CT parenchymal quantification showed lower mean intensity in acute PE (-674, p=0.002) vs controls (-656), and higher kurtosis in CTEPH (8.2) vs controls (5.1, p<0.0001).
Case-Control (n=414)
No
Does parenchymal quantification on CT pulmonary angiography differentiate between patients with CTEPH, acute PE, and controls?
Parenchymal density patterns on CT pulmonary angiography, specifically kurtosis and skewness, can serve as imaging markers to differentiate between acute PE, CTEPH, and normal lungs.
Abstract Introduction Computed Tomography (CT) pulmonary angiography is an integral part of the assessment of thromboembolic disease. Changes in penetration of the contrast in the parenchyma have been described in thromboembolic disease- with decreased signal intensity in the parenchyma with acute PE and mosaicism in CTEPH. In this study we sought to compare the statistical properties of the lung parenchyma as assessed by CT angiography between patients with PE, CTEPH and those without evidence of pulmonary thromboembolism. Methods Patients with appropriate CT imaging were enrolled from consecutive CTEPH patients undergoing PTE at Northwestern University Medical Center. From a larger cohort of patients with CT Pulmonary angiography patients with a diagnosis of PE and those without (Controls) were selected to match the CTEPH cohort based on age, sex and BMI. Lung mask generation and statistical analysis of the lung parenchyma were performed using the Chest Imaging Platform. Medians are presented. Comparisons were made using the Wilcoxon Rank-Sum Test, performed using R version 4.1. Results 87 CTEPH patients, 151 PE patients and 176 control patients were used for the analysis. There was no significant difference in lung volume between the three groups (2.88L vs 3.01L vs 2.97L, p = 0.07, 0.63, 0.31). The mean intensity was lower in both PE and CTEPH patients as compared to controls (PE: -674, CTEPH -675, control -656, p = 0.002 for acute PE, p = 0.07 for CTEPH). The standard deviation was lowest in PE (186 vs 211, p 0.0001) but the same when compared between CTEPH and Controls (208 vs 211, p = 0.56). Skewness was highest in the PE cohort (2.27 vs 2.03, p = 0.004) with minimal difference between CTEPH and control (2.13 vs 2.03, p = 0.22). On the other hand, Kurtosis was highest in CTEPH (8.2 vs 5.1, p 0.0001) with PE following second (6.1 vs 5.1, p = 0.003). Mean intensity aside, STD, Skewness and Kurtosis were all statistically significantly different between CTEPH and Acute PE. Discussion In this comparison of patients with established CTEPH undergoing PTE and those with diagnosis of acute PE and those without evidence of PE, we found statistically significant differences between the mean and moments of the parenchymal density values. These differences could reflect differences in perfusion patterns though other processes such as infiltrates and atelectasis may also be playing a part. Assessment of the parenchymal density patterns may serve as an imaging marker for thromboembolic disease. This abstract is funded by: R01HL164717
Rahaghi et al. (Fri,) conducted a case-control in Thromboembolic disease (PE, CTEPH) (n=414). CT pulmonary angiography parenchymal quantification vs. Controls without evidence of pulmonary thromboembolism was evaluated on Statistical properties of the lung parenchyma (mean intensity, standard deviation, skewness, kurtosis). CT parenchymal quantification showed lower mean intensity in acute PE (-674, p=0.002) vs controls (-656), and higher kurtosis in CTEPH (8.2) vs controls (5.1, p<0.0001).
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