Comparison of ECG Saline-Conduction Technique and ECG Wire-Based Technique for Peripherally Inserted Central Catheter Insertion: A Randomized Controlled Trial.

(1) Background: The peripherally inserted central catheter (PICC) is commonly used in medicine. The tip position was shown to be a major determinant in PICC function and related complications. Recent advances in ECG guidance might facilitate daily practice. This study aimed to compare two ECG techniques, in terms of their tip-position accuracy, puncture site layout, and signal quality; (2) Methods: This randomized open study (1:1) included 320 participants. One PICC guidance technique used ECG signal transmission with saline (ST); the other technique used a guidewire (WT). Techniques were compared by the distance between the catheter tip and the cavoatrial junction (DCAJ) on chest X-rays, insertion-point hemostasis time, and the extracorporeal catheter length between the hub and the insertion point; (3) Results: The mean DCAJs were significantly different between ST (1.36 cm, 95% CI: 1.22-1.37) and WT (1.12 cm, 95% CI: 0.98-1.25; p = 0.013) groups. When DCAJs were classified as optimal, suboptimal, or inadequate, the difference between techniques had limited clinical impact (p = 0.085). However, the hemostasis time at the puncture site was significantly better with WT (no delay in 82% of patients) compared to ST (no delay in 50% of patients; p < 0.001). Conversely, ST achieved optimal and suboptimal extracorporeal lengths significantly more frequently than WT (100% vs. 66%; p < 0.001); (4) Conclusions: ECG guidance technologies achieved significantly different tip placements, but the difference had minimal clinical impact. Nevertheless, each technique displayed an important drawback at the PICC insertion point: the extracorporeal catheter was significantly longer with WT and the hemostasis delay was significantly longer with ST.

Diagnostic performance of angiography-derived fractional flow reserve in patients with NSTEMI.

Noninvasive methods of estimating invasively measured fractional flow reserve (FFRinvasive ) are actively being explored, aiming to avoid the use of an invasive pressure wire and the administration of hyperemia-inducing drugs. Coronary angiography-derived FFR (FFRangio ) has already demonstrated its diagnostic performance in the context of stable coronary artery disease. However, its applicability in the context of non-ST-segment elevation myocardial infarction (NSTEMI) has yet to be established. We sought to determine the diagnostic performance of FFRangio exclusively in patients presenting with NSTEMI. We performed a prospective, single-center, single-arm, double-blinded study comparing FFR calculated by FFRangio to FFRinvasive in NSTEMI patients. FFRinvasive was measured in all angiographically intermediate lesions (30%-70% stenosis) and was then compared to FFRangio which was calculated at the same position, by a blinded operator. The primary endpoints were the sensitivity and specificity of FFRangio for predicting FFRinvasive using a cut-off value of ≤0.80. Among 100 NSTEMI patients who were screened, 46 patients with 60 vessels in total underwent FFRinvasive and were included in the study. The mean value of FFRinvasive was 0.83 ± 0.3 with 22 (36%) being ≤0.80 while the mean FFRangio was 0.82 ± 0.1 with 22 (36%) being ≤0.80. FFRangio exhibited a sensitivity of 95.5%, a specificity of 97.4%, and a diagnostic accuracy of 96.7%. FFRangio can precisely and noninvasively estimate FFRinvasive in acute coronary syndromes and may have a role in guiding treatment decisions related to angiographically intermediate coronary lesions in this context. WHAT IS KNOWN: FFRangio has demonstrated its diagnostic performance in validation studies, as a noninvasive and cost-effective method in the context of stable coronary artery disease but its performance has never been exclusively evaluated in NSTEMI patients. WHAT IS NEW: The present prospective single-center study demonstrates the excellent diagnostic performance of FFRangio in detecting functionally significant coronary artery stenosis in the setting of NSTEMI, providing more confidence in utilizing FFRangio in this population, avoiding the risk of an invasive pressure wire and the administration of hyperemia-inducing drugs. WHAT IS NEXT: Future randomized trials evaluating FFRangio -guided treatment of coronary artery disease (stable or ACS) are now needed to definitively establish the role of FFRangio in the physiological assessment of coronary lesions.

Appropriateness of Replacing Fluoroscopic Guidance With ECG-Electromagnetic Guidance for PICC Insertion: A Randomized Controlled Trial.

