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The proportion of each component, its spatial heterogeneity (entropy), and center-to-periphery distribution of the attenuation were calculated and correlated with the findings on CTPA semi-quantitatively evaluated by radiologists and with clinical function tests.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n CTPA scans from 52 patients (mean age, 65.2\u2009\u00b1\u200913.0 years; 27 men) diagnosed with CTEPH were analyzed. An inverse correlation was observed between the proportion of normal parenchyma and brain natriuretic propeptide (proBNP, \u03c1\u2009=\u2009\u22120.485,\n p<\/jats:italic>\n \u2009=\u20090.001), mean pulmonary arterial\u00a0pressure (\u03c1\u2009=\u2009\u22120.417,\n p<\/jats:italic>\n \u2009=\u20090.002) and pulmonary vascular resistance (\u03c1\u2009=\u2009\u22120.556,\n p<\/jats:italic>\n \u2009<\u20090.0001), mosaic attenuation (\u03c1\u2009=\u2009\u22120.527,\n p<\/jats:italic>\n \u2009<\u20090.0001), perfusion centralization (\u03c1\u2009=\u2009\u22120.489,\n p<\/jats:italic>\n \u2009=\u2009< 0.0001), and right ventricular diameter (\u03c1\u2009=\u2009\u22120.451,\n p<\/jats:italic>\n \u2009=\u20090.001). The entropy of hyperemic parenchyma showed a positive correlation with the pulmonary wedge pressure (\u03c1\u2009=\u20090.402,\n p<\/jats:italic>\n \u2009=\u20090.003). The slope of center-to-periphery attenuation distribution correlated with centralization (\u03c1\u2009=\u2009\u22120.477,\n p<\/jats:italic>\n \u2009<\u20090.0001), and with proBNP (\u03c1\u2009=\u2009\u22120.463,\n p<\/jats:italic>\n \u2009=\u20090.002).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n This study validates an automated system that leverages Bayesian analysis to quantify the severity and distribution of perfusion changes in CTPA. The results show the potential of this method to support clinical evaluations of CTEPH by providing reproducible and objective measures.<\/jats:p>\n <\/jats:sec>\n \n Key Points<\/jats:title>\n \n \n Question<\/jats:italic>\n <\/jats:bold>\n This study introduces an automated method for quantifying the extent and spatial distribution of pulmonary perfusion abnormalities in CTEPH using variational Bayesian estimation<\/jats:italic>\n .\n <\/jats:p>\n \n \n Findings<\/jats:italic>\n <\/jats:bold>\n Quantitative measures describing the extent, heterogeneity, and distribution of perfusion changes demonstrate strong correlations with key clinical hemodynamic indicators<\/jats:italic>\n .\n <\/jats:p>\n \n \n Clinical relevance<\/jats:italic>\n <\/jats:bold>\n The automated quantification of perfusion changes aligns closely with radiologists\u2019 evaluations, delivering a standardized, reproducible measure with clinical relevance<\/jats:italic>\n .\n <\/jats:p>\n <\/jats:sec>\n \n Graphical Abstract<\/jats:title>\n <\/jats:sec>","DOI":"10.1007\/s00330-025-11678-y","type":"journal-article","created":{"date-parts":[[2025,5,28]],"date-time":"2025-05-28T17:05:13Z","timestamp":1748451913000},"page":"6996-7003","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Fully automated Bayesian analysis for quantifying the extent and distribution of pulmonary perfusion changes on CT pulmonary angiography in CTEPH"],"prefix":"10.1007","volume":"35","author":[{"given":"Vojtech","family":"Suchanek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Jakubicek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hrdlicka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matej","family":"Novak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucie","family":"Miksova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavel","family":"Jansa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Burgetova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2299-4707","authenticated-orcid":false,"given":"Lukas","family":"Lambert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,28]]},"reference":[{"key":"11678_CR1","doi-asserted-by":"publisher","first-page":"3618","DOI":"10.1093\/eurheartj\/ehac237","volume":"43","author":"M Humbert","year":"2022","unstructured":"Humbert M, Kovacs G, Hoeper MM et al (2022) 2022 ESC\/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). 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Ph.D. MBA.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript 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":"Lambert, Prof. M.D. M.S.C.S. Ph.D. MBA has significant statistical expertise.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"The Ethics Committee of the General University Hospital in Prague stated that the study required neither its approval nor informed consent (198\/22 S-IV).","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"The Ethics Committee of the General University Hospital in Prague stated that the study required neither its approval nor informed consent (198\/22 S-IV).","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No overlap with previous studies exists.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}