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"Automated Quantification of the Pulmonary Vasculature in Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension"
Zhiwei Zhai, Gudula J.A.M. Boon, Marius Staring, Lisette F. van Dam, Lucia J.M. Kroft, Irene Hernandez Giron, Maarten K. Ninaber, Harm Jan Bogaard, Lilian J. Meijboom, Anton Vonk Noordegraaf, Menno V. Huisman, Frederikus A. Klok and Berend C. Stoel
Abstract
The particular mechanical obstruction of pulmonary embolism (PE) and chronic thromboembolic pulmonary hypertension (CTEPH) may affect pulmonary arteries and veins differently. Therefore, we evaluated whether pulmonary vascular morphology and densitometry using CT pulmonary angiography (CTPA) in arteries and veins could distinguish PE from CTEPH.
We analyzed CTPA images from a convenience cohort of 16 PE patients, 6 CTEPH patients and 15 controls without PE or CTEPH. Pulmonary vessels were extracted with a graph-cuts method, and separated into arteries and veins using a deep-learning classification method. By analyzing the distribution of vessel radii, vascular morphology was quantified into a slope (α) and intercept (β) for the entire pulmonary vascular tree, and for arteries and veins, separately. To quantify lung perfusion, the median pulmonary vascular density was calculated. As a reference, lung perfusion was also quantified by the contrast enhancement in the parenchymal areas, pulmonary trunk and descending aorta. All quantifications were compared between the three groups.
Vascular morphology did not differ between groups, in contrast to vascular density values (both arterial and venous; p-values 0.006 - 0.014. The median vascular density (interquartile range) was -452 (95), -567 (113) and -470 (323) HU, for the PE, control and CTEPH group, respectively. The perfusion curves from all measurements showed different patterns between groups.
In this proof of concept study, not vasculature morphology but vascular densities differentiated between normal and thrombotic obstructed vasculature. For distinction on an individual patient level, further technical improvements are needed both in terms of image acquisition/reconstruction and post-processing.
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Copyright © 2023 by the authors.
Published version © 2023 by .
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BibTeX entry
| @article{Zhai:2023, |
| author |
= {Zhai, Zhiwei and Boon, Gudula J.A.M. and Staring, Marius and van Dam, Lisette F. and Kroft, Lucia J.M. and Giron, Irene Hernandez and Ninaber, Maarten K. and Bogaard, Harm Jan and Meijboom, Lilian J. and Vonk Noordegraaf, Anton and Huisman, Menno V. and Klok, Frederikus A. and Stoel, Berend C.}, |
| title |
= {Automated Quantification of the Pulmonary Vasculature in Pulmonary Embolism and Chronic Thromboembolic Pulmonary Hypertension}, |
| journal |
= {Pulmonary Circulation}, |
| volume |
= {13}, |
| number |
= {2}, |
| pages |
= {e12223}, |
| year |
= {2023}, |
| } |
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