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Diagnosis of chronic thromboembolic pulmonary hypertension: prospective comparison of ventilation-perfusion scintigraphy and multidetector CT pulmonary angiography

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Author:
No author available
Journal Title:
Chinese Journal of Nuclear Medicine and Molecular Imaging
Issue:
5
DOI:
10.3760/cma.j.issn.2095-2848.2012.05.006
Key Word:
肺栓塞;高血压,肺性;放射性核素显像;锝;体层摄影术,X线计算机;DTPA;Pulmonary embolism;Hypertension,pulmonary;Radionuclide imaging;Technetium;Tomography,X-ray computed;DTPA

Abstract: Objective To compare the diagnostic efficacy of V/Q scintigraphy and CT pulmonary angiography (CTPA) for chronic thromboembolic PAH (CTEPH).Methods A total of 133 consecutive patients (54 males,79 females,age:(43.1 ± 14.9) years) suspected of CTEPH were prospectively enrolled in the study.All patients underwent V/Q scintigraphy,CTPA and pulmonary angiography within 7 d of clinical presentation.Pulmonary angiography was considered as the gold standard.The diagnosis of CTEPH by V/Q scan was classified as high,intermediate and low probability,and that by CTPA was classified as present,absent and indeterminate.Kappa test was used to analyze the concordance between the image modalities.Results Fifty-one patients (38.3%) had a final diagnosis of CTEPH.The other 82 patients were respectively diagnosed with IPAH (n =60),pulmonary vasculitis (n =19) and atrial septal defect (n =3).The sensitivity,specificity and accuracy of V/Q scan were 96.1% (49/51),75.6% (62/82) and 83.5% (111/133),respectively,when CTEPH with high probability was considered positive.The sensitivity,specificity and accuracy of V/Q scan were 100% (51/51),73.2% (60/82) and 83.5% (111/133),respectively,when CTEPH with high or intermediate probability was considered positive.The sensitivity,specificity and accuracy of CTPA were 92.2% (47/51),92.7% (76/82) and 92.5% (123/133),respectively.When CTEPH with high probability by V/Q scan was considered positive,the concordance between V/Q scan and CTPA was 80.5% (107/133) (Kappa =0.612,P < 0.001).Conclusions V/Q scan has a higher sensitivity for the diagnosis of CTEPH than CTPA.CTPA has a higher specificity than V/Q scan to differentiate PAH caused by other diseases,especially pulmonary vasculitis,from CTEPH.Combining V/Q scan and CTPA may improve the diagnostic accuracy of CTEPH.

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