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A maximum of three pairs per patient, each composed of hyper- and hypo-attenuating areas of mosaic perfusion, were selected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Comparative analysis of the 86 selected pairs showed: (a) a higher frequency of ill-defined micronodules (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.008), lobular ground-glass opacities (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01) and haziness (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) in hypoattenuated areas; (b) there was no significant difference in the frequency of neovascularity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.43). Similar trends were observed in hypoattenuating areas of the 66 pairs studied in the 22 patients with central and peripheral CTEPH; an absence of ill-defined micronodules, lobular ground-glass opacities, and haziness in hyperattenuating areas was noticed in the 20 pairs studied in the 7 patients with peripheral CTEPH. Patients with a mean pulmonary artery pressure\u2009\u2264\u200942\u2009mmHg (i.e., the median value of mean pulmonary artery pressure) had 45 pairs compared, showing a higher frequency of ill-defined micronodules (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) and haziness (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) in hypoattenuated areas, together with a higher frequency of subpleural systemic-to-pulmonary anastomoses (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02). There were no statistical differences in the frequency of CT findings between hypo- and hyper-attenuating areas in the 41 pairs of patients with a mean pulmonary artery pressure\u2009&gt;\u200942\u2009mm\u2009Hg.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CT features suggestive of microvasculopathy were more frequent in areas of hypoperfusion, with a trend toward homogenization of CT findings in patients with severe PH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Question<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>Lung microvascular lesions play a crucial role in the origin of residual pulmonary hypertension after successful thromboendarterectomy, currently beyond the scope of imaging<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>The expected morphological abnormalities at the level of distal pulmonary circulation in CTEPH were found to be depictable in each zone of mosaic perfusion<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Clinical relevance<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>This study suggests that the high-spatial resolution of PCD-CT has the capability of approaching the complex pathophysiology of small-vessel disease in CTEPH, providing important information prior to therapeutic decisions<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Graphical Abstract<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-025-11561-w","type":"journal-article","created":{"date-parts":[[2025,4,18]],"date-time":"2025-04-18T13:52:31Z","timestamp":1744984351000},"page":"6369-6381","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Lung microvasculopathy in chronic thromboembolic pulmonary hypertension: high-resolution findings with photon-counting detector CT in 29 patients"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1944-4288","authenticated-orcid":false,"given":"Martine","family":"Remy-Jardin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain","family":"Duhamel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Delobelle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Fran\u00e7ois","family":"Bervar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Flohr","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacques","family":"Remy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,18]]},"reference":[{"key":"11561_CR1","doi-asserted-by":"publisher","first-page":"160112","DOI":"10.1183\/16000617.0112-2016","volume":"26","author":"G Simonneau","year":"2017","unstructured":"Simonneau G, Torbicki A, Dorfm\u00fcller P, Kim N (2017) The pathophysiology of chronic thromboembolic pulmonary hypertension. 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The remaining authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"One of the authors has significant statistical expertise (Pr Alain DUHAMEL is a former Head of Department of Biostatistics, Lille; he is a co-author of this paper).","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Written informed consent was waived by the Institutional Review Board.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was not required because CT examinations were part of the standard of care for PH patients.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"None of the subjects had been previously reported.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}