Potential Role of CT Metrics in Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension

Ando, Kenji; Kuraishi, Hiroshi; Nagaoka, Tetsutaro; Tsutsumi, Takanobu; Hoshika, Yoshito; Kimura, Tōru; Ienaga, Hiroki; Morio, Yoshiteru; Takahashi, Kazuhisa

doi:10.1007/s00408-015-9813-8

Cited by 15 publications

(13 citation statements)

References 16 publications

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“…In addition, CT might also provide relevant information on the extent of emphysema and airway wall disease, which for instance could be of use in determining treatment effect. Ando et al showed in a small set of COPD subjects that the automated quantification of emphysema and the extent of small pulmonary vessels is associated with a treatment effect of pulmonary vasodilators [ 29 ]. Assessing emphysema on CT might also be used to better understand the reduced aerobic exercise capacity in lung transplants candidates with COPD and PH.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of CT Pulmonary Artery Diameter for Pulmonary Hypertension in End-Stage COPD

Hoesein

Besselink

Pompe

et al. 2016

Lung

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IntroductionPulmonary hypertension (PH) in COPD is associated with a higher mortality and an increased risk on exacerbations compared to COPD patients without PH. The aim was to evaluate the diagnostic value of pulmonary artery (PA) measurements on chest computed tomography (CT) for PH in end-stage COPD.MethodsCOPD patients evaluated for eligibility for lung transplantation between 2004 and 2015 were retrospectively analyzed. Clinical characteristics, chest CTs, spirometry, and right-sided heart catheterizations (RHC) were studied. Diameters of PA and ascending aorta (A) were measured on CT. Diagnostic properties of different cut-offs of PA diameter and PA:A ratio in diagnosing PH were calculated.ResultsOf 92 included COPD patients, 30 (32.6 %) had PH at RHC (meanPAP > 25 mm Hg). PA:A > 1 had a negative predictive value (NPV) of 77.9 % and a positive predictive value (PPV) of 63.1 % with an odds ratio (OR (CI 95 %)) of 5.60 (2.00–15.63). PA diameter ≥30 mm had a NPV of 78 % and PPV of 64 % with an OR (CI 95 %) of 6.95 (2.51–19.24).ConclusionA small PA diameter and PA:A make the presence of PH unlikely but cannot exclude its presence in end-stage COPD. A large PA diameter and PA:A maybe used to detect PH early.

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Section: Discussionmentioning

confidence: 99%

Accuracy of CT Pulmonary Artery Diameter for Pulmonary Hypertension in End-Stage COPD

Hoesein

Besselink

Pompe

et al. 2016

Lung

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“…Except for prediction of COPD exacerbations, [ 11 ] the clinical implications of our results remain largely unknown. Ando et al [ 39 ] evaluated the role of quantitative CT in determining the effect of pulmonary vasodilators in COPD patients with pulmonary hypertension and concluded that quantitative CT analysis is a plausible and beneficial tool. If an elevated PA:AA ratio is a reliable surrogate for pulmonary hypertension, it may represent a useful parameter for the diagnostic screening of patients for right heart catheterization and before considering therapy with vasodilators or other treatments aimed at the disorder.…”

Section: Discussionmentioning

confidence: 99%

CT measurements of central pulmonary vasculature as predictors of severe exacerbation in COPD

