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Goh ZM, Johns CS, Julius T, Barnes S, Dwivedi K, Elliot C, Sharkey M, Alkanfar D, Charalampololous T, Hill C, Rajaram S, Condliffe R, Kiely DG, Swift AJ. Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study. Wellcome Open Res 2024; 6:249. [PMID: 39113847 PMCID: PMC11303945 DOI: 10.12688/wellcomeopenres.16853.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2024] [Indexed: 08/10/2024] Open
Abstract
Background Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). Methods In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Results Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar's and the medical student's were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). Conclusions MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.
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Affiliation(s)
- Ze Ming Goh
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, S10 2RX, UK
| | - Christopher S. Johns
- Radiology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
| | - Tarik Julius
- Radiology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
| | - Samual Barnes
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, S10 2RX, UK
| | - Krit Dwivedi
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, S10 2RX, UK
- INSIGNEO, Institute of Insilico Medicine, Sheffield, S1 3JD, UK
| | - Charlie Elliot
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
| | - Michael Sharkey
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, S10 2RX, UK
| | - Dheyaa Alkanfar
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, S10 2RX, UK
| | - Thanos Charalampololous
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
| | - Catherine Hill
- Radiology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
| | - Smitha Rajaram
- Radiology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
| | - Robin Condliffe
- INSIGNEO, Institute of Insilico Medicine, Sheffield, S1 3JD, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
| | - David G. Kiely
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, S10 2RX, UK
- INSIGNEO, Institute of Insilico Medicine, Sheffield, S1 3JD, UK
- Sheffield Pulmonary Vascular Disease Unit, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
| | - Andrew J. Swift
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield Medical School, Sheffield, S10 2RX, UK
- Radiology Department, Sheffield Teaching Hospitals NHS Trust, Sheffield, S10 2JF, UK
- INSIGNEO, Institute of Insilico Medicine, Sheffield, S1 3JD, UK
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2
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Lozano-Carrillo LC, Alvarez-Lozada LA, Fernández-Reyes BA, Rodríguez-Alanís KV, Montemayor-Martinez A, de-la-Garza-Castro O, Quiroga-Garza A, Elizondo-Omaña RE. Main pulmonary artery diameter related to pneumonia severity. Clin Anat 2024. [PMID: 38984460 DOI: 10.1002/ca.24203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/17/2024] [Accepted: 06/28/2024] [Indexed: 07/11/2024]
Abstract
The diameter (mPAD) of the main pulmonary artery (pulmonary artery trunk) is a crucial indicator for cardiovascular health and prognoses in various conditions. Its enlargement is associated with increased mortality and severity in COVID-19-related pneumonia. However, its relevance to non-COVID pneumonia remains uncertain. The aim of this study was to establish an association between mPAD and the severity of non-COVID pneumonia. Eligible participants with qualified Chest Computed Tomography scans from November 2019 to February 2023 were recruited to a cross-sectional retrospective study. They were stratified into pneumonia and non-pneumonia cohorts. Exclusion criteria included pulmonary hypertension, polytrauma, lung neoplasia, or a history of pulmonary stenosis repair. The mPAD was measured in both groups, and medical records were reviewed to identify comorbidities. Pulmonary CT data were classified by pattern and severity, and the mPAD was measured perpendicularly to the long axis of the artery at the point of bifurcation on an axial slice. Analysis of 380 CT scans (52.6% men, 47.4% women; mean age 52.88 ± 17.58) revealed a significant difference in mPAD between pneumonia and non-pneumonia cases (mean difference: 1.19 mm, 95% CI [0.46, 1.92], p = 0.001). Age correlated positively with mPAD (r = 0.231, 95% CI [0.028, 0.069], p < 0.0001), and this correlation persisted after adjusting for confounders (r = 0.220, 95% CI [0.019, 0.073], p = 0.001). Ordinal logistic regression indicated 1.28 times higher odds of severe pneumonia with a larger diameter. The study highlights associations between mPAD, pneumonia, and severity, suggesting clinical relevance. Furthermore, the mPAD should be carefully considered in defining severity criteria for adverse outcomes in pneumonia patients. Further research is needed to refine clinical criteria on the basis of these findings.
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Affiliation(s)
- Luis Carlos Lozano-Carrillo
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Luis Adrian Alvarez-Lozada
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Bernardo Alfonso Fernández-Reyes
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Karla V Rodríguez-Alanís
- Department of Radiology, School of Medicine and University Hospital "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Alberto Montemayor-Martinez
- Department of Radiology, School of Medicine and University Hospital "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Oscar de-la-Garza-Castro
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Alejandro Quiroga-Garza
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
- Department of Radiology, School of Medicine and University Hospital "Dr. Jose Eleuterio Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
- Instituto Mexicano del Seguro Social, Delegacion de Nuevo Leon, Hospital de Traumatología y Ortopedia No. 21, Servicio de Cirugía General, Monterrey, Nuevo Leon, Mexico
| | - Rodrigo Enrique Elizondo-Omaña
- Department of Human Anatomy, Clinical-Surgical Research Group (GICQx), School of Medicine, Universidad Autonoma de Nuevo Leon, Monterrey, Nuevo Leon, Mexico
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3
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Suzuki H, Kawata Y, Aokage K, Matsumoto Y, Sugiura T, Tanabe N, Nakano Y, Tsuchida T, Kusumoto M, Marumo K, Kaneko M, Niki N. Aorta and main pulmonary artery segmentation using stacked U-Net and localization on non-contrast-enhanced computed tomography images. Med Phys 2024; 51:1232-1243. [PMID: 37519027 DOI: 10.1002/mp.16654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The contact between the aorta, main pulmonary artery (MPA), main pulmonary vein, vena cava (VC), and esophagus affects segmentation of the aorta and MPA in non-contrast-enhanced computed tomography (NCE-CT) images. PURPOSE A two-stage stacked U-Net and localization of the aorta and MPA were developed for the segmentation of the aorta and MPA in NCE-CT images. METHODS Normal-dose NCE-CT images of 24 subjects with chronic thromboembolic pulmonary hypertension (CTEPH) and low-dose NCE-CT images of 100 subjects without CTEPH were used in this study. The aorta is in contact with the ascending aorta (AA) and MPA, the AA with the VC, the aortic arch (AR) with the VC and esophagus, and the descending aorta (DA) with the esophagus. These contact surfaces were manually annotated. The contact surfaces were quantified using the contact surface ratio (CSR). Segmentation of the aorta and MPA in NCE-CT images was performed by localization of the aorta and MPA and a two-stage stacked U-Net. Localization was performed by extracting and processing the trachea and main bronchus. The first stage of the stacked U-Net consisted of a 2D U-Net, 2D U-Net with a pre-trained VGG-16 encoder, and 2D attention U-Net. The second stage consisted of a 3D U-Net with four input channels: the CT volume and three segmentation results of the first stage. The model was trained and tested using 10-fold cross-validation. Segmentation of the entire volume was evaluated using the Dice similarity coefficient (DSC). Segmentation of the contact area was also assessed using the mean surface distance (MSD). The statistical analysis of the evaluation underwent a multi-comparison correction. CTEPH and non-CTEPH cases were classified based on the vessel diameters measured from the segmented MPA. RESULTS For the noncontact surfaces of AA, the MSD of stacked U-Net was 0.31 ± 0.10 mm (p < 0.05) and 0.32 ± 0.13 mm (p < 0.05) for non-CTEPH and CTEPH cases, respectively. For contact surfaces with a CSR of 0.4 or greater in AA, the MSD was 0.52 ± 0.23 mm (p < 0.05), and 0.68 ± 0.29 mm (p > 0.05) for non-CTEPH and CTEPH cases, respectively. MSDs were lower than those of 2D and 3D U-Nets for contact and noncontact surfaces; moreover, MSDs increased slightly with larger CSRs. However, the stacked U-Net achieved MSDs of approximately 1 pixel for a wide contact surface. The area under the receiver operating characteristic curve for CTEPH and non-CTEPH classification using the right main pulmonary artery (RMPA) diameter was 0.97 (95% confidence interval [CI]: 0.94-1.00). CONCLUSIONS Segmentation of the aorta and MPA on NCE-CT images were affected by vascular and esophageal contact. The application of stacked U-Net and localization techniques for non-CTEPH and CTEPH cases mitigated the impact of contact, suggesting its potential for diagnosing CTEPH.