OBJECTIVE. Coupled ECG-electromagnetic (EM) guidance shows promise for use in placement of peripherally inserted central catheters (PICCs) when compared with the classic blind technique. However, ECG-EM guidance has not been appropriately compared with the reference standard of fluoroscopy (FX) guidance. Here, we aimed to compare ECG-EM guidance with FX guidance with regard to the final tip position of PICCs. SUBJECTS AND METHODS. A total of 120 patients (age range, 19-94 years) referred for PICC placement were randomized to the ECG-EM or FX group. All interventions were performed by PICC team members who had the same standardized training and experience. Final tip position was assessed using chest radiography and was classified as optimal, suboptimal, or inadequate requiring repositioning on the basis of the distance from the PICC tip to the cavoatrial junction (CAJ). Statistical analyses were performed using the Mann-Whitney U test for final catheter tip position (mean distance from CAJ) and Fisher and chi-square tests for proportions. RESULTS. PICCs were successfully inserted in 118 patients (53 men and 65 women). Catheter tip positions were optimal or suboptimal in 100% of the FX group and 77.2% of the ECG-EM group. Furthermore, precision of placement was significantly better (p = .004) in the FX group (mean distance from the PICC tip to the CAJ = 0.83 cm) than in the ECGEM group (mean distance from the PICC tip to the CAJ = 1.37 cm). Thirteen (22.8%) of the PICCs placed using ECG-EM guidance, all of which were inserted from the left side, were qualified as inadequate requiring repositioning and required another intervention. CONCLUSION. Our results revealed significant differences in final tip position between the ECG-EM and FX guidance techniques and indicate that ECG-EM guidance cannot appropriately replace FX guidance among unselected patients. However, ECGEM guidance could be considered as an acceptable technique for patients in whom the PICC could be inserted from the right side. TRIAL REGISTRATION. ClinicalTrials.gov NCT03652727.

Total Endovascular Repair of Post-Trauma Ascending Aortic Pseudoaneurysm and Secondary Superior Vena Cava Syndrome.

BACKGROUND: Clavicular fracture or sternoclavicular luxation is observed in 10% of all polytrauma patients and is frequently associated with concomitant intrathoracic life-threatening injuries. Posterior sternoclavicular luxation is well known to induce underlying great vessels damage. The gold standard treatment usually is a combined orthopedic and cardiovascular surgical procedure associating vascular repair, clavicular open reduction, and internal fixation. METHODS: A 59-year-old wheelchair ridden, institutionalized woman, known for psychiatric disorder, severe scoliosis, malnutrition, and chronic obstructive pulmonary disease was admitted in our hospital for chronic chest pain 3 months after a stairway wheelchair downfall. A thoracic computed tomography (CT) scan revealed a voluminous ascending aortic pseudoaneurysm (63 × 58 mm, orifice 5 mm) consecutive to perforation following posterior sternoclavicular luxation. The patient refused all therapies and was lost to follow-up. Six months later, she was readmitted for a symptomatic superior vena cava syndrome. Thoracic CT scan revealed pseudoaneurysm growth with innominate vein thrombosis and superior vena cava subocclusion. Pseudoaneurysm orifice was stable. In the presence of symptoms with massive facial edema and inability to open her eyelids, the patient accepted an endovascular treatment. RESULTS: The procedure was performed under general anesthesia using both fluoroscopic and transesophageal echocardiographic guidance. Through a femoral arterial access, a 10-mm atrial septal defect occluder device was used to seal successfully the pseudoaneurysm orifice. The superior vena cava was then opened with a 26-mm nitinol high radial force stent through a femoral venous access. Postoperative course was uneventful. At 3-month follow-up, the patient remains symptom free and a CT scan confirmed pseudoaneurysm thrombosis and superior vena cava permeability. CONCLUSION: Post-traumatic sternoclavicular posterior luxation is a cause of great vessels and ascending aorta injuries. Minimally invasive endovascular approaches can be considered to treat vascular injuries and their consequences, especially in elderly patients and those at high risk for surgery.

[Cardiac CT in cardiology in 2019†: major role and extended applications]. / CT-scan en cardiologie en 2019†: un rôle central et des applications étendues.

This article aims to clarify the value of cardiac CT as well as its new applications in the different areas of cardiology for both diagnosis and pretreatment evaluation, including stable coronary artery disease, acute coronary syndrome, valvular disease and the functional and morphological evaluation of the heart.

Cet article a pour objectif de préciser l'intérêt du CT-scan cardiaque et de ses nouvelles applications dans les différents domaines de la cardiologie aussi bien pour le diagnostic que pour l'évaluation préthérapeutique, notamment la maladie coronarienne stable, le syndrome coronarien aigu, les maladies valvulaires ainsi que l'évaluation fonctionnelle et morphologique du cœur.

