Diagnostic Value of Dual-input Computed Tomography Perfusion on Detecting Bronchial-Pulmonary Artery Fistula in Tuberculosis Patients with Massive Hemoptysis

• Published in: Academic radiology Vol. 25; no. 8; p. 1018
• Main Authors: Qu, Haixian, Wang, Maoqiang, Wang, Zhijun, Ao, Guokun, Yuan, Xiaodong, Li, Qiang, Ma, Zepeng, Xu, Qianru, Yan, Jieyu, Bai, Yanhua
• Format: Journal Article
• Language: English
• Published: United States 01.08.2018
• Subjects: Adolescent; Adult; Aged; Angiography, Digital Subtraction; Bronchial Arteries - diagnostic imaging; Bronchial Fistula - diagnostic imaging; Bronchial Fistula - microbiology; Female; Hemoptysis - microbiology; Humans; Lung - blood supply; Lung - diagnostic imaging; Male; Middle Aged; Prospective Studies; Pulmonary Artery - diagnostic imaging; ROC Curve; Sensitivity and Specificity; Tomography, X-Ray Computed - methods; Tuberculosis, Pulmonary - complications; Vascular Fistula - diagnostic imaging; Vascular Fistula - microbiology; dual-input computed tomography perfusion; bronchial circulation; Tuberculosis; hemoptysis; pulmonary circulation
• ISSN: 1878-4046
• DOI: 10.1016/j.acra.2017.12.013

This prospective study aimed to evaluate the diagnostic performance of dual-input computed tomography perfusion technique (DI-CTP) in identifying the bronchial-pulmonary artery fistula in patients tuberculosis with massive hemoptysis. Twenty patients with tuberculosis with massive hemoptysis were enrolled from January 2015 to December 2015. The association between DI-CTP parameters and the diagnostic outcomes of digital subtraction angiography was assessed. Diagnostic efficacy of DI-CTP was evaluated by receiver operating curve (ROC) analyses using the diagnostic outcomes of digital subtraction angiography, which is the gold standard for identifying bronchial-pulmonary artery fistula. Compared to lung segments with normal blood flow (n = 304), those with bronchial-pulmonary artery fistula (n = 164) had a reduced pulmonary flow value, perfusion index (PI) value, and an elevated bronchial artery (BF) value in the DI-CTP scan, which was further confirmed by multivariate logistic regression. ROC analysis showed that PI and bronchial artery has an excellent diagnostic performance (both area under the ROC curve > 0.9, P < .001) and high sensitivity and specificity (from 0.79 to 0.95 at the optimal cutoff). PI has the best diagnostic performance, with an overall diagnostic accuracy of 0.91. DI-CTP scan possesses the diagnostic value for detecting bronchial-pulmonary artery fistula in patients with tuberculosis with massive hemoptysis, providing an alternative diagnostic method.