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Affiliation(s)
- Hidenobu Suzuki
- Faculty of Science and Technology, Tokushima University, Tokushima, Japan
| | - Yoshiki Kawata
- Institute of Post-LED Photonics, Tokushima University, Tokushima, Japan
| | - Keiju Aokage
- Department of Thoracic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Yuji Matsumoto
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Toshihiko Sugiura
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Nobuhiro Tanabe
- Department of Respirology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yasutaka Nakano
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Takaaki Tsuchida
- Department of Endoscopy, Respiratory Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Masahiko Kusumoto
- Division of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | | | | | - Noboru Niki
- Faculty of Science and Technology, Tokushima University, Tokushima, Japan
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4
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Bailey GL, Wells AU, Desai SR. Imaging of Pulmonary Sarcoidosis-A Review. J Clin Med 2024; 13:822. [PMID: 38337517 PMCID: PMC10856519 DOI: 10.3390/jcm13030822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
Sarcoidosis is the classic multisystem granulomatous disease. First reported as a disorder of the skin, it is now clear that, in the overwhelming majority of patients with sarcoidosis, the lungs will bear the brunt of the disease. This review explores some of the key concepts in the imaging of pulmonary sarcoidosis: the wide array of typical (and some of the less common) findings on high-resolution computed tomography (HRCT) are reviewed and, with this, the concept of morphologic/HRCT phenotypes is discussed. The pathophysiologic insights provided by HRCT through studies where morphologic abnormalities and pulmonary function tests are compared are evaluated. Finally, this review outlines the important contribution of HRCT to disease monitoring and prognostication.
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Affiliation(s)
- Georgina L. Bailey
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK (S.R.D.)
| | - Athol U. Wells
- The Interstitial Lung Disease Unit, Royal Brompton Hospital, London SW3 6NP, UK
- The National Heart & Lung Institute, Imperial College London, London W12 7RQ, UK
- The Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, London W12 7RQ, UK
| | - Sujal R. Desai
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK (S.R.D.)
- The National Heart & Lung Institute, Imperial College London, London W12 7RQ, UK
- The Margaret Turner-Warwick Centre for Fibrosing Lung Diseases, Imperial College London, London W12 7RQ, UK
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5
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Ghrabli S, Elgendi M, Menon C. Identifying unique spectral fingerprints in cough sounds for diagnosing respiratory ailments. Sci Rep 2024; 14:593. [PMID: 38182601 PMCID: PMC10770161 DOI: 10.1038/s41598-023-50371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
Coughing, a prevalent symptom of many illnesses, including COVID-19, has led researchers to explore the potential of cough sound signals for cost-effective disease diagnosis. Traditional diagnostic methods, which can be expensive and require specialized personnel, contrast with the more accessible smartphone analysis of coughs. Typically, coughs are classified as wet or dry based on their phase duration. However, the utilization of acoustic analysis for diagnostic purposes is not widespread. Our study examined cough sounds from 1183 COVID-19-positive patients and compared them with 341 non-COVID-19 cough samples, as well as analyzing distinctions between pneumonia and asthma-related coughs. After rigorous optimization across frequency ranges, specific frequency bands were found to correlate with each respiratory ailment. Statistical separability tests validated these findings, and machine learning algorithms, including linear discriminant analysis and k-nearest neighbors classifiers, were employed to confirm the presence of distinct frequency bands in the cough signal power spectrum associated with particular diseases. The identification of these acoustic signatures in cough sounds holds the potential to transform the classification and diagnosis of respiratory diseases, offering an affordable and widely accessible healthcare tool.
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Affiliation(s)
- Syrine Ghrabli
- Biomedical and Mobile Health Technology Lab, ETH Zurich, 8008, Zurich, Switzerland
- Department of Physics, ETH Zurich, 8093, Zurich, Switzerland
| | - Mohamed Elgendi
- Biomedical and Mobile Health Technology Lab, ETH Zurich, 8008, Zurich, Switzerland.
| | - Carlo Menon
- Biomedical and Mobile Health Technology Lab, ETH Zurich, 8008, Zurich, Switzerland.
