Kurzfassung

Purpose:
The purpose of the study was to determine the most comprehensive imaging modality for assessment of vascular findings in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods and Results:
24 patients with CTEPH were examined by ECG-gated multi-detector CT angiography (MD-CTA), contrast-enhanced MR angiography (ce-MRA) and selective digital subtraction angiography (DSA). All examinations were performed within 3 days. Two readers in consensus separately evaluated...Purpose:
The purpose of the study was to determine the most comprehensive imaging modality for assessment of vascular findings in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods and Results:
24 patients with CTEPH were examined by ECG-gated multi-detector CT angiography (MD-CTA), contrast-enhanced MR angiography (ce-MRA) and selective digital subtraction angiography (DSA). All examinations were performed within 3 days. Two readers in consensus separately evaluated each imaging modality (48 main, 144 lobar and 449 segmental arteries) for presence of typical changes like complete obstructions, vessel cut-offs, intimal irregularities, incorporated thrombus formations, and bands and webs, respectively. A joint interpretation of all three imaging modalities served as reference standard.
Based on image quality, there was no nondiagnostic examination by either imaging modality. DSA did not sufficiently display 1 main, 3 lobar and 4 segmental arteries. Furthermore, the pulmonary trunc was not assessible by DSA due to the examination technique. One patient showed thrombotic material at this level being displayed only by MD-CTA and MRA. Sensitivity and specificity of MD-CTA regarding CTEPH-related changes at main/lobar and at segmental level were 100%/100% and 100%/99%, respectively. Sensitivity and specificity of ce-MRA were 83.1% / 98.6% at main/lobar level and 87.7% / 98.1% at segmental level, respectively. Sensitivity and specificity of DSA were 65.7% and 100% at main/lobar level and 75.8% / 100% at segmental level, respectively.

Conclusion:
ECG-gated MD-CTA proved to be the most adequate imaging modality for assessment of the pulmonary arteries in the diagnostic work-up of patients with CTEPH.
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