PULMONARY PERFUSION FEATURES IN PATIENTS WITH IDIOPATHIC PULMONARY
HYPERTENSION AND CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION
ACCORDING TO SUBTRACTION COMPUTED TOMOGRAPHY ANGIOPULMONOGRAPHY
En M.I.1, Veselova T.N.1, Martynyuk T.V.1, Danilov N.M.1, Ternovoy S.К.1,2
1 - A.L. Myasnikov Institute of Clinical Cardiology, E.I. Chazov National Medical Research Center of cardiology.
2 - Sechenov University. Moscow, Russia.
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o study the characteristics of pulmonary tissue perfusion in patients with idiopathic pulmonary hypertension (IPH) and chronic thromboembolic pulmonary hypertension (CTEPH) with distal type of pulmonary artery lesions using subtraction computed tomography angiography.
Materials and methods. The study included 30 patients with precapillary pulmonary hypertension: 15 patients with idiopathic (group 1) and 15 patients with chronic thromboembolic pulmonary hypertension with distal type of pulmonary artery disease (group 2). All patients underwent subtraction CT-pulmonary angiography on an Aquilion ONE 640 VISION Edition computed tomograph with 320 rows of detectors according to the Lung subtraction protocol using special chest fixation tapes to achieve a relatively equal inhalation depth. Analysis of the obtained images included visual segment-by-segment assessment of perfusion on iodine maps. We identified 3 types of perfusion defects: wedge-shaped with clear contours (type 1), patchy (type 2) and homogeneous areas of decreased perfusion (type 3).
Results. A total of 600 lung segments were analyzed: 10 segments in each lung from 30 patients (300 segments in each group). Perfusion disorders in the IPH group were detected in 13 of 15 patients (86.6%), and in the CTEPH group in all 15 patients (100%). The number of segments with normal perfusion in the IPH group (107/300, 35.6%) was significantly greater than in the CTEPH group (60/300, 20%) (p <0.00001). Analysis of segments with altered perfusion showed that wedge-shaped defects (type 1) and patchy perfusion defects (type 2) were detected significantly more often in the CTEPH group than in the IPH group. The differences in the characteristics of the defects between the groups were statistically significant: in the IPH and CTEPH groups, the number of lung segments with patchy defects was 92.74% and 77.08%, respectively (p<0.00001), number of segments with wedge-shaped defects – 2.59% and 21.66%, respectively (p<0.00001). In both groups, diffuse homogeneous perfusion defects (type 3) were significantly less common than defects of types 1 and 2.
Discussion. Subtraction CT angiopulmonography is currently not routinely used in the diagnosis of patients with pulmonary hypertension, but there are studies that show the high comparability of this method with ventilation-perfusion lung scintigraphy in assessing pulmonary perfusion. Our results are consistent with the data of a few studies on the comparative analysis of perfusion disorders in patients with pulmonary hypertension. Wedge-shaped perfusion defects in chronic thromboembolic pulmonary hypertension are recorded with thrombotic lesions of the pulmonary arteries. Patchy perfusion defects in idiopathic pulmonary hypertension are caused by structural changes in the pathogenetically altered microvasculature.
Conclusion. Assessing the type of perfusion abnormalities using subtraction CT-pulmonography contributes to the examination of patients with pulmonary hypertension and can be used in the differential diagnosis of IPH and CTEPH with distal type of pulmonary artery lesions.
Keywords: pulmonary hypertension, pulmonary embolism, subtraction CT angiopulmonography, pulmonary perfusion.
Corresponding author: En M.I., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript
For citation: En M.I., Veselova T.N., Martynyuk T.V., Danilov N.M., Ternovoy S.К. Pulmonary perfusion features in patients with idiopathic pulmonary hypertension and chronic thromboembolic pulmonary hypertension according to subtraction computed tomography angiopulmonography. REJR 2025; 15(1):84-94. DOI: 10.21569/2222-7415-2025-15-1-84-94.
Received: 16.01.25 Accepted: 27.01.25