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6
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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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7
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O’Corragain O, Alashram R, Millio G, Vanchiere C, Hwang JH, Kumaran M, Dass C, Zhao H, Panero J, Lakhter V, Gupta R, Bashir R, Cohen G, Jimenez D, Criner G, Rali P. Pulmonary artery diameter correlates with echocardiographic parameters of right ventricular dysfunction in patients with acute pulmonary embolism. Lung India 2023; 40:306-311. [PMID: 37417082 PMCID: PMC10401985 DOI: 10.4103/lungindia.lungindia_357_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/21/2022] [Accepted: 01/10/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Right ventricular dysfunction (RVD) is a key component in the process of risk stratification in patients with acute pulmonary embolism (PE). Echocardiography remains the gold standard for RVD assessment, however, measures of RVD may be seen on CTPA imaging, including increased pulmonary artery diameter (PAD). The aim of our study was to evaluate the association between PAD and echocardiographic parameters of RVD in patients with acute PE. Methods Retrospective analysis of patients diagnosed with acute PE was conducted at large academic center with an established pulmonary embolism response team (PERT). Patients with available clinical, imaging, and echocardiographic data were included. PAD was compared to echocardiographic markers of RVD. Statistical analysis was performed using the Student's t test, Chi-square test, or one-way analysis of variance (ANOVA); P < 0.05 was considered statistically significant. Results 270 patients with acute PE were identified. Patients with a PAD >30 mm measured on CTPA had higher rates of RV dilation (73.1% vs 48.7%, P < 0.005), RV systolic dysfunction (65.4% vs 43.7%, P < 0.005), and RVSP >30 mmHg (90.2% vs 68%, P = 0.004), but not TAPSE ≤1.6 cm (39.1% vs 26.1%, P = 0.086). A weak increasing linear relationship between PAD and RVSP was noted (r = 0.379, P = 0.001). Conclusions Increased PAD in patients with acute PE was significantly associated with echocardiographic markers of RVD. Increased PAD on CTPA in acute PE can serve as a rapid prognostic tool and assist with PE risk stratification at the time of diagnosis, allowing rapid mobilization of a PERT team and appropriate resource utilization.
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Affiliation(s)
- Oisin O’Corragain
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Rami Alashram
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gregory Millio
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Catherine Vanchiere
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - John Hojoon Hwang
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Maruti Kumaran
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Chandra Dass
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Huaqing Zhao
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Joseph Panero
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Vlad Lakhter
- Department of Medicine, Section of Cardiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Rohit Gupta
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Riyaz Bashir
- Department of Medicine, Section of Cardiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Gary Cohen
- Department of Radiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - David Jimenez
- Department of Respiratory, Hospital Ramón y Cajal and Medicine, Universidad de Alcalá (Instituto de Ramón y Cajal de Investigación Sanitaria), Centro de Investigación Biomeédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Gerard Criner
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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8
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Valentini A, Franchi P, Cicchetti G, Messana G, Chiffi G, Strappa C, Calandriello L, Del Ciello A, Farchione A, Preda L, Larici AR. Pulmonary Hypertension in Chronic Lung Diseases: What Role Do Radiologists Play? Diagnostics (Basel) 2023; 13:diagnostics13091607. [PMID: 37174998 PMCID: PMC10178805 DOI: 10.3390/diagnostics13091607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Pulmonary hypertension (PH) is a pathophysiological disorder, defined by a mean pulmonary arterial pressure (mPAP) > 20 mmHg at rest, as assessed by right heart catheterization (RHC). PH is not a specific disease, as it may be observed in multiple clinical conditions and may complicate a variety of thoracic diseases. Conditions associated with the risk of developing PH are categorized into five different groups, according to similar clinical presentations, pathological findings, hemodynamic characteristics, and treatment strategy. Most chronic lung diseases that may be complicated by PH belong to group 3 (interstitial lung diseases, chronic obstructive pulmonary disease, combined pulmonary fibrosis, and emphysema) and are associated with the lowest overall survival among all groups. However, some of the chronic pulmonary diseases may develop PH with unclear/multifactorial mechanisms and are included in group 5 PH (sarcoidosis, pulmonary Langerhans' cell histiocytosis, and neurofibromatosis type 1). This paper focuses on PH associated with chronic lung diseases, in which radiological imaging-particularly computed tomography (CT)-plays a crucial role in diagnosis and classification. Radiologists should become familiar with the hemodynamical, physiological, and radiological aspects of PH and chronic lung diseases in patients at risk of developing PH, whose prognosis and treatment depend on the underlying disease.
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Affiliation(s)
- Adele Valentini
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Franchi
- Department of Diagnostic Radiology, G. Mazzini Hospital, 64100 Teramo, Italy
| | - Giuseppe Cicchetti
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Gaia Messana
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Greta Chiffi
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cecilia Strappa
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucio Calandriello
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Annemilia Del Ciello
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Alessandra Farchione
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Lorenzo Preda
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Anna Rita Larici
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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9
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Scarpato BM, Locke BW, Bledsoe J, Knox DB, Conner K, Stoddard GJ, Cirulis MM, Elliott CG, Dodson MW. The association between pulmonary artery enlargement and mortality in an Emergency Department population undergoing computed tomography pulmonary angiography. Pulm Circ 2023; 13:e12225. [PMID: 37063745 PMCID: PMC10090800 DOI: 10.1002/pul2.12225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/16/2023] [Accepted: 04/03/2023] [Indexed: 04/18/2023] Open
Abstract
Findings of an enlarged pulmonary artery diameter (PAd) and increased pulmonary artery to ascending aorta ratio (PA:AA) on contrast-enhanced computed tomography pulmonary angiography (CTPA) are associated with increased mortality in particular groups of patients with cardiopulmonary disease. However, the frequency and prognostic significance of these incidental findings has not been studied in unselected patients evaluated in the Emergency Department (ED). This study aims to determine the prevalence and associated prognosis of enlarged pulmonary artery measurements in an ED cohort. We measured PA and AA diameters on 990 CTPA studies performed in the ED. An enlarged PA diameter was defined as >27 mm in females and >29 mm in males, while an increased PA:AA was defined as >0.9. Poisson regression was performed to calculate prevalence ratios for relevant comorbidities, and multivariable Cox regression was performed to calculate hazard ratios (HR) for mortality of patients with enlarged pulmonary artery measurements. An enlarged PAd was observed in 27.9% of 990 patients and was more commonly observed in older patients and in patients with obesity or heart failure. Conversely, PA:AA was increased in 34.2% of subjects, and was more common in younger patients and those with peripheral vascular disease or obesity. After controlling for age, sex, and comorbidities, both enlarged PAd (HR 1.29, 95% CI 1.00-1.68, p = 0.05) and PA:AA (HR 1.70, 95% CI 1.31-2.22 p < 0.01) were independently associated with mortality. In sum, enlarged PAd and increased PA:AA are common in patients undergoing CTPAs in the ED setting and both are independently associated with mortality.
