ArticleEuropean radiology2026
Photon-counting CT vs V/Q SPECT for lobar perfusion quantification in chronic thromboembolic pulmonary hypertension.
Article in European radiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundVentilation/perfusion single-photon emission computed tomography (V/Q-SPECT) is the standard first-line imaging method for chronic thromboembolic pulmonary hypertension (CTEPH), but it lacks anatomical detail. Photon-counting computed tomography (PCCT) enables high-resolution assessment of perfusion, vasculature, and parenchyma in one scan, potentially improving diagnostic accuracy.
objectivesTo compare quantitative lobar lung perfusion between PCCT and V/Q-SPECT in patients with suspected or confirmed CTEPH. MATERIALS AND
methodsThis retrospective single-centre study included twenty-three patients (ten females, thirteen males; mean age 67.9 ± 10.7 years). The median interval between PCCT and V/Q-SPECT imaging was 3 days (range: 0-11 days). Lung perfusion was analysed on a lobar basis using PCCT-derived perfused blood volume (PBV) maps and V/Q-SPECT perfusion images. Data were normalised using a z-score approach based on the 95% confidence interval. Lobar segmentation was performed with TotalSegmentator. Pearson correlation and Bland-Altman analyses compared lobar and whole-lung perfusion metrics. Perfusion defect volumes were quantified from normalised maps.
resultsWhole-lung perfusion correlated strongly between PCCT and V/Q-SPECT (r = 0.72, p < 0.05). Lobar correlations ranged from r = 0.62 to r = 0.85. PCCT yielded slightly higher perfusion values (mean PBV 0.50 ± 0.04) than V/Q-SPECT (0.49 ± 0.09). Bland-Altman analysis showed a bias of +0.015 (limits -0.13 to +0.16). Perfusion defect volumes correlated moderately (whole-lung r = 0.60, lobes r = 0.49-0.77, p < 0.05).
conclusionPCCT-based perfusion imaging shows high concordance with V/Q-SPECT in this cohort, supporting its feasibility as a single-modality tool for functional and anatomical lung evaluation in CTEPH. KEY POINTS: Question PCCT perfusion may address the unmet need for a combined functional and anatomical evaluation of CTEPH in a single examination. Findings PCCT showed strong correlation with V/Q-SPECT for lobar and whole-lung perfusion, with minimal bias and consistent quantitative agreement. Clinical relevance PCCT enables simultaneous high-resolution assessment of perfusion, vasculature, and parenchyma, potentially improving diagnostic confidence and streamlining CTEPH work-up in clinical practice.
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