Percutaneous endovascular management of chronic superior vena cava syndrome of benign causes : long-term follow-up.

BACKGROUND: The vast majority of superior vena cava (SVC) syndromes are of malignant causes, but with growing use of indwelling central catheters and implanted cardiac devices, benign SVC syndromes are becoming more frequent. The main objective of this study is to evaluate long term outcome in patients treated for benign SVC syndrome by endovascular techniques. METHODS: Forty-four patients, 26 men and 18 women, mean age 56, treated for benign SVC syndrome using endovascular techniques between 2002 and 2015 were included. Type of obstruction was classified according to the site of disease and degree of occlusion. Complications and recurrence of symptoms were analyzed. RESULTS: Technical and clinical success were achieved in all but one patient. Four patients (9 %) were treated by angioplasty alone and 40 (91 %) required stent implantation. Mean clinical follow-up was 1275 days. Nine patients had at least one episode of recurrence after a mean of 385 days. Four minor and two major complications were reported. CONCLUSION: Percutaneous endovascular techniques to treat benign SVC syndrome are safe with good long term patency. Recurrence of symptoms can easily be addressed by repeat procedure. KEY POINTS: • Malposition of indwelling central catheter can cause superior vena cava obstruction. • Image-guided catheter placement helps prevent superior vena cava obstruction. • Imaging and superior vena cava obstruction classification allows adequate procedure planning. • Endovascular techniques are safe and effective for superior vena cava syndrome treatment.

Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial.

OBJECTIVES: To demonstrate non-inferiority of iobitridol 350 for coronary CT angiography (CTA) compared to higher iodine content contrast media regarding rate of patients evaluable for the presence of coronary artery stenoses. METHODS: In this multicentre trial, 452 patients were randomized to receive iobitridol 350, iopromide 370 or iomeprol 400 and underwent coronary CTA using CT systems with 64-detector rows or more. Two core lab readers assessed 18 coronary segments per patient regarding image quality (score 0 = non diagnostic to 4 = excellent quality), vascular attenuation, signal and contrast to noise ratio (SNR, CNR). Patients were considered evaluable if no segment had a score of 0. RESULTS: Per-patient, the rate of fully evaluable CT scans was 92.1, 95.4 and 94.6 % for iobitridol, iopromide and iomeprol, respectively. Non-inferiority of iobitridol over the best comparator was demonstrated with a 95 % CI of the difference of [-8.8 to 2.1], with a pre-specified non-inferiority margin of -10 %. Although average attenuation increased with higher iodine concentrations, average SNR and CNR did not differ between groups. CONCLUSIONS: With current CT technology, iobitridol 350 mg iodine/ml is not inferior to contrast media with higher iodine concentrations in terms of image quality for coronary stenosis assessment. KEY POINTS: • Iodine concentration is an important parameter for image quality in coronary CTA. • Contrast enhancement must be balanced against the amount of iodine injected. • Iobitridol 350 is non-inferior compared to CM with higher iodine concentrations. • Higher attenuation with higher iodine concentrations, but no SNR or CNR differences.

Does spontaneous remission occur in polyarteritis nodosa?
.

BACKGROUND: Polyarteritis nodosa (PAN) is a systemic vasculitis involving mainly medium-sized arteries and, rarely, small-sized arteries. The diagnosis is principally based on clinical exams, biopsy of an affected organ, and/or arteriography of renal or mesenteric arteries. Once diagnosed, immunosuppressive agents, such as glucocorticoids and cyclophosphamide, are generally introduced as soon as possible. Whether spontaneous remission of PAN occurs is therefore largely unknown. PRESENTATION: We describe the case of a 51-year-old woman who presented with a 4-day-history of intense pain in her left flank, hypertension, fever, microscopic hematuria, and acute renal failure. Contrast-enhanced renal ultrasound strongly suggested bilateral renal infarction. Medical history and an extensive workup allowed to exclude systemic embolism, recreational drug abuse, cardiac arrhythmias, and thrombophilia. A possible diagnosis of PAN was considered; however, within 2 weeks of admission, spontaneous remission of her clinical and biological symptoms occurred without the use of any immunosuppressive treatment. Finally, 3 months later, renal arteriography confirmed the diagnosis of PAN. The patient remains free of symptoms 1 year after initial presentation. CONCLUSION: This case illustrates the importance of considering PAN in the differential diagnosis of renal infarction with inflammatory syndrome and shows that spontaneous remission of renal PAN can occur.
.

