Development of a lung perfusion automated quantitative model based on dual-energy CT pulmonary angiography in patients with chronic pulmonary thromboembolism.

IF 4.5 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Insights into Imaging Pub Date : 2025-08-18 DOI:10.1186/s13244-025-02067-6

Linfeng Xi, Jianping Wang, Anqi Liu, Yifei Ni, Jie Du, Qiang Huang, Yishan Li, Jing Wen, Hongyi Wang, Shuai Zhang, Yunxia Zhang, Zhu Zhang, Dingyi Wang, Wanmu Xie, Qian Gao, Yong Cheng, Zhenguo Zhai, Min Liu

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引用次数: 0

Abstract

Objective: To develop PerAIDE, an AI-driven system for automated analysis of pulmonary perfusion blood volume (PBV) using dual-energy computed tomography pulmonary angiography (DE-CTPA) in patients with chronic pulmonary thromboembolism (CPE).

Materials and methods: In this prospective observational study, 32 patients with chronic thromboembolic pulmonary disease (CTEPD) and 151 patients with chronic thromboembolic pulmonary hypertension (CTEPH) were enrolled between January 2022 and July 2024. PerAIDE was developed to automatically quantify three distinct perfusion patterns-normal, reduced, and defective-on DE-CTPA images. Two radiologists independently assessed PBV scores. Follow-up imaging was conducted 3 months after balloon pulmonary angioplasty (BPA).

Results: PerAIDE demonstrated high agreement with the radiologists (intraclass correlation coefficient = 0.778) and reduced analysis time significantly (31 ± 3 s vs. 15 ± 4 min, p < 0.001). CTEPH patients had greater perfusion defects than CTEPD (0.35 vs. 0.29, p < 0.001), while reduced perfusion was more prevalent in CTEPD (0.36 vs. 0.30, p < 0.001). Perfusion defects correlated positively with pulmonary vascular resistance (ρ = 0.534) and mean pulmonary artery pressure (ρ = 0.482), and negatively with oxygenation index (ρ = -0.441). PerAIDE effectively differentiated CTEPH from CTEPD (AUC = 0.809, 95% CI: 0.745-0.863). At the 3-month post-BPA, a significant reduction in perfusion defects was observed (0.36 vs. 0.33, p < 0.01).

Conclusion: CTEPD and CTEPH exhibit distinct perfusion phenotypes on DE-CTPA. PerAIDE reliably quantifies perfusion abnormalities and correlates strongly with clinical and hemodynamic markers of CPE severity.

Trial registration: ClinicalTrials.gov, NCT06526468. Registered 28 August 2024- Retrospectively registered, https://clinicaltrials.gov/study/NCT06526468?cond=NCT06526468&rank=1 .

Critical relevance statement: PerAIDE is a dual-energy computed tomography pulmonary angiography (DE-CTPA) AI-driven system that rapidly and accurately assesses perfusion blood volume in patients with chronic pulmonary thromboembolism, effectively distinguishing between CTEPD and CTEPH phenotypes and correlating with disease severity and therapeutic response.

Key points: Right heart catheterization for definitive diagnosis of chronic pulmonary thromboembolism (CPE) is invasive. PerAIDE-based perfusion defects correlated with disease severity to aid CPE-treatment assessment. CTEPH demonstrates severe perfusion defects, while CTEPD displays predominantly reduced perfusion. PerAIDE employs a U-Net-based adaptive threshold method, which achieves alignment with and faster processing relative to manual evaluation.

Abstract Image

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基于双能CT肺血管造影的慢性肺血栓栓塞患者肺灌注自动定量模型的建立。

目的：开发PerAIDE，一种人工智能驱动的系统，用于使用双能计算机断层肺血管造影（DE-CTPA）自动分析慢性肺血栓栓塞（CPE）患者的肺灌注血容量（PBV）。材料和方法：在这项前瞻性观察研究中，在2022年1月至2024年7月期间，纳入了32例慢性血栓栓塞性肺病（CTEPD）患者和151例慢性血栓栓塞性肺动脉高压（CTEPH）患者。PerAIDE可以在DE-CTPA图像上自动量化三种不同的灌注模式——正常、减少和缺陷。两名放射科医生独立评估PBV评分。球囊肺血管成形术后3个月随访影像学。结果：PerAIDE与放射科医师的一致性高（类内相关系数= 0.778），分析时间显著缩短（31±3 s vs 15±4 min）。结论：CTEPD和CTEPH在DE-CTPA上表现出不同的灌注表型。PerAIDE可靠地量化灌注异常，并与CPE严重程度的临床和血流动力学标志物密切相关。试验注册：ClinicalTrials.gov, NCT06526468。注册于2024年8月28日-追溯注册，https://clinicaltrials.gov/study/NCT06526468?cond=NCT06526468&rank=1。关键相关性声明：PerAIDE是一种双能计算机断层肺血管造影（DE-CTPA）人工智能驱动系统，可快速准确地评估慢性肺血栓栓塞患者的灌注血容量，有效区分CTEPD和CTEPH表型，并与疾病严重程度和治疗反应相关。重点：右心导管明确诊断慢性肺血栓栓塞（CPE）是有创的。基于peraide的灌注缺陷与疾病严重程度相关，有助于cpe治疗评估。CTEPH表现为严重的灌注缺陷，而CTEPD主要表现为灌注减少。PerAIDE采用基于u - net的自适应阈值方法，实现了与人工评估的一致性和更快的处理速度。

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来源期刊

Insights into Imaging Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

7.30

自引率

4.30%

发文量

182

审稿时长

13 weeks

期刊介绍： Insights into Imaging (I³) is a peer-reviewed open access journal published under the brand SpringerOpen. All content published in the journal is freely available online to anyone, anywhere! I³ continuously updates scientific knowledge and progress in best-practice standards in radiology through the publication of original articles and state-of-the-art reviews and opinions, along with recommendations and statements from the leading radiological societies in Europe. Founded by the European Society of Radiology (ESR), I³ creates a platform for educational material, guidelines and recommendations, and a forum for topics of controversy. A balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes I³ an indispensable source for current information in this field. I³ is owned by the ESR, however authors retain copyright to their article according to the Creative Commons Attribution License (see Copyright and License Agreement). All articles can be read, redistributed and reused for free, as long as the author of the original work is cited properly. The open access fees (article-processing charges) for this journal are kindly sponsored by ESR for all Members. The journal went open access in 2012, which means that all articles published since then are freely available online.