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AIM: The aim of this study was to compare the diagnostic accuracy and interobserver agreement of dual-energy computed tomography pulmonary angiography (DECT-PA) and cone-beam computed tomography pulmonary angiography (CBCT-PA) for the evaluation of chronic thromboembolic pulmonary hypertension (CTEPH), using digital subtraction angiography pulmonary angiography (DSA-PA) as the reference standard. MATERIALS AND METHODS: This retrospective study included 109 patients with confirmed CTEPH who underwent DECT-PA, CBCT-PA, and DSA-PA within a three-month interval between January 2017 and June 2022. Pulmonary arteries were evaluated at main, lobar, segmental, and subsegmental levels. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated. Interobserver agreement was assessed using Cohen's kappa (κ). RESULTS: Overall diagnostic accuracy was comparable between DECT-PA (89.5%) and CBCT-PA (89.3%). DECT-PA demonstrated higher overall sensitivity (65.0% vs 53.5%, P = 0.019) but CBCT-PA achieved greater interobserver agreement (κ = 0.76 vs 0.74). Sensitivity declined in distal segments for both modalities, with CBCT-PA outperforming DECT-PA at the subsegmental level (51.9% vs 43.6%). Specificity remained high across modalities (>89%). The CBCT-PA showed superior agreement for lesion subtype classification, particularly for occlusions (κ = 0.839). CONCLUSION: DECT-PA and CBCT-PA offer complementary strengths for the evaluation of CTEPH. DECT-PA provides high specificity for central and segmental lesions, supporting its role in initial assessment. CBCT-PA improves sensitivity and reproducibility in distal arteries, reinforcing its value for procedural planning and detailed vascular assessment. These findings support the use of DECT-PA as a first-line diagnostic tool and highlight the role of CBCT-PA as an adjunct in patients with distal or morphologically complex disease, potentially influencing diagnostic pathways and procedural planning in CTEPH.
Páez-Carpio et al. (Sat,) studied this question.