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Photon-counting computed tomography (PCCT) enables high-resolution assessment of perfusion, vasculature, and parenchyma in one scan, potentially improving diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare quantitative lobar lung perfusion between PCCT and V\/Q-SPECT in patients with suspected or confirmed CTEPH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      This retrospective single-centre study included twenty-three patients (ten females, thirteen males; mean age 67.9\u2009\u00b1\u200910.7 years). The median interval between PCCT and V\/Q-SPECT imaging was 3 days (range: 0\u201311 days). Lung perfusion was analysed on a lobar basis using PCCT-derived perfused blood volume (PBV) maps and V\/Q-SPECT perfusion images. Data were normalised using a\n                      <jats:italic>z<\/jats:italic>\n                      -score approach based on the 95% confidence interval. Lobar segmentation was performed with TotalSegmentator. Pearson correlation and Bland\u2013Altman analyses compared lobar and whole-lung perfusion metrics. Perfusion defect volumes were quantified from normalised maps.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Whole-lung perfusion correlated strongly between PCCT and V\/Q-SPECT (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.72,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Lobar correlations ranged from\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.62 to\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.85. PCCT yielded slightly higher perfusion values (mean PBV 0.50\u2009\u00b1\u20090.04) than V\/Q-SPECT (0.49\u2009\u00b1\u20090.09). Bland\u2013Altman analysis showed a bias of +0.015 (limits \u22120.13 to +0.16). Perfusion defect volumes correlated moderately (whole-lung\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.60, lobes\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.49\u20130.77,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PCCT-based perfusion imaging shows high concordance with V\/Q-SPECT in this cohort, supporting its feasibility as a single-modality tool for functional and anatomical lung evaluation in CTEPH.<\/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>PCCT perfusion may address the unmet need for a combined functional and anatomical evaluation of CTEPH in a single examination<\/jats:italic>\n                      .\n                    <\/jats:p>\n                    <jats:p>\n                      <jats:bold>\n                        <jats:italic>Findings<\/jats:italic>\n                      <\/jats:bold>\n                      <jats:italic>PCCT showed strong correlation with V\/Q-SPECT for lobar and whole-lung perfusion, with minimal bias and consistent quantitative agreement<\/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>PCCT enables simultaneous high-resolution assessment of perfusion, vasculature, and parenchyma, potentially improving diagnostic confidence and streamlining CTEPH work-up in clinical practice<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-026-12547-y","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T08:53:58Z","timestamp":1777020838000},"page":"7139-7151","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Photon-counting CT vs V\/Q SPECT for lobar perfusion quantification in chronic thromboembolic pulmonary hypertension"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3052-5945","authenticated-orcid":false,"given":"Matthias M. 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Wacker, and Hoen-oh Shin have received institutional grants from Siemens Healthineers.","order":2,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No complex statistical methods were necessary for this paper.","order":3,"name":"Ethics","label":"Statistics and biometry","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Written informed consent was obtained from all subjects (patients) in this study.","order":4,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"Institutional Review Board approval was obtained.","order":5,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"No study subjects or cohorts have been previously reported.","order":6,"name":"Ethics","label":"Study subjects or cohorts overlap","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"order":7,"name":"Ethics","label":"Methodology","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}}]}}