[Deep vein thrombosis in uncommon localisations]. / Thromboses veineuses profondes de localisation inhabituelle.

Venous thromboembolism (VTE) with its two components, deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common disease with an incidence of 0,75­2,69/1000. Deep vein thrombosis is localized in unusual sites in about 10 %, and rare DVT's have specific symptoms and risk factors. Uncommon DVT's are often related to local factors, inflammation, cancer, hematologic diseases and thrombophilia. Their diagnostic workup is less straightforward than in suspected VTE of lower limbs and PE, and rare DVT's are often unexpected findings of imaging studies. By extrapolating evidence of lower limbs VTE, most rare DVT are treated by anticoagulants, except retinal vein thrombosis. However, evidence for the type and duration of anticoagulation is limited.

La maladie thromboembolique veineuse avec ses deux facettes, la thrombose veineuse profonde et l'embolie pulmonaire (EP), est fréquente (incidence 0,75­2,69 ‰). Environ 10 % des thromboses ont des localisations inhabituelles et sont caractérisées par des symptômes et étiologies spécifiques. Les thromboses rares sont souvent liées à des facteurs locaux, inflammatoires, des néoplasies, des maladies hématologiques ou une thrombophilie. La démarche diagnostique est moins standardisée par rapport à celle pour les thromboses des membres inférieurs et souvent il s'agit de découvertes fortuites d'imagerie. Avec l'exception de la thrombose rétinienne, une anticoagulation thérapeutique est instaurée dans la majorité des cas, en analogie au traitement des autres thromboses, cependant avec un faible niveau d'évidence quant au choix et à la durée de l'anticoagulation.

[Rare vascular diseases, building dedicated multidisciplinary specialized center]. / Maladies vasculaires rares, mise en place d'un centre multidisciplinaire spécialisé au CHUV.

Rare Vascular Diseases (RVD) encompass different types of vessel involvement. Some cause a dilation, others a weakening or tortuosity of the arterial wall, others an obstruction or excessive calcification of arterial walls. Clinical pathway of patients with RVD to diagnosis is often long and complex. Thus, in order to allow early diagnosis and coordinated multidisciplinary management and follow-up, a specialized RVD centre has been set-up at the CHUV, following the framework of the national concept of rare diseases.

Les maladies vasculaires rares (MVR) englobent différents types d'atteintes des vaisseaux. Certaines engendrent une dilatation ou une tortuosité de la paroi artérielle, d'autres une fragilisation de la paroi, d'autres encore entraînent une obstruction du vaisseau, une calcification excessive des parois, ou des malformations vasculaires. Comme pour toutes les maladies rares, le parcours des patients vers un diagnostic est souvent long et complexe. Afin de permettre un diagnostic le plus précoce possible, ainsi qu'un suivi coordonné et une prise en charge multidisciplinaire médicale et sociale, un centre des MVR a été mis en place au CHUV, dans le cadre du concept national des maladies rares.

[Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome): clinical manifestations and multidisciplinary management]. / Maladie de Rendu-Osler. Manifestations cliniques et prise en charge multidisciplinaire.

Hereditary hemorrhagic telangiectasia (HHT), or Osler- Weber-Rendu syndrome, is a rare genetic disorder with autosomal dominant inheritance, characterized by recurrent epistaxis, mucocutaneous telangiectasia and visceral arteriovenous malformations (AVMs), which may lead to severe complications. The diagnosis of HHT is often delayed due to the rarity of the disease, and the variety of clinical manifestations. The management of HHT includes systematic screening for visceral AVMs at regular intervals, preventive interventions to reduce the risk of complications, and symptomatic measures. A multidisciplinary standardized program in specialised centers may improve the management of patients with HHT.

Tortuosity in non-atherosclerotic vascular diseases is associated with age, arterial aneurysms, and hypertension.

