Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CT
Background: CT pulmonary angiography (CTPA) plays a critical role in guiding balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, conventional CT (cCT) has limited sensitivity in detecting peripheral lesions, which is critical for avoi...
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Elsevier
2025-11-01
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| author | Satoshi Higuchi, MD, PhD Taijyu Satoh, MD, PhD Hidenobu Takagi, MD, PhD Mitsuru Nakada, RT Takuya Kawahara, PhD, MPH Nobuhiro Yaoita, MD, PhD Shuhei Sugiyama, RT Tomoya Onuma, RT Kenta Shirata, RT Shingo Kayano, RT Hideki Ota, MD, PhD Satoshi Yasuda, MD, PhD Kei Takase, MD, PhD |
| author_facet | Satoshi Higuchi, MD, PhD Taijyu Satoh, MD, PhD Hidenobu Takagi, MD, PhD Mitsuru Nakada, RT Takuya Kawahara, PhD, MPH Nobuhiro Yaoita, MD, PhD Shuhei Sugiyama, RT Tomoya Onuma, RT Kenta Shirata, RT Shingo Kayano, RT Hideki Ota, MD, PhD Satoshi Yasuda, MD, PhD Kei Takase, MD, PhD |
| author_sort | Satoshi Higuchi, MD, PhD |
| collection | DOAJ |
| description | Background: CT pulmonary angiography (CTPA) plays a critical role in guiding balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, conventional CT (cCT) has limited sensitivity in detecting peripheral lesions, which is critical for avoiding complications. This study compared ultra-high-resolution CT (UHRCT; 0.25 mm detector elements) and conventional CT (cCT; 0.6 mm detector elements) in identifying and classifying segmental and subsegmental lesions, using invasive selective angiography during BPA as the reference standard. Methods: This single-center retrospective study included 42 patients with newly diagnosed CTEPH who underwent CT pulmonary angiography (CTPA) with either cCT or UHRCT and subsequently completed BPA. The morphology and location of lesions were independently assessed using selective angiography and CTPA. Sensitivity, specificity, and lesion classification accuracy were assessed using selective angiography as the reference standard. Results: A total of 1687 branches in 42 patients (male/female 11/31, mean age 66 years) were analyzed. The sensitivity and specificity of cCT were 54.6% (95% CI: 48.2–60.8) and 85.2% (95% CI: 75.6–91.4), respectively. In contrast, UHRCT demonstrated significantly higher sensitivity (94.3%, 95% CI: 91.9–96.1) but lower specificity (60.2%, 95% CI: 46.7–72.2). The sensitivity difference was more prominent in subsegmental branches (p for interaction = 0.11). UHRCT more accurately classified lesion types in 83.7% of cases (95% CI: 76.7–88.9), versus 69.1% (95% CI: 58.3–78.1) with cCT. Web lesions remained the most difficult to detect. Conclusion: Higher-spatial-resolution CTPA provides a higher lesion detection sensitivity, particularly in subsegmental branches, and more accurately classified lesion type in patients with CTEPH treated with BPA, potentially aiding procedural planning and guidance. |
| format | Article |
| id | doaj-art-3991b52fb63149ed9cf8774d3dc46c47 |
| institution | Kabale University |
| issn | 2950-1334 |
| language | English |
| publishDate | 2025-11-01 |
| publisher | Elsevier |
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| series | JHLT Open |
| spelling | doaj-art-3991b52fb63149ed9cf8774d3dc46c472025-08-20T04:01:57ZengElsevierJHLT Open2950-13342025-11-011010034410.1016/j.jhlto.2025.100344Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CTSatoshi Higuchi, MD, PhD0Taijyu Satoh, MD, PhD1Hidenobu Takagi, MD, PhD2Mitsuru Nakada, RT3Takuya Kawahara, PhD, MPH4Nobuhiro Yaoita, MD, PhD5Shuhei Sugiyama, RT6Tomoya Onuma, RT7Kenta Shirata, RT8Shingo Kayano, RT9Hideki Ota, MD, PhD10Satoshi Yasuda, MD, PhD11Kei Takase, MD, PhD12Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan; Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, The Netherlands; Corresponding author: Satoshi Higuchi, MD, PhD, Department of Diagnostic Radiology, Tohoku University Hospital, Seiryo, Aoba, Sendai 980–8574 Japan. Telephone: 022-717-7417. Fax: 022-717-7512.Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Diagnostic Radiology, Tohoku University Hospital, Sendai, JapanDepartment of Radiology, Tohoku University Hospital, Sendai, JapanClinical Research Promotion Center, The University of Tokyo Hospital, Bunkyo, JapanDepartment of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Radiology, Tohoku University Hospital, Sendai, JapanDepartment of Radiology, Tohoku University Hospital, Sendai, JapanDepartment of Radiology, Tohoku University Hospital, Sendai, JapanDepartment of Radiology, Tohoku University Hospital, Sendai, JapanDepartment of Diagnostic Radiology, Tohoku University Hospital, Sendai, JapanDepartment of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, JapanDepartment of Diagnostic Radiology, Tohoku University Hospital, Sendai, JapanBackground: CT pulmonary angiography (CTPA) plays a critical role in guiding balloon pulmonary angioplasty (BPA) for patients with chronic thromboembolic pulmonary hypertension (CTEPH). However, conventional CT (cCT) has limited sensitivity in detecting peripheral lesions, which is critical for avoiding complications. This study compared ultra-high-resolution CT (UHRCT; 0.25 mm detector elements) and conventional CT (cCT; 0.6 mm detector elements) in identifying and classifying segmental and subsegmental lesions, using invasive selective angiography during BPA as the reference standard. Methods: This single-center retrospective study included 42 patients with newly diagnosed CTEPH who underwent CT pulmonary angiography (CTPA) with either cCT or UHRCT and subsequently completed BPA. The morphology and location of lesions were independently assessed using selective angiography and CTPA. Sensitivity, specificity, and lesion classification accuracy were assessed using selective angiography as the reference standard. Results: A total of 1687 branches in 42 patients (male/female 11/31, mean age 66 years) were analyzed. The sensitivity and specificity of cCT were 54.6% (95% CI: 48.2–60.8) and 85.2% (95% CI: 75.6–91.4), respectively. In contrast, UHRCT demonstrated significantly higher sensitivity (94.3%, 95% CI: 91.9–96.1) but lower specificity (60.2%, 95% CI: 46.7–72.2). The sensitivity difference was more prominent in subsegmental branches (p for interaction = 0.11). UHRCT more accurately classified lesion types in 83.7% of cases (95% CI: 76.7–88.9), versus 69.1% (95% CI: 58.3–78.1) with cCT. Web lesions remained the most difficult to detect. Conclusion: Higher-spatial-resolution CTPA provides a higher lesion detection sensitivity, particularly in subsegmental branches, and more accurately classified lesion type in patients with CTEPH treated with BPA, potentially aiding procedural planning and guidance.http://www.sciencedirect.com/science/article/pii/S2950133425001399CTEPHBPAUltra-high-resolution CTSubsegmental lesion |
| spellingShingle | Satoshi Higuchi, MD, PhD Taijyu Satoh, MD, PhD Hidenobu Takagi, MD, PhD Mitsuru Nakada, RT Takuya Kawahara, PhD, MPH Nobuhiro Yaoita, MD, PhD Shuhei Sugiyama, RT Tomoya Onuma, RT Kenta Shirata, RT Shingo Kayano, RT Hideki Ota, MD, PhD Satoshi Yasuda, MD, PhD Kei Takase, MD, PhD Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CT JHLT Open CTEPH BPA Ultra-high-resolution CT Subsegmental lesion |
| title | Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CT |
| title_full | Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CT |
| title_fullStr | Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CT |
| title_full_unstemmed | Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CT |
| title_short | Detectability of subsegmental lesions in patients with inoperable CTEPH: Comparison between ultra-high-resolution vs. conventional CT |
| title_sort | detectability of subsegmental lesions in patients with inoperable cteph comparison between ultra high resolution vs conventional ct |
| topic | CTEPH BPA Ultra-high-resolution CT Subsegmental lesion |
| url | http://www.sciencedirect.com/science/article/pii/S2950133425001399 |
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