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Affiliation(s)
- Brittany M. Scarpato
- Division of Pulmonary and Critical Care MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Pulmonary and Critical Care MedicineIntermountain Medical CenterMurrayUtahUSA
| | - Brian W. Locke
- Division of Pulmonary and Critical Care MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Pulmonary and Critical Care MedicineIntermountain Medical CenterMurrayUtahUSA
| | - Joseph Bledsoe
- Division of Emergency MedicineIntermountain Medical CenterMurrayUtahUSA
- Department of Emergency MedicineStanford MedicineStanfordCaliforniaUSA
| | - Daniel B. Knox
- Department of Pulmonary and Critical Care MedicineIntermountain Medical CenterMurrayUtahUSA
| | - Karen Conner
- Division of RadiologyIntermountain Medical CenterMurrayUtahUSA
| | | | - Meghan M. Cirulis
- Division of Pulmonary and Critical Care MedicineUniversity of UtahSalt Lake CityUtahUSA
- Department of Pulmonary and Critical Care MedicineIntermountain Medical CenterMurrayUtahUSA
- Department of Pulmonary and Critical Care MedicinePulmonary Hypertension Care Center, Intermountain Medical CenterUtahMurrayUSA
| | - Charles Gregory Elliott
- Department of Pulmonary and Critical Care MedicineIntermountain Medical CenterMurrayUtahUSA
- Department of Pulmonary and Critical Care MedicinePulmonary Hypertension Care Center, Intermountain Medical CenterUtahMurrayUSA
| | - Mark W. Dodson
- Department of Pulmonary and Critical Care MedicineIntermountain Medical CenterMurrayUtahUSA
- Department of Pulmonary and Critical Care MedicinePulmonary Hypertension Care Center, Intermountain Medical CenterUtahMurrayUSA
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10
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Piccari L, Allwood B, Antoniou K, Chung JH, Hassoun PM, Nikkho SM, Saggar R, Shlobin OA, Vitulo P, Nathan SD, Wort SJ. Pathogenesis, clinical features, and phenotypes of pulmonary hypertension associated with interstitial lung disease: A consensus statement from the Pulmonary Vascular Research Institute's Innovative Drug Development Initiative - Group 3 Pulmonary Hypertension. Pulm Circ 2023; 13:e12213. [PMID: 37025209 PMCID: PMC10071306 DOI: 10.1002/pul2.12213] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/03/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
Pulmonary hypertension (PH) is a frequent complication of interstitial lung disease (ILD). Although PH has mostly been described in idiopathic pulmonary fibrosis, it can manifest in association with many other forms of ILD. Associated pathogenetic mechanisms are complex and incompletely understood but there is evidence of disruption of molecular and genetic pathways, with panvascular histopathologic changes, multiple pathophysiologic sequelae, and profound clinical ramifications. While there are some recognized clinical phenotypes such as combined pulmonary fibrosis and emphysema and some possible phenotypes such as connective tissue disease associated with ILD and PH, the identification of further phenotypes of PH in ILD has thus far proven elusive. This statement reviews the current evidence on the pathogenesis, recognized patterns, and useful diagnostic tools to detect phenotypes of PH in ILD. Distinct phenotypes warrant recognition if they are characterized through either a distinct presentation, clinical course, or treatment response. Furthermore, we propose a set of recommendations for future studies that might enable the recognition of new phenotypes.
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Affiliation(s)
- Lucilla Piccari
- Department of Pulmonary Medicine Hospital del Mar Barcelona Spain
| | - Brian Allwood
- Department of Medicine, Division of Pulmonology Stellenbosch University & Tygerberg Hospital Cape Town South Africa
| | - Katerina Antoniou
- Department of Thoracic Medicine University of Crete School of Medicine Heraklion Crete Greece
| | - Jonathan H Chung
- Department of Radiology The University of Chicago Medicine Chicago Illinois USA
| | - Paul M Hassoun
- Department of Medicine, Division of Pulmonary and Critical Care Medicine Johns Hopkins University Baltimore Maryland USA
| | | | - Rajan Saggar
- Lung & Heart-Lung Transplant and Pulmonary Hypertension Programs University of California Los Angeles David Geffen School of Medicine Los Angeles California USA
| | - Oksana A Shlobin
- Advanced Lung Disease and Transplant Program, Inova Health System Falls Church Virginia USA
| | - Patrizio Vitulo
- Department of Pulmonary Medicine IRCCS Mediterranean Institute for Transplantation and Advanced Specialized Therapies Palermo Sicilia Italy
| | - Steven D Nathan
- Advanced Lung Disease and Transplant Program, Inova Health System Falls Church Virginia USA
| | - Stephen John Wort
- National Pulmonary Hypertension Service at the Royal Brompton Hospital London UK
- National Heart and Lung Institute, Imperial College London UK
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11
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Hahn LD, Papamatheakis DG, Fernandes TM, Poch DS, Yang J, Shen J, Hoh CK, Hsiao A, Kerr KM, Pretorius V, Madani MM, Kim NH, Kligerman SJ. Multidisciplinary Approach to Chronic Thromboembolic Pulmonary Hypertension: Role of Radiologists. Radiographics 2023; 43:e220078. [DOI: 10.1148/rg.220078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Lewis D. Hahn
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Demosthenes G. Papamatheakis
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Timothy M. Fernandes
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - David S. Poch
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Jenny Yang
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Jody Shen
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Carl K. Hoh
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Albert Hsiao
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Kim M. Kerr
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Victor Pretorius
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Michael M. Madani
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Nick H. Kim
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
| | - Seth J. Kligerman
- From the Departments of Radiology (L.D.H., C.K.H., A.H., S.J.K.), Pulmonology (D.G.P., T.M.F., D.S.P., J.Y., C.K.H., K.M.K., N.H.K.), and Cardiothoracic Surgery (V.P., M.M.M.), University of California San Diego School of Medicine, 9300 Campus Point Dr, La Jolla, CA 92037-0841; and Department of Radiology, Stanford School of Medicine, Palo Alto, Calif (J.S.)
