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Averjanovaitė V, Gumbienė L, Zeleckienė I, Šileikienė V. Unmasking a Silent Threat: Improving Pulmonary Hypertension Screening Methods for Interstitial Lung Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:58. [PMID: 38256318 PMCID: PMC10820938 DOI: 10.3390/medicina60010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
This article provides a comprehensive overview of the latest literature on the diagnostics and treatment of pulmonary hypertension (PH) associated with interstitial lung disease (ILD). Heightened suspicion for PH arises when the advancement of dyspnoea in ILD patients diverges from the expected pattern of decline in pulmonary function parameters. The complexity of PH associated with ILD (PH-ILD) diagnostics is emphasized by the limitations of transthoracic echocardiography in the ILD population, necessitating the exploration of alternative diagnostic approaches. Cardiac magnetic resonance imaging (MRI) emerges as a promising tool, offering insights into hemodynamic parameters and providing valuable prognostic information. The potential of biomarkers, alongside pulmonary function and cardiopulmonary exercise tests, is explored for enhanced diagnostic and prognostic precision. While specific treatments for PH-ILD remain limited, recent studies on inhaled treprostinil provide new hope for improved patient outcomes.
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Affiliation(s)
| | - Lina Gumbienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | | | - Virginija Šileikienė
- Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
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Erdoğan M, Öztürk S, Erdöl MA, Kasapkara A, Beşler MS, Kayaaslan B, Hasanoğlu İ, Durmaz T, Güner R. Prognostic utility of pulmonary artery and ascending aorta diameters derived from computed tomography in COVID-19 patients. Echocardiography 2021; 38:1543-1551. [PMID: 34355824 PMCID: PMC8444889 DOI: 10.1111/echo.15170] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 11/22/2022] Open
Abstract
Aim Chest computed tomography (CT) imaging plays a diagnostic and prognostic role in Coronavirus disease 2019 (COVID‐19) patients. This study aimed to investigate and compare predictive capacity of main pulmonary artery diameter (MPA), ascending aorta diameter (AAo), and MPA‐to‐AAo ratio to determine in‐hospital mortality in COVID‐19 patients. Materials and methods This retrospective study included 255 hospitalized severe or critical COVID‐19 patients. MPA was measured at the level of pulmonary artery bifurcation perpendicular to the direction of the vessel through transverse axial images and AAo was measured by using the same CT slice at its maximal diameter. MPA‐to‐AAo ratio was calculated by division of MPA to AAo. Results Multivariate logistic regression model yielded MPA ≥29.15 mm (OR: 4.95, 95% CI: 2.01–12.2, p = 0.001), MPA (OR: 1.28, 95% CI: 1.13–1.46, p < 0.001), AAo (OR: .90, 95% CI: .81–.99, p = 0.040), and MPA‐to‐AAo ratio ≥.82 (OR: 4.67, 95% CI: 1.86–11.7, p = 0.001) as independent predictors of in‐hospital mortality. Time‐dependent multivariate Cox‐proportion regression model demonstrated MPA ≥29.15 mm (HR: 1.96, 95% CI: 1.03–3.90, p = 0.047) and MPA (HR: 1.08, 95% CI: 1.01–1.17, p = 0.048) as independent predictors of in‐hospital mortality, whereas AAo and MPA‐to‐AAo ratio did not reach statistical significance. Conclusion Pulmonary artery enlargement strongly predicts in‐hospital mortality in hospitalized COVID‐19 patients. MPA, which can be calculated easily from chest CT imaging, can be beneficial in the prognostication of these patients.
