• Yvonne M Ende-Verhaar, Lilian J Meijboom, KroftLucia J MLJMDepartment of Radiology, Leiden University Medical Center, Leiden, The Netherlands., BeenenLudo F MLFMDepartments of Radiology, Amsterdam University Medical Center, AMC, Amsterdam, The Netherlands., Gudula J A M Boon, Saskia Middeldorp, Esther J Nossent, Petr Symersky, Menno V Huisman, Harm Jan Bogaard, Anton Vonk Noordegraaf, and Frederikus A Klok.
• Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands.
• J. Heart Lung Transplant. 2019 Jul 1; 38 (7): 731-738.

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) is often diagnosed after a long delay, even though signs may already be present on the computed tomography pulmonary angiogram (CTPA) used to diagnose a preceding acute pulmonary embolism (PE). In this setting of suspected acute PE, we evaluated the diagnostic accuracy of dedicated CTPA reading for the diagnosis of already existing CTEPH.MethodsThree blinded expert radiologists scored radiologic signs of CTEPH on initial CTPA scans with confirmed acute PE in 50 patients who were subsequently diagnosed with CTEPH during follow-up (cases), and in 50 patients in whom sequential echocardiograms performed >2 years after the acute PE diagnosis did not show any signs of pulmonary hypertension (controls). All 50 control index CTPA scans had signs of right ventricular (RV) overload. Sensitivity and specificity of expert CTPA reading was calculated, and best-predicting radiologic parameters were identified.ResultsThe overall expert reading yielded a sensitivity of 72% (95% confidence interval [CI] 58%-84%) and a specificity of 94% (95% CI 83%-99%) for CTEPH diagnosis. Multivariate analysis identified 6 radiologic parameters as independent predictors: intravascular webs; pulmonary artery retraction or dilatation; bronchial artery dilatation; right ventricular (RV) hypertrophy; and interventricular septum flattening. The presence of 3 or more these parameters was associated with a sensitivity of 70% (95% CI 55%-82%), a specificity of 96% (95% CI 86%-100%), and a c-statistic of 0.92.ConclusionsStandardized reading of CTPA scans performed for acute PE can be useful for the diagnosis of CTEPH when structured identification of 6 characteristics is employed during interpretation. The use of this strategy may help reduce diagnostic delay of CTEPH.Copyright © 2019 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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