Fig 1.
Diagnostic algorithm for chronic thromboembolic pulmonary hypertension according to the European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines for the diagnosis and treatment of pulmonary hypertension.
CTEPH, chronic thromboembolic pulmonary hypertension; HRCT, high-resolution computed tomography; mPAP, mean pulmonary artery pressure; PCWP, pulmonary capillary wedge pressure; PFT, pulmonary function test; PH, pulmonary hypertension; PVR, pulmonary vascular resistance; RHC, right-sided heart catheterization; TTE, transthoracic echocardiography.
Fig 2.
Vascular measurements on MDCTA scans.
Main pulmonary artery diameter (dPA), ascending aorta diameter (dAA) and right and left pulmonary artery diameter (drPA, dlPA) were assessed on transverse image.
Fig 3.
Cardiac chamber size measurements on MDCTA scans.
Right and left atrial (dRA, dLA) and ventricular (dRV, dLV) diameters were assessed on transverse image at the end diastole.
Table 1.
Patients’ demographic and hemodynamic characteristics.
Fig 4.
Vascular signs of chronic PE in patients with CTEPH.
(A) Axial MDCTA image shows wall-adherent thrombus (arrow) in the pulmonary artery trunk and the right main pulmonary artery. (B) Axial MDCTA image shows wall-adherent thrombus (arrows) in the right and left pulmonary arteries.
Fig 5.
Cardiac thrombi in patients with CTEPH.
Axial MDCTA image shows wall-adherent thrombus (arrow) in the right atrium.
Fig 6.
Mosaic perfusion in patients with CTEPH.
(A) Axial CT image shows sharply demarcated segmental and subsegmental areas of hypo- and hyperattenuation (pattern 1). (B) Axial CT image shows perihilar areas of increased attenuation and vascularity with peripheral perfusion defects (pattern 2). (C) Axial CT image shows patchy heterogeneous lung attenuation (pattern 3).
Fig 7.
Bronchial collateral arteries in patients with CTEPH.
Axial MDCTA image shows bronchial collateral arteries (arrow) in a patient with wall-adherent intraluminal thrombi in the right pulmonary artery and left lower lobe artery.
Fig 8.
Bronchial dilatation in patients with CTEPH.
(A) Axial CT image shows dilated bronchi (arrows) in the right upper lobe. (B) Axial CT image shows dilated bronchi (arrows) in both lower lobes.
Fig 9.
Parenchymal densities in patients with CTEPH.
Axial CT image shows peripheral cavitary mass (arrow) combined with mosaic perfusion pattern 1.
Table 2.
CT imaging findings in patients newly diagnosed with CTEPH.
Table 3.
Vessel and cardiac chamber diameter measurements in patients newly diagnosed with CTEPH.
Table 4.
Comparison of the CT imaging findings with vessel and cardiac chamber diameter measurements.
Table 5.
Comparison of the CT imaging findings with demographics.
Table 6.
Comparison of the CT imaging findings with mPAP.
Fig 10.
Comparison between ROC curves for RHF-related death prediction according to each significant characteristic with full model.
Table 7.
CT imaging findings in survivors and patients who died of RHF.
Table 8.
Vessel and cardiac chamber diameter measurements in survivors and patients who died of RHF.