Quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT

Abstract Quantitative measurement of lung perfusion is a promising tool to evaluate lung pathophysiology as well as to assess disease severity and monitor treatment. However, this novel technique has not been adopted clinically due to various technical and physiological challenges; and it is still i...

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Autores principales:	Laura Jimenez-Juan, Hatem Mehrez, Chris Dey, Shabnam Homampour, Pascal Salazar-Ferrer, John T. Granton, Ting-Yim Lee, Narinder Paul
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/43cff427d2804299baf21d11ba2ea033
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spelling	oai:doaj.org-article:43cff427d2804299baf21d11ba2ea0332021-12-02T14:01:35ZQuantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT10.1038/s41598-020-80177-52045-2322https://doaj.org/article/43cff427d2804299baf21d11ba2ea0332021-01-01T00:00:00Zhttps://doi.org/10.1038/s41598-020-80177-5https://doaj.org/toc/2045-2322Abstract Quantitative measurement of lung perfusion is a promising tool to evaluate lung pathophysiology as well as to assess disease severity and monitor treatment. However, this novel technique has not been adopted clinically due to various technical and physiological challenges; and it is still in the early developmental phase where the correlation between lung pathophysiology and perfusion maps is being explored. The purpose of this research work is to quantify the impact of pulmonary artery occlusion on lung perfusion indices using lung dynamic perfusion CT (DPCT). We performed Lung DPCT in ten anesthetized, mechanically ventilated juvenile pigs (18.6–20.2 kg) with a range of reversible pulmonary artery occlusions (0%, 40–59%, 60–79%, 80–99%, and 100%) created with a balloon catheter. For each arterial occlusion, DPCT data was analyzed using first-pass kinetics to derive blood flow (BF), blood volume (BV) and mean transit time (MTT) perfusion maps. Two radiologists qualitatively assessed perfusion maps for the presence or absence of perfusion defects. Perfusion maps were also analyzed quantitatively using a linear segmented mixed model to determine the thresholds of arterial occlusion associated with perfusion derangement. Inter-observer agreement was assessed using Kappa statistics. Correlation between arterial occlusion and perfusion indices was evaluated using the Spearman-rank correlation coefficient. Our results determined that perfusion defects were detected qualitatively in BF, BV and MTT perfusion maps for occlusions larger than 55%, 80% and 55% respectively. Inter-observer agreement was very good with Kappa scores > 0.92. Quantitative analysis of the perfusion maps determined the arterial occlusion threshold for perfusion defects was 50%, 76% and 44% for BF, BV and MTT respectively. Spearman-rank correlation coefficients between arterial occlusion and normalized perfusion values were strong (− 0.92, − 0.72, and 0.78 for BF, BV and MTT, respectively) and were statically significant (p < 0.01). These findings demonstrate that lung DPCT enables quantification and stratification of pulmonary artery occlusion into three categories: mild, moderate and severe. Severe (occlusion ≥ 80%) alters all perfusion indices; mild (occlusion < 55%) has no detectable effect. Moderate (occlusion 55–80%) impacts BF and MTT but BV is preserved.Laura Jimenez-JuanHatem MehrezChris DeyShabnam HomampourPascal Salazar-FerrerJohn T. GrantonTing-Yim LeeNarinder PaulNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-9 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Laura Jimenez-Juan Hatem Mehrez Chris Dey Shabnam Homampour Pascal Salazar-Ferrer John T. Granton Ting-Yim Lee Narinder Paul Quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT
description	Abstract Quantitative measurement of lung perfusion is a promising tool to evaluate lung pathophysiology as well as to assess disease severity and monitor treatment. However, this novel technique has not been adopted clinically due to various technical and physiological challenges; and it is still in the early developmental phase where the correlation between lung pathophysiology and perfusion maps is being explored. The purpose of this research work is to quantify the impact of pulmonary artery occlusion on lung perfusion indices using lung dynamic perfusion CT (DPCT). We performed Lung DPCT in ten anesthetized, mechanically ventilated juvenile pigs (18.6–20.2 kg) with a range of reversible pulmonary artery occlusions (0%, 40–59%, 60–79%, 80–99%, and 100%) created with a balloon catheter. For each arterial occlusion, DPCT data was analyzed using first-pass kinetics to derive blood flow (BF), blood volume (BV) and mean transit time (MTT) perfusion maps. Two radiologists qualitatively assessed perfusion maps for the presence or absence of perfusion defects. Perfusion maps were also analyzed quantitatively using a linear segmented mixed model to determine the thresholds of arterial occlusion associated with perfusion derangement. Inter-observer agreement was assessed using Kappa statistics. Correlation between arterial occlusion and perfusion indices was evaluated using the Spearman-rank correlation coefficient. Our results determined that perfusion defects were detected qualitatively in BF, BV and MTT perfusion maps for occlusions larger than 55%, 80% and 55% respectively. Inter-observer agreement was very good with Kappa scores > 0.92. Quantitative analysis of the perfusion maps determined the arterial occlusion threshold for perfusion defects was 50%, 76% and 44% for BF, BV and MTT respectively. Spearman-rank correlation coefficients between arterial occlusion and normalized perfusion values were strong (− 0.92, − 0.72, and 0.78 for BF, BV and MTT, respectively) and were statically significant (p < 0.01). These findings demonstrate that lung DPCT enables quantification and stratification of pulmonary artery occlusion into three categories: mild, moderate and severe. Severe (occlusion ≥ 80%) alters all perfusion indices; mild (occlusion < 55%) has no detectable effect. Moderate (occlusion 55–80%) impacts BF and MTT but BV is preserved.
format	article
author	Laura Jimenez-Juan Hatem Mehrez Chris Dey Shabnam Homampour Pascal Salazar-Ferrer John T. Granton Ting-Yim Lee Narinder Paul
author_facet	Laura Jimenez-Juan Hatem Mehrez Chris Dey Shabnam Homampour Pascal Salazar-Ferrer John T. Granton Ting-Yim Lee Narinder Paul
author_sort	Laura Jimenez-Juan
title	Quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT
title_short	Quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT
title_full	Quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT
title_fullStr	Quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT
title_full_unstemmed	Quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT
title_sort	quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion ct
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/43cff427d2804299baf21d11ba2ea033
work_keys_str_mv	AT laurajimenezjuan quantitativeassessmentofpulmonaryarteryocclusionusinglungdynamicperfusionct AT hatemmehrez quantitativeassessmentofpulmonaryarteryocclusionusinglungdynamicperfusionct AT chrisdey quantitativeassessmentofpulmonaryarteryocclusionusinglungdynamicperfusionct AT shabnamhomampour quantitativeassessmentofpulmonaryarteryocclusionusinglungdynamicperfusionct AT pascalsalazarferrer quantitativeassessmentofpulmonaryarteryocclusionusinglungdynamicperfusionct AT johntgranton quantitativeassessmentofpulmonaryarteryocclusionusinglungdynamicperfusionct AT tingyimlee quantitativeassessmentofpulmonaryarteryocclusionusinglungdynamicperfusionct AT narinderpaul quantitativeassessmentofpulmonaryarteryocclusionusinglungdynamicperfusionct
_version_	1718392136905261056

Quantitative assessment of pulmonary artery occlusion using lung dynamic perfusion CT

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