et al. 2018

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To identify a predictive value for the exacerbation status of chronic obstructive pulmonary disease (COPD) subjects, we evaluated the relationship between pulmonary vascular measurements on chest CT and severe COPD exacerbation.Six hundred three subjects enrolled in the COPDGene population were included and divided into nonexacerbator (n = 313) and severe exacerbator (n = 290) groups, based on whether they had an emergency room visit and/or hospitalization for COPD exacerbation. We measured the diameter of the main pulmonary artery (MPA) and ascending aorta (AA) at 2 different sites of the MPA (the tubular midportion and bifurcation) on both axial images and multiplanar reconstructions. Using multiple logistic regression analyses, we evaluated the relationship between each CT-measured pulmonary vasculature and exacerbation status.Axial and multiplanar MPA to AA diameter ratios (PA:AA ratios) at the tubular midportion and the axial PA:AA ratios at the bifurcation indicated significant association with severe exacerbation. The strongest association was found with the axial PA:mean AA ratio at the bifurcation (adjusted odds ratio [OR] = 12.53, 95% confidence interval [CI] = 2.35–66.74, P = .003) and the axial PA:major AA ratio at the tubular midportion (adjusted OR = 10.72, 95% CI = 1.99–57.86, P = .006). No differences were observed in the MPA diameter. Receiver operating characteristic analysis of these variables indicates that they may serve as a good predictive value for severe exacerbation (area under the curve, 0.77–0.78). The range of cut-off value for PA:AA ratio was 0.8 to 0.87.CT-measured PA:AA ratios at either the bifurcation or the tubular site, measured either on axial or multiplanar images, are useful for identification of the risk of severe exacerbation, and consequently can be helpful in guiding the management of COPD. Although CT measurement was used at the level of pulmonary bifurcation in previous studies, we suggest that future studies should monitor the tubular site of the MPA for maximum diagnostic value of CT in pulmonary hypertension or severe COPD exacerbation, as the tubular site of the MPA remains relatively constant on CT images.

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“…The technological evolution of CT devices and computer analysis programs allowed the development of objective, quantitative tools for analysis of the lung parenchyma (in cases of emphysema or fibrosis), the airways (in cases of chronic obstructive pulmonary disease, asthma, or cystic fibrosis), and, more recently, the pulmonary vessels. Some studies, such as that conducted by Ando et al ( 23 ) , have demonstrated the potential of quantitative evaluation of the pulmonary vasculature for the detection of the effect of treatment with vasodilators in patients with chronic obstructive pulmonary disease and PH.…”

Section: Discussionmentioning

confidence: 99%

Use of computed tomography and automated software for quantitative analysis of the vasculature of patients with pulmonary hypertension

et al. 2017

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ObjectiveTo perform a quantitative analysis of the lung parenchyma and pulmonary vasculature of patients with pulmonary hypertension (PH) on computed tomography angiography (CTA) images, using automated software.Materials and MethodsWe retrospectively analyzed the CTA findings and clinical records of 45 patients with PH (17 males and 28 females), in comparison with a control group of 20 healthy individuals (7 males and 13 females); the mean age differed significantly between the two groups (53 ± 14.7 vs. 35 ± 9.6 years; p = 0.0001).ResultsThe automated analysis showed that, in comparison with the controls, the patients with PH showed lower 10th percentile values for lung density, higher vascular volumes in the right upper lung lobe, and higher vascular volume ratios between the upper and lower lobes. In our quantitative analysis, we found no differences among the various PH subgroups. We inferred that a difference in the 10th percentile values indicates areas of hypovolemia in patients with PH and that a difference in pulmonary vascular volumes indicates redistribution of the pulmonary vasculature and an increase in pulmonary vasculature resistance.ConclusionAutomated analysis of pulmonary vessels on CTA images revealed alterations and could represent an objective diagnostic tool for the evaluation of patients with PH.

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Potential Role of CT Metrics in Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension

Abstract: Our study demonstrates that the use of quantitative CT analysis is a plausible and beneficial tool for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH.

Cited by 15 publications

References 16 publications

Accuracy of CT Pulmonary Artery Diameter for Pulmonary Hypertension in End-Stage COPD

Accuracy of CT Pulmonary Artery Diameter for Pulmonary Hypertension in End-Stage COPD

CT measurements of central pulmonary vasculature as predictors of severe exacerbation in COPD

Use of computed tomography and automated software for quantitative analysis of the vasculature of patients with pulmonary hypertension

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