BACKGROUND: Increased arterial tortuosity has been associated with various cardiovascular complications. However, the extent and role of arterial tortuosity in non-atherosclerotic vascular diseases remain to be fully elucidated. This study aimed to assess arterial tortuosity index (ATI) in patients with non-atherosclerotic vascular diseases and the associated factors. METHODS: This is a retrospective analysis of patients with non-atherosclerotic vascular diseases referred to the Malformation and Rare Vascular Disease Center at the University Hospital in Lausanne (Switzerland). Computed tomography angiography (CTA) images performed between October 2010 and April 2022 were retrieved and the aortic tortuosity index (ATI) was calculated. Patients were classified based on diagnosis into the following groups: arterial dissection & aneurysm, arteritis & autoimmune disease, hereditary connective tissue diseases, and fibromuscular dysplasia (FMD). Univariate and multivariate logistic regression analysis was used to determine potentially relevant predictors of aortic tortuosity. RESULTS: The mean age upon computed tomography angiography (CTA) was 46.8 (standard deviation [SD] 14.6) years and 59.1% of the patients were female. Mean ATI was higher in patients over 60 years old (1.27), in those with arterial aneurysms (mean: 1.11), and in those diagnosed with hypertension (mean: 1.13). When only patients over 60 years old were considered, those diagnosed with connective tissue diseases had the highest ATI. At multivariate regression analysis, increasing age (p < 0.05), presence of arterial aneurysms (p < 0.05), and hypertension (p < 0.05) were independently associated with ATI. CONCLUSIONS: The ATI may be a promising tool in diagnostic evaluation, cardiovascular risk stratification, medical or surgical management, and prognostic assessment in several non-atherosclerotic vascular conditions. Further studies with longitudinal design and larger cohorts are needed to validate the role of ATI in the full spectrum of vascular diseases.

[Popliteal artery aneurysms: management in 2013]. / Anévrismes de l'artère poplitée: quelle prise en charge en 2013?

Although rare, popliteal artery aneurysms are the most common peripheral aneurysms and are frequently associated with abdominal aorta aneurysms. They are often bilateral. One third of patients are asymptomatic at diagnosis, with an insidious evolution. Symptomatic patients may present with symptoms of either acute ischemia or chronic ischemia, or rarely compression or rupture. Surgical exclusion of aneurysm followed by venous bypass remains the treatment of choice. Endovascular treatment is an attractive alternative currently reserved for patients at high risk, with good anatomical criteria. Elective treatment before symptoms onset is preferable given the best results in terms of patency and complications. A conservative approach is allowed for small aneurysms without major embolic risk provided careful monitoring by ultrasound.

Virtually Augmented Self-Hypnosis in Peripheral Vascular Intervention: A Randomized Controlled Trial.

PURPOSE: Hypnosis is useful for diminishing distress during medical procedures. This study investigated the efficacy of virtually augmented self-hypnosis as an adjunctive non-pharmacological method for procedural pain and anxiety relief during endovascular interventions (EVI). METHODS: We compared an immersive distraction experience (clinicaltrials.gov identifier NCT04561596) featuring virtual reality (VR) using a head-mounted display versus treatment as usual (TAU). Patients followed the "Aqua" module (Oncomfort™) consisting of a scuba dive and breathing exercises. They experienced a self-induced dissociative state similar to clinical hypnosis without direct intervention of a professional. Enrollment followed a 1:1 randomized open study (VR or TAU). Patients' feelings were evaluated just before and after the procedure, and 3 months following intervention. Anxiety was evaluated using the State Trait Anxiety Inventory (STAI) and pain (sensory, emotional, and memory) with a visual analogue scale (VAS). RESULTS: This study included 100 patients. Mean anxiety (pre-post) was significantly reduced within groups and between groups (difference of 4.2 points, p = 0.016). The percentage of responders to anxiety lowering were 76 and 46% for VR and TAU, respectively (p = 0.004). The two groups did not significantly differ in mean sensory-intensity and affective emotional pain (pre-post) using VAS, in negative memories concerning remembered pain at 3 months (difference > 1 from immediate post-procedural reported pain intensity), mean procedural time, or the need for analgesic or sedative drugs. CONCLUSIONS: VR self-hypnosis has the potential to improve the management of patients' distress during radiological procedures. It is safe and effective for reducing anxiety during EVI.

Nonthrombotic pulmonary embolism.

OBJECTIVE: The purpose of this essay is to highlight the clinical features and imaging findings associated with different types of nonthrombotic pulmonary embolism. CONCLUSION: Nonthrombotic pulmonary embolism is an infrequent condition with various causes that can be life-threatening pathologic conditions. The entity presents a diagnostic challenge because of the low specificity of clinical symptoms and imaging signs. Awareness of the imaging features of nonthrombotic pulmonary embolism facilitates correct diagnosis and leads to appropriate patient care.

Three-Dimensional Adaptive Image Compression Concept for Medical Imaging: Application to Computed Tomography Angiography for Peripheral Arteries.