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Affiliation(s)
- Mehmet Erdoğan
- Department of Cardiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Selçuk Öztürk
- Department of Cardiology, Faculty of Medicine, Bozok University Yozgat, Ankara, Turkey
| | - Mehmet Akif Erdöl
- Department of Cardiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Ahmet Kasapkara
- Department of Cardiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Muhammed Said Beşler
- Department of Radiology, Ministry of Health, Ankara Bilkent City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Tahir Durmaz
- Department of Cardiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Yildirim Beyazit University, Ankara, Turkey
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3
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Schiaffino S, Codari M, Cozzi A, Albano D, Alì M, Arioli R, Avola E, Bnà C, Cariati M, Carriero S, Cressoni M, Danna PSC, Della Pepa G, Di Leo G, Dolci F, Falaschi Z, Flor N, Foà RA, Gitto S, Leati G, Magni V, Malavazos AE, Mauri G, Messina C, Monfardini L, Paschè A, Pesapane F, Sconfienza LM, Secchi F, Segalini E, Spinazzola A, Tombini V, Tresoldi S, Vanzulli A, Vicentin I, Zagaria D, Fleischmann D, Sardanelli F. Machine Learning to Predict In-Hospital Mortality in COVID-19 Patients Using Computed Tomography-Derived Pulmonary and Vascular Features. J Pers Med 2021; 11:501. [PMID: 34204911 PMCID: PMC8230339 DOI: 10.3390/jpm11060501] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/26/2022] Open
Abstract
Pulmonary parenchymal and vascular damage are frequently reported in COVID-19 patients and can be assessed with unenhanced chest computed tomography (CT), widely used as a triaging exam. Integrating clinical data, chest CT features, and CT-derived vascular metrics, we aimed to build a predictive model of in-hospital mortality using univariate analysis (Mann-Whitney U test) and machine learning models (support vectors machines (SVM) and multilayer perceptrons (MLP)). Patients with RT-PCR-confirmed SARS-CoV-2 infection and unenhanced chest CT performed on emergency department admission were included after retrieving their outcome (discharge or death), with an 85/15% training/test dataset split. Out of 897 patients, the 229 (26%) patients who died during hospitalization had higher median pulmonary artery diameter (29.0 mm) than patients who survived (27.0 mm, p < 0.001) and higher median ascending aortic diameter (36.6 mm versus 34.0 mm, p < 0.001). SVM and MLP best models considered the same ten input features, yielding a 0.747 (precision 0.522, recall 0.800) and 0.844 (precision 0.680, recall 0.567) area under the curve, respectively. In this model integrating clinical and radiological data, pulmonary artery diameter was the third most important predictor after age and parenchymal involvement extent, contributing to reliable in-hospital mortality prediction, highlighting the value of vascular metrics in improving patient stratification.
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Affiliation(s)
- Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 Milan, Italy; (S.S.); (M.C.); (G.D.L.); (F.S.); (F.S.)
| | - Marina Codari
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA; (M.C.); (D.F.)
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy; (S.G.); (V.M.); (L.M.S.)
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (D.A.); (C.M.)
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Section of Radiological Sciences, Università degli Studi di Palermo, Via del Vespro 127, 90127 Palermo, Italy
| | - Marco Alì
- Department of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano S.p.A., Via Simone Saint Bon 20, 20147 Milan, Italy;
| | - Roberto Arioli
- Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy; (R.A.); (P.S.C.D.); (Z.F.); (A.P.); (D.Z.)
| | - Emanuele Avola
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (E.A.); (S.C.); (G.D.P.)
| | - Claudio Bnà
- Unit of Interventional Radiology, Unit of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, 25124 Brescia, Italy; (C.B.); (L.M.)
| | - Maurizio Cariati
- Diagnostic and Interventional Radiology Service, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, 20142 Milan, Italy; (M.C.); (R.A.F.); (S.T.)
| | - Serena Carriero
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (E.A.); (S.C.); (G.D.P.)
| | - Massimo Cressoni
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 Milan, Italy; (S.S.); (M.C.); (G.D.L.); (F.S.); (F.S.)
| | - Pietro S. C. Danna
- Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy; (R.A.); (P.S.C.D.); (Z.F.); (A.P.); (D.Z.)
| | - Gianmarco Della Pepa
- Postgraduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (E.A.); (S.C.); (G.D.P.)
| | - Giovanni Di Leo
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 Milan, Italy; (S.S.); (M.C.); (G.D.L.); (F.S.); (F.S.)
| | - Francesco Dolci
- Emergency Department, ASST Crema—Ospedale Maggiore, Largo Ugo Dossena 2, 26013 Crema, Italy;
| | - Zeno Falaschi
- Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy; (R.A.); (P.S.C.D.); (Z.F.); (A.P.); (D.Z.)
| | - Nicola Flor
- Unit of Radiology, Ospedale Universitario Luigi Sacco—ASST Fatebenefratelli Sacco, Via Giovanni Battista Grassi 74, 20157 Milan, Italy;
| | - Riccardo A. Foà
- Diagnostic and Interventional Radiology Service, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, 20142 Milan, Italy; (M.C.); (R.A.F.); (S.T.)
