Diagnostic Performance of Lung Perfusion and CTPA for CTEPH among a Southeast Asia Population

Michael Tong

Research output: ThesisDoctoral Thesis

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Abstract

Introduction:
The diagnostic approach for patients with suspected Chronic Thrombo-Embolic Pulmonary Hypertension (CTEPH) is a combination of clinical and pre-test probability assessment, and diagnostic imaging of computed tomography pulmonary angiogram (CTPA) or lung ventilation and perfusion scintigraphy (V/Q). There is a paucity of literature, particularly for Southeast Asia (SEA) populations, regarding the efficacy of these imaging approaches. This study investigated the sensitivity and specificity of V/Q and CTPA in the diagnosis of CTEPH in SEA patients.

Method/Approach:
A retrospective analysis was undertaken on 133 consecutive patients presenting for pulmonary hypertension (PH). The population included 42 males, 91 females, 683 V/Q images and 6288 CTPA images for patients in the age range 18 to 93 years (mean 66). All data was retrospectively analysed by two nuclear medicine physicians/radiologists and classified as findings consistent with CTEPH or inconsistent with CTEPH. These classifications were independently and ollectively correlated with a final diagnosis of CTEPH or no CTEPH, made as a collective clinical decision by the primary attending physician based on the results of
relevant investigations.

Results:
The accuracy, sensitivity, and specificity of V/Q for detection of CTEPH were 83.5%, 57.4% and 97.7% respectively, with a positive predictive value (PPV) of 93.1% and a negative predictive value (NPV) of 80.8% when only high probability reports were considered CTEPH positive. The accuracy, sensitivity, and specificity of V/Q for detection of CTEPH were 96.2%, 97.9% and 95.3% respectively, with a PPV of 92.0% and a NPV of 98.8% when both high probability and intermediate probability reports were considered CTEPH positive. The accuracy, sensitivity
and specificity of CTPA for detection of CTEPH were 70.7%, 19.1% and 98.8% respectively, with 90% PPV and 69.1% NPV. All 47 CTEPH positive studies were reported as having abnormal lung perfusion scans.

Conclusion:
This study demonstrated the higher diagnostic efficacy of V/Q over CTPA in diagnosing CTEPH in the SEA population. At the same time, in addressing the study objective, a normal lung perfusion has shown to exclude the presence of CTEPH in PH patients. Perfusion imaging is recommended first in eliminating the need for ventilation if perfusion is normal.
Original languageEnglish
QualificationDoctor of Philosophy
Awarding Institution
  • Charles Sturt University
Supervisors/Advisors
  • Wheat, Janelle, Co-Supervisor
  • Currie, Geoff, Principal Supervisor
Place of PublicationAustralia
Publisher
Publication statusPublished - 2020

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