Utility of CT Scan Evaluation for Predicting Pulmonary Hypertension in Patients With Parenchymal Lung Disease

Tan, Rana Teresa; Kuzo, Ronald S.; Goodman, Lawrence R.; Siegel, Ronald; Haasler, George R.; Presberg, Kenneth W.

doi:10.1378/chest.113.5.1250

Cited by 357 publications

(244 citation statements)

References 34 publications

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“…Therefore, the difference in correlations between the two CSA groups and Ppa may reflect the difference between the proportions of elastic versus muscular pulmonary vessels in each group. Characteristics of central large vessels, such as the measured MPAD or MPAD/AoD, correlated poorly if at all with Ppa, a finding in agreement with previous work (17).…”

Section: Discussionsupporting

confidence: 91%

“…We also used Spearman correlation coefficients to express the relationship between Ppa and PFTs, %LAA 2950 , Pa O 2 , and other variables previously described as indicators of pulmonary arterial pressure, including MPAD and MPAD/AoD (17,(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

“…For the evaluation of the dimensions of the central pulmonary vessels, the diameter of the main pulmonary artery (MPAD) was measured at its widest portion within 3 cm of the bifurcation on the conventional CT image (17). On the same slice, the diameter of the ascending aorta (AoD) was measured.…”

Section: Ct Measurement Of Small Pulmonary Vessels and Main Pulmonarymentioning

confidence: 99%

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Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Matsuoka¹,

Washko²,

Yamashiro³

et al. 2010

Am J Respir Crit Care Med

166

158

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Rationale: Vascular alteration of small pulmonary vessels is one of the characteristic features of pulmonary hypertension in chronic obstructive pulmonary disease. The in vivo relationship between pulmonary hypertension and morphological alteration of the small pulmonary vessels has not been assessed in patients with severe emphysema. Objectives: We evaluated the correlation of total cross-sectional area of small pulmonary vessels (CSA) assessed on computed tomography (CT) scans with the degree of pulmonary hypertension estimated by right heart catheterization. Methods: In 79 patients with severe emphysema enrolled in the National Emphysema Treatment Trial (NETT), we measured CSA less than 5 mm 2 (CSA ,5 ) and 5 to 10 mm 2 (CSA 5210 ), and calculated the percentage of total CSA for the lung area (%CSA ,5 and %CSA 5-10 , respectively). The correlations of %CSA ,5 and %CSA 5-10 with pulmonary arterial mean pressure (Ppa) obtained by right heart catheterization were evaluated. Multiple linear regression analysis using Ppa as the dependent outcome was also performed. Measurements and Main Results: The %CSA ,5 had a significant negative correlation with Ppa (r 5 20.512, P , 0.0001), whereas the correlation between %CSA 5-10 and Ppa did not reach statistical significance (r 5 20.196, P 5 0.083). Multiple linear regression analysis showed that %CSA ,5 and diffusing capacity of carbon monoxide (DL CO ) % predicted were independent predictors of Ppa (r 2 5 0.541): %CSA ,5 (P , 0.0001), and DL CO % predicted (P 5 0.022). Conclusions: The %CSA ,5 measured on CT images is significantly correlated to Ppa in severe emphysema and can estimate the degree of pulmonary hypertension.Keywords: chronic obstructive pulmonary disease; emphysema; pulmonary hypertension; CT Pulmonary hypertension is an important predictor of mortality in chronic obstructive pulmonary disease (COPD) (1-3). Various factors, including endothelial dysfunction, inflammation, and hypoxia, have been recognized as potential contributors to the development of secondary pulmonary hypertension in emphysema, but its pathogenesis has not been fully clarified. Nevertheless, it is generally recognized that vascular remodeling of small pulmonary arteries is an essential morphological feature of pulmonary hypertension; narrowing and diminution of the small pulmonary vessels have been shown on conventional angiography in emphysema (4-6). However, to our knowledge, the in vivo relationship between pulmonary hypertension and the magnitude of small pulmonary vessel morphological change has not been quantitatively assessed in severe emphysema.A recent histological study suggested that vascular remodeling leads to reduced distensibility of small pulmonary vessels and that this remodeling is closely related to pulmonary hypertension (7). Such a decrease in distensibility of small pulmonary vessels may lead to increased pulmonary vascular resistance and elevated pulmonary vascular pressure. Therefore, we hypothesized that measurements of the total cross-sectional area of small ...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Ct Measurement Of Small Pulmonary Vessels and Main Pulmonarymentioning

confidence: 99%

See 1 more Smart Citation

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Matsuoka¹,

Washko²,

Yamashiro³

et al. 2010

Am J Respir Crit Care Med

166

158

View full text Add to dashboard Cite

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“…At the same location, the ascending aorta can be measured to provide the ratio of PA diameter to that of the aorta (92). A PA diameter of 29 mm or more was determined to have 97% PPV, 87% sensitivity, and 89% specificity for the presence of pulmonary hypertension (94). Specificity increases to 100% if accompanied by findings of a segmental artery-to-bronchus ratio greater than one in three of four pulmonary lobes (94).…”

Section: Ct Diagnosis Of Ctephmentioning

confidence: 99%

“…A PA diameter of 29 mm or more was determined to have 97% PPV, 87% sensitivity, and 89% specificity for the presence of pulmonary hypertension (94). Specificity increases to 100% if accompanied by findings of a segmental artery-to-bronchus ratio greater than one in three of four pulmonary lobes (94). However, a diameter less than 29 mm does not rule out pulmonary hypertension (94).…”

Section: Ct Diagnosis Of Ctephmentioning

confidence: 99%

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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Cardiopulmonary imaging, functional and laboratory studies in sickle cell disease associated pulmonary hypertension

et al. 2008

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Pulmonary hypertension (PHT) occurs in approximately 30% of adults with sickle cell disease (SCD) and is an independent risk factor for early death. In this study, we aimed to determine the value of general laboratory testing, plain chest radiography, electrocardiography (ECG), high-resolution computer tomography (HRCT) of the thorax, pulmonary function testing, and plasma N-terminal brain natriuretic peptide (NTproBNP) and brain natriuretic peptide (BNP) in patients with SCD-related PHT. A cohort of 85 ambulatory sickle cell patients were prospectively screened for PHT with echocardiography (defined as a tricuspid regurgitation flow velocity of ≥2.5 m/sec). All patients were systematically evaluated by the aforementioned diagnostic tests comparing patients with and without PHT. The prevalence of PHT was 41% in HbSS/HbSb 0 -thalassemia patients and 13% in HbSC/HbSb 1 -thalassemia patients. No statistically significant differences were detected in ECG, chest radiography, HRCT, and pulmonary function testing between patients with and without PHT. The degree of anemia and renal dysfunction, but not the presence of PHT, were the most important determinants of plasma (NT-pro)BNP levels. The performed imaging and functional studies do not seem to be of value in identifying etiological conditions (such as airflow obstruction or parenchymal lung disease) nor do they offer clues to the presence of mild PHT in SCD. Am. J. Hematol. 83:850-854, 2008. V

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Utility of CT Scan Evaluation for Predicting Pulmonary Hypertension in Patients With Parenchymal Lung Disease

Cited by 357 publications

References 34 publications

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

Pulmonary Hypertension and Computed Tomography Measurement of Small Pulmonary Vessels in Severe Emphysema

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Cardiopulmonary imaging, functional and laboratory studies in sickle cell disease associated pulmonary hypertension

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