Diagnoses of pulmonary embolism from non-contrast 4DCT using image processing-derived quantitative perfusion scores

Computed tomography pulmonary angiography (CTPA) is the gold standard for pulmonary embolism (PE) diagnosis, but patients with iodinated contrast allergies or renal insufficiency are often ineligible. CT-derived perfusion (CTP) is a novel, non-contrast method to quantify pulmonary perfusion from an inhale/exhale CT image pair (4DCT). The resulting CT-P information can be used to identify hypo-perfused regions associated with PE. This pilot study introduces a thresholding approach that estimates the number of lung lobes with perfusion deficits according to optimally selected CTP thresholds. The number of lobes indicated as low-functioning provides a score to categorize patients as PE-positive, negative, or inconclusive. We trained and validated the model on a retrospective dataset of 123 suspected PE patients, achieving 72% accuracy, 75% sensitivity, and 69% specificity, with 17% of cases inconclusive. To our knowledge, this is the first PE diagnostic model from non-contrast 4DCT, showing the feasibility of non-contrast PE diagnosis strategies.