[Use of dual-energy computed tomographic angiopulmonography in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary artery thromboendarterectomy].

OBJECTIVE: To estimate the contribution of dual-energy computed tomographic (CT angiopulmonography t o a diagnostic algorithm in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and its role in the evaluation of postoperative changes. MATERIAL AND METHODS: CT angiopulmonography was performed on the 64-slice Discovery HD 750 system (GE Healthcare) using the dual-energy scanning mode (140 and 80 kV). The examination results in patients with CTEPH were analyzed. RESULTS: All the patients were found to have typical CT signs of CTEPH: abnormal contrast enhancement of the pulmonary arteries, their dilatation and tortuosity; signs of right cardiac overload: right ventricular dilatation and/or hypertrophy, bronchial artery dilatation, decreased peripheral vascular pattern, mosaic pulmonary perfusion, and wedge-shaped perfusion defects on the iodine maps. Mosaic pulmonary perfusion areas were also found in all the patients. Perfusion defects were more clearly visualized when dual-energy CT by constructing iodine perfusion maps was used. Analyzing the perfusion maps in 6 patients operated on revealed a 20-50% reduction in perfusion deficit. CONCLUSION: Information on the vascular bed and pulmonary perfusion may be obtained in patients with CTEPH within one investigation, which is important to plan surgical treatment. Construction of iodine pulmonary perfusion maps allows evaluation of perfusion recovery after artery thromboendarterectomy.

[Age-related diagnostic features of congenital atrial septal defect in adults according to the data of radiodiagnostic studies].

OBJECTIVE: To reveal diagnostic features in atrial septal defect (ASD) in different age groups; to define a role of X-ray study in the diagnosis of ASD. MATERIAL AND METHODS: Forty-eight patients (16 men and 32 women) aged 15 to 71 years with ASD at different sites were examined. All the patients underwent chest X-ray, echocardiography, and cardiac phase-contrast magnetic resonance imaging (MRI). The examinees were divided into 2 age groups: 1) less than 40 years (n = 18) and 2) more than 40 years (n = 30). The groups were compared using quantitative and alternative signs and they did not significantly differ in the volume of intracardiac shunt and in the size of the defect. The X-ray and MRI indicators reflecting the calibers of pulmonary arteries were also compared in patient groups with different pulmonary artery systolic pressures (PASP) (< 35, 36-60, and > 60 mm Hg). RESULTS: The older age group more frequently showed signs of heart failure, valvular regurgitation, and an atypical X-ray pattern. The sizes of atria, pulmonary artery and its branches, and PASP were also increased in the older age group. The patient group with high PASP (> 60 mm Hg) significantly differed from the others in all the indicators analyzed. Normal PASP and moderate pulmonary hypertension groups greatly differed only in the Moore index. CONCLUSION: Chest X-ray reflects rather precisely the hemodynamic type of the defect. High pulmonary hypertension has clear X-ray and MRI manifestations. The specificity of X-ray in the diagnosis of PASP is lower in the older age group due to the higher rate of an atypical X-ray pattern. Radiology is important in detecting pulmonary venous hypertension in patients with PASP. Pulmonary venous hypertension is indicative of elevated pressure in the left atrium and pulmonary veins and arises from different causes: shunt inversion, restrictive defect, mitral valve comorbidity, and left ventricular systolic and diastolic dysfunction.