Screening for portopulmonary hypertension using computed tomography‐based measurements of the main pulmonary artery and ascending aorta diameters in patients with portal hypertension

Abstract

Aim: This study aimed to demonstrate the feasibility of identifying candidates of portopulmonary hypertension (PoPH) from general portal hypertension patients based on chest computed tomography (CT) results. Methods: One hundred and thirty patients with portal hypertension who had undergone interventional radiology therapies at our hospital between August 2011 and July 2021 were included, and preoperative clinical data were collected. Suspicious PoPH was defined as main pulmonary artery diameter (mPA-D) ≥ 29 mm or the ratio of mPA-D to ascending aorta diameter (mPA-D/aAo-D) ≥ 1.0, and probable PoPH as mPA-D ≥ 33 mm based on the chest CT. Prevalence of suspicious and probable PoPH was evaluated, and the differences in clinical characteristics of each population were compared.Results: Overall, 29 (22.3%) and 5 (3.8%) patients were categorized as suspicious and probable PoPH, respectively. Univariate analyses revealed that female sex, higher shortest diameter of inferior vena cava, presence of portosystemic shunts ≥ 5 mm, and lower blood urea nitrogen levels were significantly associated with suspicious PoPH (p < 0.05). Multivariate analyses identified all four factors as significantly independent determinants of suspicious PoPH (p < 0.05). In addition, among the population of suspicious PoPH, there were significant differences in seven parameters, including total bilirubin levels and spleen volume between patients with and without probable PoPH (p < 0.05). However, no significant independent indicators of probable PoPH were found. Conclusions: CT-based measurements of mPA-D and mPA-D/aAo-D have the potential to screen patients with suspicious PoPH in clinical practice focused on portal hypertension.Abbreviations: aAo-D, ascending aorta diameter; ALBI, albumin-bilirubin; APRI, aspartate aminotransferase-to-platelet ratio index; AUROC, area under the receiver operating characteristic; BNP, brain natriuretic peptide; BUN, blood urea nitrogen; CP, Child-Pugh; CT, computed tomography; HVPG, hepatic venous pressure gradient; IVC-LD, longest diameter of inferior vena cava; IV-COL-7S, 7S domain of type IV collagen; IVC-SD, shortest diameter of inferior vena cava; MELD, Model for End-Stage Liver Disease; MELD-Na, Model for End-Stage Liver Diseasesodium; mPA-D, main pulmonary artery diameter; mPA-D/aAo-D, ratio of main pulmonary artery diameter to ascending aorta diameter; mPAP, mean pulmonary arterial pressure; PAH, pulmonary arterial hypertension; PAP, pulmonary arterial pressure; PoPH, portopulmonary hypertension; PSS, portosystemic shunt; PV, portal vein; RHC, right heart catheterization; ROC, receiver operating characteristic; SpV, splenic vein.

Risk factors for portopulmonary hypertension in patients with cirrhosis: a prospective, multicenter study

“…A study from Japan reported that female gender, higher shortest diameter of the inferior vena cava, presence of portosystemic shunts of ≥ 5 mm, and lower blood urea nitrogen levels were independent factors related to PoPH in 130 patients with portal hypertension [24]. It has also been reported from studies conducted in other countries that the incidence of PoPH is signi cantly higher in female patients than in male patients [10,13,30,31].…”

“…Non-invasive examinations have been reported as auxiliary methods for predicting PoPH. Subjective symptoms (such as shortness of breath), serum brain natriuretic peptide (BNP) measurement, and measurement of the main pulmonary artery diameter have been reported have utility in the early detection of PoPH [22][23][24]. Measurement of the tricuspid regurgitation pressure gradient (TRPG) values by echocardiography is recommended as the most objective examination for the detection of PoPH [15,20].…”

Significance of a multidisciplinary approach to congenital extrahepatic portosystemic shunt: A changing paradigm for the treatment

“…Various methods for early diagnosis and severity of POPH have been recently reported in these patients. 18,19 However, the management of POPH remains uncertain, as the pathophysiology is unclear.…”

“…The development of POPH related to end‐stage liver disease and cirrhosis has been a subject of debate for many years. Various methods for early diagnosis and severity of POPH have been recently reported in these patients 18,19 . However, the management of POPH remains uncertain, as the pathophysiology is unclear.…”

Comparison of the Vasoconstriction Effect of Phenylephrine and Ephedrine on the Uterine Arteries of Pregnant Rabbits: A CT Imaging-Based Study

“…As shown in previous studies, CT angiography is a good exam for visualizing the different branches of arteries and studying the anatomic variations in their origin, especially in the case of uterine arteries [14,32] . CT demonstrates good penetration, can clearly show certain organs and arteries, has great potential for exploring smaller branches of blood vessels, and can be used to diagnose vascular diseases such as stenosis and occlusion [33][34] . Therefore, in this study, we used CT imaging to observe changes in the diameter of the uterine and peripheral arteries to evaluate changes in placental perfusion and peripheral resistance.…”