- Unit of Interventional Radiology, Unit of Radiology, ASST Crema—Ospedale Maggiore, Largo Ugo Dossena 2, 26013 Crema, Italy; (G.L.); (A.S.)
| | - Salvatore Gitto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy; (S.G.); (V.M.); (L.M.S.)
| | - Giovanni Leati
- Unit of Interventional Radiology, Unit of Radiology, ASST Crema—Ospedale Maggiore, Largo Ugo Dossena 2, 26013 Crema, Italy; (G.L.); (A.S.)
| | - Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy; (S.G.); (V.M.); (L.M.S.)
| | - Alexis E. Malavazos
- High Speciality Center for Dietetics, Nutritional Education and Cardiometabolic Prevention, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 Milan, Italy;
| | - Giovanni Mauri
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (G.M.); (A.V.)
- Division of Interventional Radiology, IEO—Istituto Europeo di Oncologia IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (D.A.); (C.M.)
| | - Lorenzo Monfardini
- Unit of Interventional Radiology, Unit of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati 57, 25124 Brescia, Italy; (C.B.); (L.M.)
| | - Alessio Paschè
- Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy; (R.A.); (P.S.C.D.); (Z.F.); (A.P.); (D.Z.)
| | - Filippo Pesapane
- Division of Breast Radiology, IEO—Istituto Europeo di Oncologia IRCCS, Via Giuseppe Ripamonti 435, 20141 Milan, Italy;
| | - Luca M. Sconfienza
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy; (S.G.); (V.M.); (L.M.S.)
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161 Milan, Italy; (D.A.); (C.M.)
| | - Francesco Secchi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 Milan, Italy; (S.S.); (M.C.); (G.D.L.); (F.S.); (F.S.)
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy; (S.G.); (V.M.); (L.M.S.)
| | - Edoardo Segalini
- Department of General and Emergency Surgery, ASST Crema—Ospedale Maggiore, Largo Ugo Dossena 2, 26013 Crema, Italy;
| | - Angelo Spinazzola
- Unit of Interventional Radiology, Unit of Radiology, ASST Crema—Ospedale Maggiore, Largo Ugo Dossena 2, 26013 Crema, Italy; (G.L.); (A.S.)
| | - Valeria Tombini
- ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy; (V.T.); (I.V.)
| | - Silvia Tresoldi
- Diagnostic and Interventional Radiology Service, ASST Santi Paolo e Carlo, Via Antonio di Rudinì 8, 20142 Milan, Italy; (M.C.); (R.A.F.); (S.T.)
| | - Angelo Vanzulli
- Department of Oncology and Hematology-Oncology, Università degli Studi di Milano, Via Festa del Perdono 7, 20122 Milan, Italy; (G.M.); (A.V.)
- ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy; (V.T.); (I.V.)
| | - Ilaria Vicentin
- ASST Grande Ospedale Metropolitano Niguarda, Piazza dell’Ospedale Maggiore 3, 20162 Milan, Italy; (V.T.); (I.V.)
| | - Domenico Zagaria
- Radiodiagnostics, Department of Diagnosis and Treatment Services, Azienda Ospedaliero Universitaria Maggiore della Carità, Corso Giuseppe Mazzini 18, 28100 Novara, Italy; (R.A.); (P.S.C.D.); (Z.F.); (A.P.); (D.Z.)
| | - Dominik Fleischmann
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA; (M.C.); (D.F.)
- Cardiovascular Institute, 265 Campus Drive, Stanford University, Stanford, CA 94305, USA
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Rodolfo Morandi 30, 20097 Milan, Italy; (S.S.); (M.C.); (G.D.L.); (F.S.); (F.S.)
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Luigi Mangiagalli 31, 20133 Milan, Italy; (S.G.); (V.M.); (L.M.S.)