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12
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Hsia CCW, Bates JHT, Driehuys B, Fain SB, Goldin JG, Hoffman EA, Hogg JC, Levin DL, Lynch DA, Ochs M, Parraga G, Prisk GK, Smith BM, Tawhai M, Vidal Melo MF, Woods JC, Hopkins SR. Quantitative Imaging Metrics for the Assessment of Pulmonary Pathophysiology: An Official American Thoracic Society and Fleischner Society Joint Workshop Report. Ann Am Thorac Soc 2023; 20:161-195. [PMID: 36723475 PMCID: PMC9989862 DOI: 10.1513/annalsats.202211-915st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Multiple thoracic imaging modalities have been developed to link structure to function in the diagnosis and monitoring of lung disease. Volumetric computed tomography (CT) renders three-dimensional maps of lung structures and may be combined with positron emission tomography (PET) to obtain dynamic physiological data. Magnetic resonance imaging (MRI) using ultrashort-echo time (UTE) sequences has improved signal detection from lung parenchyma; contrast agents are used to deduce airway function, ventilation-perfusion-diffusion, and mechanics. Proton MRI can measure regional ventilation-perfusion ratio. Quantitative imaging (QI)-derived endpoints have been developed to identify structure-function phenotypes, including air-blood-tissue volume partition, bronchovascular remodeling, emphysema, fibrosis, and textural patterns indicating architectural alteration. Coregistered landmarks on paired images obtained at different lung volumes are used to infer airway caliber, air trapping, gas and blood transport, compliance, and deformation. This document summarizes fundamental "good practice" stereological principles in QI study design and analysis; evaluates technical capabilities and limitations of common imaging modalities; and assesses major QI endpoints regarding underlying assumptions and limitations, ability to detect and stratify heterogeneous, overlapping pathophysiology, and monitor disease progression and therapeutic response, correlated with and complementary to, functional indices. The goal is to promote unbiased quantification and interpretation of in vivo imaging data, compare metrics obtained using different QI modalities to ensure accurate and reproducible metric derivation, and avoid misrepresentation of inferred physiological processes. The role of imaging-based computational modeling in advancing these goals is emphasized. Fundamental principles outlined herein are critical for all forms of QI irrespective of acquisition modality or disease entity.
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13
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Marchetti F, Izzi N, Donatelli A, Valentini A, Muzic SI, Dore R, Di Sabatino A, Perrone T, Falaschi F, Sabatini U, Ballesio A, Meloni F, Lettieri S, Mojoli F, Perlini S, Novati S, Pagani E, Klersy C, Bruno R, Preda L. Mid-term follow-up chest CT findings in recovered COVID-19 patients with residual symptoms. Br J Radiol 2023; 96:20220012. [PMID: 36427055 PMCID: PMC10997016 DOI: 10.1259/bjr.20220012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 09/24/2022] [Accepted: 10/06/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES More than a year has passed since the initial outbreak of SARS-CoV-2, which caused many hospitalizations worldwide due to COVID-19 pneumonia and its complications. However, there is still a lack of information detailing short- and long-term outcomes of previously hospitalized patients. The purpose of this study is to analyze the most frequent lung CT findings in recovered COVID-19 patients at mid-term follow-ups. METHODS A total of 407 consecutive COVID-19 patients who were admitted to the Fondazione IRCCS Policlinico San Matteo, Pavia and discharged between February 27, 2020, and June 26, 2020 were recruited into this study. Out of these patients, a subset of 108 patients who presented with residual asthenia and dyspnea at discharge, altered spirometric data, positive lung ultrasound and positive chest X-ray was subsequently selected, and was scheduled to undergo a mid-term chest CT study, which was evaluated for specific lung alterations and morphological patterns. RESULTS The most frequently observed lung CT alterations, in order of frequency, were ground-glass opacities (81%), linear opacities (74%), bronchiolectases (64.81%), and reticular opacities (63.88%). The most common morphological pattern was the non-specific interstitial pneumonia pattern (63.88%). Features consistent with pulmonary fibrosis were observed in 32 patients (29.62%). CONCLUSIONS Our work showed that recovered COVID-19 patients who were hospitalized and who exhibited residual symptoms after discharge had a slow radiological recovery with persistent residual lung alterations. ADVANCES IN KNOWLEDGE This slow recovery process should be kept in mind when determining the follow-up phases in order to improve the long-term management of patients affected by COVID-19.
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Affiliation(s)
- Francesca Marchetti
- Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, University of Pavia, Pavia, Italy
| | - Nicoletta Izzi
- Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, University of Pavia, Pavia, Italy
| | - Antonella Donatelli
- Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, University of Pavia, Pavia, Italy
| | - Adele Valentini
- Radiology Institute, Fondazione IRCCS Policlinico San
Matteo, Pavia, Italy
| | - Shaun Ivan Muzic
- Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, University of Pavia, Pavia, Italy
| | - Roberto Dore
- Radiology Unit, Cinical Institute Città di
Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione I.R.C.C.S.
Policlinico San Matteo, University of Pavia, Pavia,
Italy
| | - Tiziano Perrone
- Department of Internal Medicine, Fondazione I.R.C.C.S.
Policlinico San Matteo, University of Pavia, Pavia,
Italy
| | - Francesco Falaschi
- Internal Medicine 2, Fondazione IRCCS Policlinico San Matteo,
University of Pavia, Pavia, Italy
| | - Umberto Sabatini
- Department of Internal Medicine, Fondazione I.R.C.C.S.
Policlinico San Matteo, University of Pavia, Pavia,
Italy
| | - Alessia Ballesio
- Department of Internal Medicine, Fondazione I.R.C.C.S.
Policlinico San Matteo, University of Pavia, Pavia,
Italy
| | - Federica Meloni
- University of Pavia and Pneumology Unit, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
| | - Sara Lettieri
- Department of Anesthesia, Intensive Care and Pain Therapy,
Fondazione IRCCS Policlinico San Matteo, Pavia,
Italy
| | - Francesco Mojoli
- Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, University of Pavia, Pavia, Italy
| | - Stefano Perlini
- Department of Internal Medicine, Fondazione I.R.C.C.S.
Policlinico San Matteo, University of Pavia, Pavia,
Italy
| | - Stefano Novati
- Department of Infectious Diseases, Fondazione IRCCS
Policlinico San Matteo, University of Pavia, Pavia,
Italy
| | - Elisabetta Pagani
- Department of Infectious Diseases, Fondazione IRCCS
Policlinico San Matteo, University of Pavia, Pavia,
Italy
| | - Catherine Klersy
- Clinic Epidemiology and Biometry Unit, Fondazione IRCCS
Policlinico San Matteo, Pavia, Italy
| | - Raffaele Bruno
- Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, University of Pavia, Pavia, Italy
| | - Lorenzo Preda
- Department of Clinical, Surgical, Diagnostic and Pediatric
Sciences, University of Pavia, Pavia, Italy
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14
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Stubbs H, MacLellan A, Lua S, Dormand H, Church C. The right ventricle under pressure: Anatomy and imaging in sickness and health. J Anat 2023; 242:17-28. [PMID: 35285014 PMCID: PMC9773164 DOI: 10.1111/joa.13654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/28/2022] [Accepted: 03/02/2022] [Indexed: 12/25/2022] Open
Abstract
The right ventricle (RV) is an important structure which serves a multitude of vital physiological functions in health. For many years, the left ventricle has dominated the focus of understanding in both biology and pathophysiology and the RV was felt to be more of a passive structure which rarely had an effect on disease states. However, it is increasingly recognised that the RV is essential to the homoeostasis of normal physiology and disturbances in RV structure and function have a substantial effect on patient outcomes. Indeed, the prognosis of diseases of lung diseases affecting the pulmonary vasculature and left heart disease is intimately linked to the function of the right ventricle. This review sets out to describe the developmental and anatomical complexities of the right ventricle while exploring the modern techniques employed to image and understand its function from a clinical perspective.
