Semi-Quantitative Analysis of Lung Perfusion SPECT/CT for Evaluation of Response to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

Shin Ae Han; Sangwon Han; Jinho Lee; Do-Yoon Kang; Jae Seung Lee; Dae-Hee Kim; Duk-Woo Park; Jong-Min Song; Jin-Sook Ryu; Dae Hyuk Moon

doi:10.1007/s13139-024-00858-1

Semi-Quantitative Analysis of Lung Perfusion SPECT/CT for Evaluation of Response to Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension

Nucl Med Mol Imaging. 2024 Aug;58(5):291-299. doi: 10.1007/s13139-024-00858-1. Epub 2024 Mar 22.

Authors

Affiliations

¹ Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea.
² Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
³ Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

PMID: 39036460
PMCID: PMC11255175 (available on 2025-08-01)
DOI: 10.1007/s13139-024-00858-1

Abstract

Purpose: We aimed to investigate the response to balloon pulmonary angioplasty (BPA) in chronic thromboembolic pulmonary hypertension (CTEPH) using semi-quantitative analysis of lung perfusion SPECT/CT.

Methods: This is a single-center retrospective study of patients with CTEPH who underwent BPA and pre- and post-BPA lung perfusion SPECT/CT between 2015 and 2022. Segmental defects on SPECT/CT were visually assessed and semi-quantitatively scored as 1 (large defect) or 0.5 (moderate defect) in accordance with modified PIOPED II criteria. The perfusion defect score was defined as (Σ segmental defect scores/18) × 100 (%). Associations between perfusion defect score and hemodynamic or functional parameters including WHO functional class, six-minute walking distance (6MWD), serum B-type natriuretic peptide (BNP), mean arterial pulmonary pressure (mPAP), pulmonary vascular resistance (PVR), and tricuspid regurgitation pressure gradient (TRPG) on echocardiography were statistically analyzed.

Results: A total of 24 consecutive patients were included. The perfusion defect score significantly improved after BPA (median 58.3% vs. 47.2%, P < 0.001), in conjunction with the WHO functional class, 6MWD, serum BNP, mPAP, and TRPG. Perfusion defect scores were significantly correlated with 6MWD (rho = - 0.583, P < 0.001), serum BNP (rho = 0.514, P < 0.001), mPAP (rho = 0.583, P < 0.001), and PVR (rho = 0.575, P < 0.001). The improvement in the perfusion defect score was significantly associated with improvement in mPAP (rho = 0.844, P < 0.001).

Conclusion: Our results suggest that semi-quantitative analysis of lung perfusion SPECT/CT can provide a potential imaging biomarker for monitoring the efficacy of BPA.

Supplementary information: The online version contains supplementary material available at 10.1007/s13139-024-00858-1.

Keywords: Balloon pulmonary angioplasty; Chronic thromboembolic pulmonary hypertension; Pulmonary arterial pressure; Single photon emission computed tomography; Technetium Tc 99m aggregated albumin.

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