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Foley RW, Kaneria N, Ross RVM, Suntharalingam J, Hudson BJ, Rodrigues JC, Robinson G. Computed tomography appearances of the lung parenchyma in pulmonary hypertension. Br J Radiol 2021; 94:20200830. [PMID: 32915646 DOI: 10.1259/bjr.20200830] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Computed tomography (CT) is a valuable tool in the workup of patients under investigation for pulmonary hypertension (PH) and may be the first test to suggest the diagnosis. CT parenchymal lung changes can help to differentiate the aetiology of PH. CT can demonstrate interstitial lung disease, emphysema associated with chronic obstructive pulmonary disease, features of left heart failure (including interstitial oedema), and changes secondary to miscellaneous conditions such as sarcoidosis. CT also demonstrates parenchymal changes secondary to chronic thromboembolic disease and venous diseases such as pulmonary venous occlusive disease (PVOD) and pulmonary capillary haemangiomatosis (PCH). It is important for the radiologist to be aware of the various manifestations of PH in the lung, to help facilitate an accurate and timely diagnosis. This pictorial review illustrates the parenchymal lung changes that can be seen in the various conditions causing PH.
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Affiliation(s)
- Robert W Foley
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Nirav Kaneria
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Rob V MacKenzie Ross
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Jay Suntharalingam
- Department of Respiratory Medicine, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Benjamin J Hudson
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Jonathan Cl Rodrigues
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
| | - Graham Robinson
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Avon, Bath, United Kingdom
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5
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Spagnolo P, Cozzi A, Foà RA, Spinazzola A, Monfardini L, Bnà C, Alì M, Schiaffino S, Sardanelli F. CT-derived pulmonary vascular metrics and clinical outcome in COVID-19 patients. Quant Imaging Med Surg 2020; 10:1325-1333. [PMID: 32550141 DOI: 10.21037/qims-20-546] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To assess pulmonary vascular metrics on chest CT of COVID-19 patients, and their correlation with pneumonia extent (PnE) and outcome, we analyzed COVID-19 patients with an available previous chest CT, excluding those performed for cardiovascular disease. From February 21 to March 21, 2020, of 672 suspected COVID-19 patients from two centers who underwent CT, 45 RT-PCR-positives (28 males, median age 75, IQR 66-81 years) with previous CTs performed a median 36 months before (IQR 12-72 months) were included. We assessed PnE, pulmonary artery (PA) diameter, ascending aorta (Ao) diameter, and PA/Ao ratio. Most common presentations were fever and dyspnea (15/45) and fever alone (13/45). Outcome was available for 41/45 patients, 15/41 dead and 26/41 discharged. Ground-glass opacities (GGOs) alone were found in 29/45 patients, GGOs with consolidations in 15/45, consolidations alone in 1/45. All but one patient had bilateral pneumonia, 9/45 minimal, 22/45 mild, 9/45 moderate, and 5/45 severe PnE. PA diameter (median 31 mm, IQR 28-33 mm) was larger than before (26 mm, IQR 25-29 mm) (P<0.001), PA/Ao ratio (median 0.83, IQR 0.76-0.92) was higher than before (0.76, IQR 0.72-0.82) (P<0.001). Patients with adverse outcome (death) had higher PA diameter (P=0.001), compared to discharged ones. Only weak correlations were found between ΔPA or ΔPA/Ao and PnE (ρ≤0.453, P≤0.032), with 4/45 cases with moderate-severe PnE and minimal increase in PA metrics. In conclusion, enlarged PA diameter was associated to death in COVID-19 patients, a finding deserving further investigation as a potential driver of therapy decision-making.
