CTPA was acquired using multidetector row CT scanners with light speed 16 row- detectors and a high definition 64 row-detector (GE health care) using 8x 12 mm collimation and 2.5 mm reconstruction. A bolus of 100 ml nonionic iodinated contrast medium (300 mg/ml) was administrated at 4 ml/s via peripheral cannula with a variable start time that was determined using atomic bolus trigger software with a region of interest positioned at the level of the main pulmonary trunk. The images were acquired in the craniocaudal direction with Z-axis coverage, and the field of view was chosen to include the entire chest. The CTPA scans were assessed in consensus by two experienced radiologists who were unaware of VQ scan results. Primary findings that were suggestive of CTEPH included visualization of the pulmonary thrombus (main, segmental, or subsegmental arteries), calcified thrombus, recanalization, focal stenosis, post-stenotic dilation, webs, secondary signs of pulmonary hypertension (such as diameter of pulmonary arteries), right and left ventricular size and parenchymal lungs changes (such as mosaic perfusion abnormalities), and presence of pulmonary scarring or infarction (Figure 2 A-E).

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