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Affiliation(s)
- Harrison Stubbs
- Scottish Pulmonary Vascular Unit, Golden Jubilee National HospitalGlasgowScotland
- University of GlasgowGlasgowScotland
| | - Alexander MacLellan
- Scottish Pulmonary Vascular Unit, Golden Jubilee National HospitalGlasgowScotland
- University of GlasgowGlasgowScotland
| | - Stephanie Lua
- Scottish Pulmonary Vascular Unit, Golden Jubilee National HospitalGlasgowScotland
| | - Helen Dormand
- Scottish Pulmonary Vascular Unit, Golden Jubilee National HospitalGlasgowScotland
| | - Colin Church
- Scottish Pulmonary Vascular Unit, Golden Jubilee National HospitalGlasgowScotland
- University of GlasgowGlasgowScotland
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15
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Sirajuddin A, Mirmomen SM, Henry TS, Kandathil A, Kelly AM, King CS, Kuzniewski CT, Lai AR, Lee E, Martin MD, Mehta P, Morris MF, Raptis CA, Roberge EA, Sandler KL, Donnelly EF. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update. J Am Coll Radiol 2022; 19:S502-S512. [PMID: 36436973 DOI: 10.1016/j.jacr.2022.09.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations may be helpful in diagnosing and determining the etiology of pulmonary hypertension. Imaging examinations discussed in this document include chest radiography, ultrasound echocardiography, ventilation/perfusion scintigraphy, CT, MRI, right heart catheterization, and pulmonary angiography. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Travis S Henry
- Panel Chair, University of California San Francisco, San Francisco, California; Co-Director, ACR Education Center High Resolution CT of the Chest Course; Division Chief of Cardiothoracic Imaging, Duke University
| | - Asha Kandathil
- University of Texas Southwestern Medical Center, Dallas, Texas; Associate Program Director, Cardiothoracic Radiology Fellowship, The University of Texas Southwestern Medical Center
| | - Aine Marie Kelly
- Emory University Hospital, Atlanta, Georgia; Assistant Program Director Radiology Residency
| | - Christopher S King
- Inova Fairfax Hospital, Falls Church, Virginia; American College of Chest Physicians; Associate Medical Director, Advanced Lung Disease and Transplant Program; Associate Medical Director, Pulmonary Hypertension Program; System Director, Respiratory Therapy; Pulmonary Fibrosis Foundation
| | | | - Andrew R Lai
- University of California San Francisco, San Francisco, California; Primary care physician; former Director of the University of California San Francisco Hospitalist Procedure Service; former Director of the University of California San Francisco Division of Hospital Medicine's Case Review Committee, and former Director of procedures/quality improvement rotation for for the UCSF Internal Medicince residency
| | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan; Director M1Radiology Education University of Michigan Medical School, Associated Program Director Diagnostic Radiology Michigan Medicine, Director of Residency Education Cardiothoracic Division Michigan
| | - Maria D Martin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Director Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health
| | - Parth Mehta
- University of Illinois at Chicago College of Medicine, Chicago, Illinois; American College of Physicians
| | - Michael F Morris
- University of Arizona College of Medicine, Phoenix, Arizona; Director of Cardiac CT and MRI
| | | | - Eric A Roberge
- Uniformed Services University of the Health Sciences-Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Kim L Sandler
- Vanderbilt University Medical Center, Nashville, Tennessee; Imaging Chair Thoracic Committee ECOG-ACRIN; Co-Chair Lung Screening 2.0 Steering Committee; Co-Director Vanderbilt Lung Screening Program
| | - Edwin F Donnelly
- Specialty Chair, The Ohio State University Wexner Medical Center, Columbus, Ohio; Ohio State University Medical Center: Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology
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16
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Lee GM, Carroll MB, Galvin JR, Walker CM. Mosaic Attenuation Pattern. Radiol Clin North Am 2022; 60:963-978. [DOI: 10.1016/j.rcl.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Cortopassi IO, Gosangi B, Asch D, Bader AS, Gange CP, Rubinowitz AN. Diseases of the pulmonary arteries: imaging appearances and pearls. Clin Imaging 2022; 91:111-125. [DOI: 10.1016/j.clinimag.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/16/2022] [Accepted: 08/19/2022] [Indexed: 11/03/2022]
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18
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Kamada H, Nakamura M, Ota H, Higuchi S, Takase K. Blood flow analysis with computational fluid dynamics and 4D-flow MRI for vascular diseases. J Cardiol 2022; 80:386-396. [PMID: 35718672 DOI: 10.1016/j.jjcc.2022.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/16/2022] [Indexed: 10/31/2022]
Abstract
Both computational fluid dynamics (CFD) and time-resolved, three-dimensional, phase-contrast, magnetic resonance imaging (4D-flow MRI) enable visualization of time-varying blood flow structures and quantification of blood flow in vascular diseases. However, they are totally different. CFD is a method to calculate blood flow by solving the governing equations of fluid mechanics, so the obtained flow field is somewhat virtual. On the other hand, 4D-flow MRI measures blood flow in vivo, thus the flow is real. Recently, with the development and enhancement of computers, medical imaging techniques, and related software, blood flow analysis has become more accessible to clinicians and its usefulness in vascular diseases has been demonstrated. In this review, we have outlined the methods and characteristics of CFD and 4D-flow MRI, respectively. We have discussed the differences in the characteristics between both methods; reviewed the milestones achieved by blood flow analysis in various vascular diseases; and discussed the usefulness, challenges, and limitations of blood flow analysis. We have discussed the difficulties and limitations of current blood flow analysis. We have also discussed our views on future directions.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan.
| | - Masanori Nakamura
- Department of Electrical and Mechanical Engineering, Nagoya Institute of Technology, Nagoya, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Satoshi Higuchi
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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ÇORAPLI G, ÇİL E, ŞAHİN TUTAK A, ÇORAPLI M. The effect of main pulmonary artery diameter on the prognosis of COVID-19 patients in the ICU. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1072443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The aim of this study was to examine the effect of main pulmonary artery diameter (MPAD), which is evaluated in patients when first admitted to the intensive care unit due to COVID-19, on mortality.
