Three-dimensional fractal analysis of 99mTc-MAA SPECT images in chronic thromboembolic pulmonary hypertension for evaluation of response to balloon pulmonary angioplasty: association with pulmonary arterial pressure. Issue 6 (June 2017)

• Record Type: Journal Article
• Authors: Maruoka, Yasuhiro; Nagao, Michinobu; Baba, Shingo; Isoda, Takuro; Kitamura, Yoshiyuki; Yamazaki, Yuzo; Abe, Koichiro; Sasaki, Masayuki; Abe, Kohtaro; Honda, Hiroshi
• Is Part Of: Nuclear medicine communications. Volume 38:Issue 6(2017:Jun.)
• Publication Date: 2017-06
• Subjects: 99mTc-MAA SPECT -- balloon pulmonary angioplasty -- chronic thromboembolic pulmonary hypertension -- fractal analysis; Nuclear medicine -- Periodicals; 616.07575
• DOI: 10.1097/MNM.0000000000000673
• Languages: English
• ISSNs: 0143-3636

Abstract

Abstract : Objective: Balloon pulmonary angioplasty (BPA) is used for inoperable chronic thromboembolic pulmonary hypertension (CTEPH), but its effect cannot be evaluated noninvasively. We devised a noninvasive quantitative index of response to BPA using three-dimensional fractal analysis (3D-FA) of technetium-99m-macroaggregated albumin ( 99m Tc-MAA) single-photon emission computed tomography (SPECT). Patients and methods: Forty CTEPH patients who underwent pulmonary perfusion scintigraphy and mean pulmonary arterial pressure (mPAP) measurement by right heart catheterization before and after BPA were studied. The total uptake volume (TUV) in bilateral lungs was determined from maximum intensity projection 99m Tc-MAA SPECT images. Fractal dimension was assessed by 3D-FA. Parameters were compared before and after BPA, and between patients with post-BPA mPAP more than 30 mmHg and less than or equal to 30 mmHg. Receiver operating characteristic analysis was carried out. Results: BPA significantly improved TUV (595±204–885±214 ml, P <0.001) and reduced the laterality of uptake (238±147–135±131 ml, P <0.001). Patients with poor therapeutic response (post-BPA mPAP≥30 mmHg, n =16) showed a significantly smaller TUV increase ( P =0.044) and a significantly greater post-BPA fractal dimension ( P <0.001) than the low-mPAP group. Fractal dimension correlated with mPAP values before and after BPA ( P =0.013 and 0.001, respectively). A post-BPA fractal dimension threshold of 2.4 distinguished between BPA success and failure with 75% sensitivity, 79% specificity, 78% accuracy, and area under the curve of 0.85. Conclusion: 3D-FA using 99m Tc-MAA SPECT pulmonary perfusion scintigraphy enables a noninvasive evaluation of the response of CTEPH patients to BPA.