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Affiliation(s)
- Pietro Spagnolo
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Andrea Cozzi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
| | - Riccardo Alessandro Foà
- Unit of Interventional Radiology, Department of Radiology, ASST Crema - Ospedale Maggiore, Crema, Italy
| | - Angelo Spinazzola
- Unit of Interventional Radiology, Department of Radiology, ASST Crema - Ospedale Maggiore, Crema, Italy
| | - Lorenzo Monfardini
- Unit of Interventional Radiology, Unit of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Claudio Bnà
- Unit of Interventional Radiology, Unit of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Marco Alì
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Unit of Diagnostic Imaging and Stereotactic Radiosurgery, C.D.I. Centro Diagnostico Italiano S.p.A., Milano, Italy
| | - Simone Schiaffino
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milano, Italy
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Rauch M, Marinova M, Schild HH, Strunk H. Cardiovascular Computed Tomography Findings after Pneumonectomy: Comparison to Lobectomy. Acad Radiol 2017; 24:860-866. [PMID: 28242102 DOI: 10.1016/j.acra.2017.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/26/2017] [Accepted: 01/27/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To identify and compare cardiovascular findings on computed tomography (CT) scans after pneumonectomy (PNX) with those after lobectomy (LOBX). MATERIALS AND METHODS Pre- and postoperative CT scans from 25 PNX patients were retrospectively analyzed and compared to those from 30 LOBX patients. The diameter of the main pulmonary artery (PA) and its ratio to the ascending aorta (PA/Ao) were determined. Cardiac morphometry values were ascertained by measuring maximum diameters of the right and left ventricle on axial (RVaxial, LVaxial) and four-chamber (RV4-ch, LV4-ch) views. RVaxial/LVaxial and RV4-ch/LV4-ch ratios were calculated. Vessel stumps were evaluated for thrombosis. RESULTS After PNX, PA (31.1 ± 5.8 mm vs 28.7 ± 5.4 mm, P = 0.003), PA/Ao (0.97 ± 0.15 vs 0.86 ± 0.12, P = 0.0001), and cardiac morphometry values significantly increased (RVaxial 43.6 ± 7.4 vs 39.4 ± 7.1, P = 0.029; RV4-ch 41.1 ± 6.3 vs 37.6 ± 5.7, P = 0.041; RVaxial/LVaxial 1.18 ± 0.27 vs 1.03 ± 0.22, P = 0.04; RV4-ch/LV4-ch 1.17 ± 0.21 vs 1.02 ± 0.16, P = 0.03). There were no significant differences between right and left PNX. One case of PA stump thrombosis was identified after right PNX. LOBX resulted in a significant increase in PA (30.6 ± 4.3 vs 28.7 ± 3.5, P = 0.005) and PA/Ao (0.90 ± 0.09 vs 0.85 ± 0.10, P = 0.017), whereas cardiac morphometry values were not significantly changed compared to baseline values. No vessel stump thrombosis was observed after LOBX. In comparison to LOBX, all ascertained values were significantly elevated after PNX. CONCLUSIONS Morphologic alterations of the cardiovascular system following PNX can be identified on CT scans. Alterations are more distinct after PNX compared to LOBX.
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Affiliation(s)
- Maximilian Rauch
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany.
| | - Milka Marinova
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
| | - Hans Heinz Schild
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
| | - Holger Strunk
- Department of Radiology, University Hospital Bonn, Sigmund-Freud-Strasse 25, 53105 Bonn, Germany
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7
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Granger LA, Pariaut R, Vila J, Coulter CE, Rademacher N, Queiroz-Williams P. COMPUTED TOMOGRAPHIC MEASUREMENT OF THE MAIN PULMONARY ARTERY TO AORTIC DIAMETER RATIO IN HEALTHY DOGS: A COMPARISON TO ECHOCARDIOGRAPHICALLY DERIVED RATIOS. Vet Radiol Ultrasound 2016; 57:376-86. [PMID: 27059810 DOI: 10.1111/vru.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 01/07/2023] Open
Abstract
Indicators of pulmonary hypertension in dogs examined with thoracic computed tomography (CT) are not well established in the veterinary literature. In humans, the main pulmonary artery to aortic diameter ratio (MPA:Ao) measured via CT, has been shown to be more sensitive than echocardiographic variables for predicting presence and severity of pulmonary hypertension, in some cases. In veterinary literature, the MPA:Ao has been determined echocardiographically to have an upper limit of about 1:1. Measurement of this ratio has not been described in dogs using CT. The objectives of this cross-sectional, prospective study were to compare echocardiographic measurement of MPA:Ao with that obtained via CT, determine if measurement of MPA:Ao via CT is repeatable and reproducible, and determine the effect of respiration and contrast administration on the measurement of MPA:Ao via CT. Ten healthy dogs without pulmonary hypertension were anesthetized to undergo thoracic CT using three protocols and echocardiography. The MPA:Ao was measured three times by three observers for each of the three CT protocols and compared to echocardiographic measurements. The mean MPA:Ao measured among all observers and CT protocols was 1.108 ± 0.152 (SD). The effect of CT scan protocol on MPA:Ao significantly differed among the three methods (P = 0.0014), where expiratory scans had lower MPA:Ao than inspiratory scans. The ratio measured on inspiratory CT scans consistently overestimated MPA:Ao when compared to echocardiography (bias = 0.226). Findings did not support the echocardiographically derived upper limit of MPA:Ao as an upper limit for determination of main pulmonary arterial enlargement on CT.