Material and Method: Thoracic computed tomography examinations performed during the initial admission to hospital of patients who were treated in the intensive care unit between October 1, 2020, and June 1, 2021, were evaluated retrospectively. Cox regression analysis was performed with the program R-Project to evaluate the relationship between MPAD and mortality.
Results: No significant correlation was found between MPAD and mortality in models used with or without adjusting for age and sex (respectively P: 0.890 and P: 0.920).
Conclusion: The MPAD value measured at the initial admission of COVID-19 patients hospitalized in the intensive care unit is not a parameter that can be used to predict mortality.
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Affiliation(s)
| | - Ercan ÇİL
- ADIYAMAN ÜNİVERSİTESİ, TIP FAKÜLTESİ
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20
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Kostura M, Smalley C, Koyfman A, Long B. Right heart failure: A narrative review for emergency clinicians. Am J Emerg Med 2022; 58:106-113. [PMID: 35660367 DOI: 10.1016/j.ajem.2022.05.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/18/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Right heart failure (RHF) is a clinical syndrome with impaired right ventricular cardiac output due to a variety of etiologies including ischemia, elevated pulmonary arterial pressure, or volume overload. Emergency department (ED) patients with an acute RHF exacerbation can be diagnostically and therapeutically challenging to manage. OBJECTIVE This narrative review describes the pathophysiology of right ventricular dysfunction and pulmonary hypertension, the methods to diagnose RHF in the ED, and management strategies. DISCUSSION Right ventricular contraction normally occurs against a low pressure, highly compliant pulmonary vascular system. This physiology makes the right ventricle susceptible to acute changes in afterload, which can lead to RHF. Patients with acute RHF may present with an acute illness and have underlying chronic pulmonary hypertension due to left ventricular failure, pulmonary arterial hypertension, chronic lung conditions, thromboemboli, or idiopathic conditions. Patients can present with a variety of symptoms resulting from systemic edema and hemodynamic compromise. Evaluation with electrocardiogram, laboratory analysis, and imaging is necessary to evaluate cardiac function and end organ injury. Management focuses on treating the underlying condition, optimizing oxygenation and ventilation, treating arrhythmias, and understanding the patient's hemodynamics with bedside ultrasound. As RHF patients are preload dependent they may require fluid resuscitation or diuresis. Hypotension should be rapidly addressed with vasopressors. Cardiac contractility can be augmented with inotropes. Efforts should be made to support oxygenation while trying to avoid intubation if possible. CONCLUSIONS Emergency clinician understanding of this condition is important to diagnose and treat this life-threatening cardiopulmonary disorder.
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Affiliation(s)
- Matthew Kostura
- Department of Emergency Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Courtney Smalley
- Department of Emergency Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- SAUSHEC, Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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21
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Rehman A, Darira J, Ahmed MS, Hamid K, Shazlee MK, Hyder SMS. Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating With Echocardiography: A Study at a Tertiary Care Hospital. Cureus 2022; 14:e25319. [PMID: 35755553 PMCID: PMC9231577 DOI: 10.7759/cureus.25319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: Pulmonary hypertension (PH) is a threatening condition, and it is far more common than previously assumed, especially after the COVID pandemic. Its outcome is not good; if detected late, and can lead to right ventricular failure, which can be fatal. Our goal was to evaluate CT signs of PH, correlate them with echocardiography, and identify the cut-off values of these signs in our population. Method: In this study, 160 patients having both CT and echocardiography with a maximum gap of one month were assessed from June to November 2021. The association between CT signs and echocardiography to diagnose PH was investigated. The Pearson and Spearman correlation and area under receiver operating curve (AUROC) tests were performed in the analysis. Receiver operating characteristic curve analysis was also used to assess CT’s diagnostic capability and cut-off values. Result: The correlation between main pulmonary artery (MPA) diameter and main pulmonary artery to aorta ratio (MPA/AO) with mean pulmonary artery pressure (mPAP) was weak but statistically significant (r = 0.316 and r = 0.321, p<0.001). However, there was a very weak correlation between the right and left pulmonary artery and mPAP with correlation coefficients (r) of 0.155 and 0.138, respectively. For the first time in our population, we measured the cut-off values of MPA and MPA/AO ratios for PH which were 26 and 0.88 mm, respectively. Conclusions: The CT signs of PH correlate with echocardiography; however, should not be used solely; the cut-off values should be used according to race and population.
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22
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Ishikawa T, Egusa M, Kawamoto D, Nishimura T, Sasaki R, Saeki I, Sakaida I, Takami T. Screening for portopulmonary hypertension using computed tomography-based measurements of the main pulmonary artery and ascending aorta diameters in patients with portal hypertension. Hepatol Res 2022; 52:255-268. [PMID: 34822208 DOI: 10.1111/hepr.13735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/10/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
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.
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Affiliation(s)
- Tsuyoshi Ishikawa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
| | - Maho Egusa
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
| | - Daiki Kawamoto
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
| | - Tatsuro Nishimura
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
| | - Ryo Sasaki
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
| | - Issei Saeki
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
| | - Isao Sakaida
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
| | - Taro Takami
- Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Ube-Yamaguchi, Japan
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23
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Yang S, Lei S, Peng F, Wu SJ. Detection of Pulmonary Hypertension by Combining Echocardiography and Chest Radiography. Acad Radiol 2022; 29 Suppl 2:S23-S30. [PMID: 33160858 DOI: 10.1016/j.acra.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/07/2020] [Accepted: 10/01/2020] [Indexed: 11/01/2022]
Abstract
RATIONALE AND OBJECTIVES In pulmonary hypertension (PH) patients, chest radiographs often show an increase in the diameter of the right descending pulmonary artery (RDPA). The purpose of this study is to evaluate whether a combination of echocardiography and chest radiography for detecting PH is more accurate than echocardiography alone. MATERIALS AND METHODS Between 2013 and 2019, a total of 1301 patients were included in this study. Among them, 1030 patients with congenital heart disease (CHD) were used to establish a linear regression model by combining echocardiographic and chest radiographic variables, and 136 CHD patients and 135 non-CHD patients were used to compare the accuracy between a new model and the 2015 ESC/ERS guidelines for right heart catheterization recommendation. The chest radiographic diameter of the RDPA, and the echocardiography-measured tricuspid regurgitation pressure gradient and the main pulmonary artery diameter were assessed. RESULTS The TG-RDPA composite index correlated more strongly than either the TG or RDPA (r = 0.741 vs 0.709 or 0.544; both p value <0.001). The TG-RDPA composite index was more accurate in detecting PH than the ESC/ERS 2015 guidelines (overall accuracy: 83.8% vs 77.1%; missed diagnoses rate: 12.0% vs 22.5%). The overall accuracy of the main pulmonary artery-RDPA composite index (r = 0.599, p value <0.001) was 84.1% compared to overall accuracy of 77.1% using the ESC/ERS 2015 guidelines. CONCLUSION A combination of echocardiography and chest X-ray may be a more accurate way to detect PH and an alternative method for suspected PH patients without tricuspid regurgitation velocity.
