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Lung Perfused Blood Volume Images With Dual-Energy Computed Tomography for Chronic Thromboembolic Pulmonary Hypertension: Correlation to Scintigraphy With Single-Photon Emission Computed Tomography

Nakazawa, Tetsuro MD; Watanabe, Yoshiyuki MD; Hori, Yoshiro MD; Kiso, Keisuke; Higashi, Masahiro MD; Itoh, Toshihide BEng; Naito, Hiroaki MD

Journal of Computer Assisted Tomography: September/October 2011 - Volume 35 - Issue 5 - pp 590-595
doi: 10.1097/RCT.0b013e318224e227
Thoracic Imaging

Objective: The purpose of this study was to evaluate the feasibility and diagnostic utility of lung perfused blood volume (LPBV) images generated by dual-energy computed tomography (CT), as compared with pulmonary perfusion scintigraphy, for patients with chronic thromboembolic pulmonary hypertension.

Methods: Patients (n = 51) with chronic pulmonary thromboembolic embolism were examined by dual-source CT in dual-energy mode. Lung perfused blood volume images were generated by analysis of the iodine content of the lung parenchyma using dual-energy data. Pulmonary perfusion defects were evaluated on a segment-by-segment basis in images obtained by both LPBV and pulmonary scintigraphy. Findings suggestive of chronic thromboembolic pulmonary hypertension in CT pulmonary angiography were analyzed.

Results: All examinations were acquired without complications, and the contrast enhancement of the pulmonary artery was sufficient for diagnosis of vascular thromboses. In the LPBV images, in 76 (8.3%) of 918 segments, it was difficult to assess perfusion because of artifacts. The agreement between the 2 modalities was good (κ = 0.70). The sensitivity of LPBV in detecting perfusion defects was 96%; the specificity was 76%; the positive predictive value was 94%, and the negative predictive value was 29%.

Conclusions: Lung perfused blood volume imaging by dual-energy CT is feasible for the evaluation of pulmonary perfusion and is comparable to pulmonary scintigraphy. It is possible to evaluate vessels and pulmonary perfusion with CT pulmonary angiography and LPBV images and to assess pulmonary perfusion more definitively in diagnosing chronic pulmonary thromboembolic embolism.

From the *Department of Radiology, National Cerebral and Cardiovascular Center; †Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Osaka; ‡Department of Radiology, Niigata University Medical and Dental Hospital, Niigata; and §Research and Collaboration, Siemens Japan, Tokyo, Japan.

Received for publication April 5, 2011; accepted May 17, 2011.

Reprints: Tetsuro Nakazawa, MD, 5-7-1 Fujishirodai, Suita city, Osaka 565-8565, Japan (e-mail:

The authors report no conflicts of interest.

Copyright © 2011 Wolters Kluwer Health, Inc. All rights reserved.