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Objectives: Lung perfusion blood volume (PBV) using dual-energy computed tomography has recently become an accepted technique for diagnosing pulmonary thromboembolism. We evaluated the correlation among lung PBV, single-photon emission computed tomography (SPECT) and catheter pulmonary angiography images in patients with chronic thromboembolic pulmonary hypertension (CTEPH) before and after balloon pulmonary angioplasty (BPA)., Methods: In total, 17 patients and 57 sessions were evaluated with the three modalities. Segmental lung perfusion and its improvement in lung PBV and SPECT were compared with catheter pulmonary angiography as the reference standard before and after BPA., Results: The sensitivity for detecting segmental perfusion defects using SPECT and lung PBV was 85% and 92%, the specificity was 99% and 99%, the accuracy was 92% and 95%, the positive predictive value was 99% and 99%, and the negative predictive value was 88% and 93%. The sensitivity for detecting segmental perfusion improvement using SPECT and lung PBV was 61% and 69%, the specificity was 75% and 83%, the accuracy was 62% and 70%, the positive predictive value was 97% and 98%, and the negative predictive value was 12% and 16%., Conclusions: Lung PBV is a useful technique for evaluation of segmental lung perfusion and its improvement in patients with CTEPH., Key Points: • BPA is a new treatment for patients with CTEPH. • Lung PBV images may be more sensitive for pulmonary blood flow. • The current work demonstrates that Lung PBV images are useful in evaluating patients with CTEPH. • The current work demonstrates that Lung PBV is useful in gauging the treatment effect of BPA.

Inflammatory abdominal aortic aneurysm (IAAA) is characterized by inflammatory and/or fibrotic changes in the periaortic regions of the retroperitoneum. Surgical repair is usually selected for this disease. However, the perioperative mortality associated with open surgical repair of IAAs is three times higher than that with noninflammatory aortic aneurysms due to inflammation and periaortic fibrosis (PAF). Endovascular aneurysm repair of IAAs excludes the aneurysm and seems to reduce the size of the aneurysmal sac and the extent of PAF with acceptable peri-interventional and long-term morbidity. We describe the successful endovascular repair of an IAAA and the serial CT findings after repair.

The purpose was to evaluate CT findings of hemorrhage extending along the pulmonary artery (PA) due to ruptured aortic dissection (AD) and its prognostic factors. In 232 patients with Stanford type A AD, 21 patients (9.1%; 11 women; mean 70.3 years) were diagnosed. Twelve patients had double-barreled (classic) AD, and nine patients had intramural hematoma (IMH; closed false lumen) of the aorta. Based on CT findings, hemorrhage was classified into three categories as follows: category 1 (IMH of the PA or blood localized around the PA), category 2 (extending into the interlobular septa), and category 3 (extending into the alveoli). The factors influencing prognosis, including CT features and patient characteristics, were evaluated. Fourteen (66.7%) of the 21 patients underwent emergency surgery, and 8 (38.1%) patients died within 72 h of onset. Twelve cases (57.1%) were classified into category 1, 2 cases (9.5%) into category 2, and 7 cases (33.3%) into category 3. Double-barreled AD and category 3 hemorrhage were significant risk factors for death in univariate analyses. In multivariate analyses, the presence of category 3 hemorrhage was the only significant risk factor for death. CT findings indicative of a poor prognosis include double-barreled type AD and category 3 hemorrhage.

To determine the clinical efficacy of contrast-enhanced magnetic resonance (MR) perfusion imaging in the diagnosis of perfusion abnormality in the pulmonary artery (PA) in Takayasu's arteritis (TA). Twenty-one patients were evaluated. Pulmonary MR perfusion images were acquired using a 2-dimensional (2D) fast spoiled gradient echo sequence with single-slice technique (TR/TE, 5.3/1.3; flip angle, 30 degrees; receiver bandwidth, 31.2 kHz/pixel; acquisition time, 0.7 s; and total acquisition time, 49 s). Seventy continuous subtracted MR images were evaluated, and the presence of perfusion abnormality was determined in lobe-based (n=126) and patient-based (n=21) analyses. Sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV) were calculated using perfusion scintigraphy as a standard reference. For lobe-based analysis, sensitivity was 91.7-95.8%, specificity was 92.2-93.7%, and PPV and NPV were 73.3-76.7% and 97.9-99.0%, respectively. For patient-based analyses, sensitivity was 100%, specificity was 72.7%, and PPV and NPV were 76.9% and 100%, respectively. Kappa values for each analysis were between 0.78-1.00. In conclusion, MR perfusion imaging appears to be a valuable, noninvasive method to estimate PA involvement in patients with TA.

We describe computed tomographic (CT) findings at the early stage of infected abdominal aortic aneurysm in three patients. Periaortic mass and increased fat density were the characteristic findings of early aortic infection on CT. Similar findings caused by other diseases may be difficult to differentiate by imaging alone, but these findings should be used to trigger close follow-up for patients with suspected infected abdominal aortic aneurysm.

We describe a patient with Behçet's disease who developed multiple aneurysms and retroperitoneal hemorrhage due to rupture of a renal artery aneurysm. Despite successful transcatheter arterial embolization, the patient died due to pneumonia. Our retrospective review of the case revealed that the CT scan obtained 3 months before the rupture had demonstrated dilatation of bilateral renal arteries.