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

Abstract

Rong-Zheng Ma,1 Ping-Ping Han,1 Xin-Cao Tao,2 Huan Li,1 Ling Wang,1 Zhen-Guo Zhai,2 Li-Ping Fu1 1Department of Nuclear Medicine, China-Japan Friendship Hospital, Beijing, 100029, People’s Republic of China; 2Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, National Clinical Research Center for Respiratory Diseases, Beijing, 100029, People’s Republic of ChinaCorrespondence: Li-Ping FuDepartment of Nuclear Medicine, China-Japan Friendship Hospital, No. 2 of Yinghuayuan Road, Chaoyang District, Beijing, 100029, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected] ZhaiDepartment of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, No. 2 of Yinghuayuan Road, Chaoyang District, Beijing, 100029, People’s Republic of ChinaTel [phone]Fax [phone]Email [email protected]: The study is designed 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.Methods: A total of 83 patients suspected of having CTEPH who received V/Q tomography were retrospectively analyzed. The consistency between SPECT V/Q imaging and pulmonary angiography was compared to investigate the correlation between the percentage of pulmonary perfusion defect score (PPDs%) and the hemodynamic indices. Patients were grouped according to the pulmonary arterial hypertension risk stratification, and the V/Q imaging results were compared between different groups.Results: 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.Conclusion: SPECT V/Q imaging achieved an accurate diagnosis of CTEPH. The semi-quantitative analysis index (PPDs%) was correlated with the hemodynamic indices and 6MWD. SPECT V/Q could be used for the preoperative risk assessment of patients with CTEPH.Keywords: pulmonary artery, thrombosis, pulmonary hypertension, pulmonary perfusion/ventilation imaging, 99mTc-MAA, risk stratification

Keywords

• pulmonary artery
• thrombosis
• pulmonary hypertension
• pulmonary perfusion/ventilation imaging
• 99mtc-maa
• risk stratification