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Affiliation(s)
- L Abbigail Granger
- Department of Veterinary Clinical Sciences, Lousiana State University School of Veterinary Medicine, Baton Rouge, LA, 70803
| | - Romain Pariaut
- Department of Veterinary Clinical Sciences, Lousiana State University School of Veterinary Medicine, Baton Rouge, LA, 70803
| | - Jorge Vila
- Department of Veterinary Clinical Sciences, Lousiana State University School of Veterinary Medicine, Baton Rouge, LA, 70803
| | - Cassaundra E Coulter
- Department of Veterinary Clinical Sciences, Lousiana State University School of Veterinary Medicine, Baton Rouge, LA, 70803
| | - Nathalie Rademacher
- Department of Veterinary Clinical Sciences, Lousiana State University School of Veterinary Medicine, Baton Rouge, LA, 70803
| | - Patricia Queiroz-Williams
- Department of Veterinary Clinical Sciences, Lousiana State University School of Veterinary Medicine, Baton Rouge, LA, 70803
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Moses D, Sammut C, Zrimec T. Automatic segmentation and analysis of the main pulmonary artery on standard post-contrast CT studies using iterative erosion and dilation. Int J Comput Assist Radiol Surg 2015; 11:381-95. [DOI: 10.1007/s11548-015-1265-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 07/07/2015] [Indexed: 11/24/2022]
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Comparison of CT-Determined Pulmonary Artery Diameter, Aortic Diameter, and Their Ratio in Healthy and Diverse Clinical Conditions. PLoS One 2015; 10:e0126646. [PMID: 25955036 PMCID: PMC4425684 DOI: 10.1371/journal.pone.0126646] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 04/04/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The main pulmonary artery diameter (mPA), aortic diameter (Ao), and the mPA/Ao ratio, easily measured using chest computed tomography (CT), provide information that enables the diagnosis and evaluation of cardiopulmonary diseases. Here, we used CT to determine the sex- and age-specific distribution of normal reference values for mPA, Ao, and mPA/Ao ratio in an adult Korean population. METHODS Data from non-contrast, ECG-gated, coronary-calcium-scoring CT images of 2,547 individuals who visited the Health Screening Center of the Severance Hospital were analyzed. Healthy individuals (n = 813) included those who do not have hypertension, diabetes, asthma, obstructive lung disease, ischemic heart disease, stroke, smoking, obesity, and abnormal CT findings. Both mPA and Ao were measured at the level of bifurcation of the main pulmonary artery. RESULTS The mean mPA and Ao were 25.9 mm and 30.0 mm in healthy participants, respectively, while the mean mPA/Ao ratio was 0.87. Medical conditions associated with a larger mPA were male, obesity, smoking history, hypertension, and diabetes. A larger mPA/Ao ratio was associated with female, the obese, non-smoker, normotensive, and normal serum level of lipids, while a smaller mPA/Ao ratio was associated with older age. In healthy individuals, the 90th percentile sex-specific mPA, Ao, and mPA/Ao ratio were, 31.3 mm (95% CI 29.9-32.2), 36.8 mm (95% CI 35.7-37.5), and 1.05 (95% CI 0.99-1.07) in males, and 29.6 mm (95% CI 29.1-30.2), 34.5 mm (95% CI 34.1-34.9), and 1.03 (95% CI 1.02-1.06) in females, respectively. CONCLUSION In the Korean population, the mean mPA reference values in male and female were 26.5 mm and 25.8 mm, respectively, while the mean mPA/Ao ratio was 0.87. These values were influenced by a variety of underlying medical conditions.
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