Advances in computed tomography (CT) have resulted in a substantial increase in the size of datasets. We built a new concept of medical image compression that provides the best compromise between compression rate and image quality. The method is based on multiple contexts and regions-of-interest (ROI) defined according to the degree of clinical interest. High priority areas (primary ROIs) are assigned a lossless compression. Other areas (secondary ROIs and background) are compressed with moderate or heavy losses. The method is applied to a whole dataset of CT angiography (CTA) of the lower extremity vasculature. It is compared to standard lossy compression techniques in terms of quantitative and qualitative image quality. It is also compared to standard lossless compression techniques in terms of image size reduction and compression ratio. The proposed compression method met quantitative criteria for high-quality encoding. It obtained the highest qualitative image quality rating score, with a statistically significant difference compared to other methods. The average compressed image size was up to 61% lower compared to standard compression techniques, with a 9:1 compression ratio compared with original non-compressed images. Our new adaptive 3D compression method for CT images can save data storage space while preserving clinically relevant information.

Computed tomography reference dimensions for identification of stented surgical mitral bioprostheses valve size.

BACKGROUND: Selection of the transcatheter heart valve size for a mitral valve-in-valve procedure is based on the type and manufacturer's labelled size. However, accurate information of surgical heart valve (SHV) size may not be available in the patient's medical record. The purpose of this study is to establish reference data for computed tomography (CT) dimensions of commonly used mitral SHV in order to determine the manufacturer's labelled size from a cardiac CT data set. METHODS: CT datasets of 105 patients with surgical mitral bioprosthesis and available manufacturer labeled datasets were included in the analysis. CT derived valve dimensions were assessed by two observers using multiplanar reformats aligned with the basal sewing ring. A circular region of interest was used in a standardized fashion to minimize influence of image acquisition and reconstruction parameters. Interobserver variability was assessed by Bland-Altman analysis. RESULTS: The CT-derived dimensions were stratified by valve size and type, and SHV properties were demonstrated for 5 common valve types. Variability of measurements was small and inter-observer limits of agreement were narrow. Stratified by SHV type, no overlap was noted for CT-derived dimensions among different SHV sizes . A reference table of CT characteristics of surgical mitral bioprosthesis types was created. CONCLUSION: The study provides reference CT data for determining the manufacturers' labeled SHV size across a range of commonly used mitral SHVs. The findings will be important to help identify types of surgical mitral bioprosthesis utilizing CT characteristics for patients without SHV size documentation.

Pulmonary Blood Volume Measured by Dual-Energy Computed Tomography Can Help Distinguish Patients With Pulmonary Hypertension.

Purpose: To evaluate the correlation between whole lung enhancement (WLE) and pulmonary blood volume (PBV) obtained through dual energy computed tomography pulmonary angiography (DECTPA) and echocardiography-derived systolic pulmonary arterial pressure (SPAP). Methods: Sixty-eight patients who underwent DECTPA were enrolled in the study after giving informed consent. A transthoracic echocardiography was performed for all the subjects within 48 h of their DECTPA study to measure SPAP. The correlation of the two DECTPA-derived parameters, WLE and PBV, with SPAP was assessed. In addition, the predictive strength of these parameters was compared with that of traditional computed tomography (CT) signs of pulmonary hypertension (PH). Results: The SPAP value showed a moderate correlation with main pulmonary artery (MPA) diameter (r = 0.48, P < 0.001), while having a weak correlation with WLE (r = -0.33, P = 0.007), PBV (r = -0.31, P = 0.01) and MPA/ascending aorta (MPA/AA) ratio (r = 0.26, P = 0.03). On regression analysis, MPA diameter (B ± SE: 1.8 ± 0.6, P = 0.004) and WLE (B ± SE: -0.5 ± 0.3, P = 0.042) had significant association with SPAP. In addition, SPAP ≥30 mmHg was related to the right to left ventricular diameter (RV/LV) ratio [OR (CI 95%): 24.39 (1.3-573.2), P = 0.04] and reversely associated with PBV [OR (CI 95%): 0.96 (0.93-0.98), P = 0.005]. Acquired cutoff value of 83% for PBV showed sensitivity and specificity of 73% to identify SPAP ≥30 mmHg [AUC (CI 95%):0.727 (0.588-0.866), P = 0.008]. Conclusions: Automated postprocessing calculation of iodine distribution analysis by DECTPA could be considered as an adjunctive tool to investigate for PH.