |
4 |
| 80. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. |
Review/Other-Dx |
N/A |
To provide evidence-based guidelines on exposure of patients to ionizing radiation. |
No abstract available. |
4 |