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24
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Utility of Automated Cardiac Chamber Volumetry by Non-Gated CT Pulmonary Angiography for Detection of Pulmonary Hypertension Using the 2018 Updated Hemodynamic Definition. AJR Am J Roentgenol 2022; 219:66-75. [PMID: 35080457 DOI: 10.2214/ajr.21.27147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND: Noninvasive tests for pulmonary hypertension (PH) are needed to help select patients for diagnostic right heart catheterization (RHC). CT pulmonary angiography (CTPA) is commonly performed for suspected PH. OBJECTIVE: To assess the utility of CTPA-based cardiac chamber volumetric measurements for diagnosis of PH in comparison with echocardiographic and conventional CTPA parameters, using as reference the 2018 updated hemodynamic definition. METHODS: This retrospective study included 109 patients (median age, 68 years; 72 women, 37 men) who underwent non-gated CTPA, echocardiography, and RHC for workup of suspected PH between August 2013 and February 2016. Two radiologists independently used automated 3D segmentation software to determine volumes of the right ventricle (RV), right atrium (RA), left ventricle (LV), and left atrium (LA), and measured axial diameters of cardiac chambers, main pulmonary artery, and ascending aorta. Interobserver agreement was assessed, and mean values were obtained; one observer repeated volumetric measurements to assess intraobserver agreement. ROC analysis was used to assess diagnostic performance for detection of PH. A multivariable binary logistic regression model was established. RESULTS: A total of 60/109 patients had PH. Intra- and interobserver agreement were excellent for all volume measurements (intraclass correlation coefficients, 0.935-0.999). In patients with, versus without, PH, RV volume was 172.6 versus 118.1 ml, and RA volume was 130.2 versus 77.0 ml (both p<.05). Cardiac chamber measurements with highest AUC for PH were RV/LV volume ratio and RA volume (both 0.791). Significant predictors of PH after adjustment for age, sex, and body surface area included RV volume per 10 ml [odds ratio (OR)=1.21], RA volume per 10 ml (OR=1.27), RV/LV volume ratio (OR=2.91), and RA/LA volume ratio (OR=11.22). Regression analysis yielded a predictive model for PH containing two independent predictors, echocardiographic pulmonary arterial systolic pressure and CTPA-based RA volume; the model had AUC 0.898, sensitivity 83.3%, and specificity 85.7%. CONCLUSION: Automated cardiac chamber volumetry using non-gated CTPA, particularly of the RA, provides incremental utility relative to echocardiographic and conventional CTPA parameters for diagnosis of PH. CLINICAL IMPACT: Automated cardiac chamber volumetry on CTPA may facilitate early nonvinvasive detection of PH, identifying patients warranting further evaluation by RHC.
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25
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Ongen G, Gokalp G, Nas OF, Ozpar R, Candan S. The association between the CT severity index and the pulmonary artery area in COVID-19 pneumonia. Acta Radiol 2022:2841851211070491. [PMID: 35068179 DOI: 10.1177/02841851211070491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The pulmonary artery area (PAA) is a valuable non-invasive method for the diagnosis of pulmonary hypertension. PURPOSE To compare the change in PAA in patients with COVID-19 with the computed tomography (CT) severity index using follow-up imaging. MATERIAL AND METHODS A total of 81 patients who were followed up and underwent CT assessment more than once at our hospital's pandemic department were evaluated retrospectively. Patients with progression were separated into three groups: progression ranging from mild-to-mild infiltration (Group A, CT severity index of 0-2); progression from mild to severe infiltration (Group B, CT severity index of 0-2 to 3-5); and progression from severe-to-severe infiltration (Group C, CT severity index of 3-5). The PAAs were calculated separately. RESULTS The mean age was 56 ± 12 years. In terms of those patients showing progression in the CT images, the number of patients in Groups A, B, and C was 29, 40, and 12 in the right lung; 32, 45, and 4 in the left lung; 23, 45, and 13 on both lungs, respectively. There was no significant difference between the main, right, and left PAAs in Group A (P > 0.05). In Group B, there were significant increases in the areas of the main, right, and left PAAs (P < 0.05). There were also significant increases in the areas of the right and main pulmonary arteries in Group C (P < 0.05). CONCLUSION PAAs increase as disease involvement advances in cases with COVID-19 pneumonia, which is thought to be correlated with progression.
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Affiliation(s)
- Gokhan Ongen
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Gokhan Gokalp
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Omer Fatih Nas
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Rifat Ozpar
- School of Medicine, Department of Radiology, Bursa Uludag University, Bursa, Turkey
| | - Selman Candan
- Ministry of Health, Department of Radiology, Kelkit State Hospital, Gumushane, Turkey
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Farrell C, Balasubramanian A, Hays AG, Hsu S, Rowe S, Zimmerman SL, Hassoun PM, Mathai SC, Mukherjee M. A Clinical Approach to Multimodality Imaging in Pulmonary Hypertension. Front Cardiovasc Med 2022; 8:794706. [PMID: 35118142 PMCID: PMC8804287 DOI: 10.3389/fcvm.2021.794706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) is a clinical condition characterized by progressive elevations in mean pulmonary artery pressures and right ventricular dysfunction, associated with significant morbidity and mortality. For resting PH to develop, ~50-70% of the pulmonary vasculature must be affected, suggesting that even mild hemodynamic abnormalities are representative of advanced pulmonary vascular disease. The definitive diagnosis of PH is based upon hemodynamics measured by right heart catheterization; however this is an invasive and resource intense study. Early identification of pulmonary vascular disease offers the opportunity to improve outcomes by instituting therapies that slow, reverse, or potentially prevent this devastating disease. Multimodality imaging, including non-invasive modalities such as echocardiography, computed tomography, ventilation perfusion scans, and cardiac magnetic resonance imaging, has emerged as an integral tool for screening, classifying, prognosticating, and monitoring response to therapy in PH. Additionally, novel imaging modalities such as echocardiographic strain imaging, 3D echocardiography, dual energy CT, FDG-PET, and 4D flow MRI are actively being investigated to assess the severity of right ventricular dysfunction in PH. In this review, we will describe the utility and clinical application of multimodality imaging techniques across PH subtypes as it pertains to screening and monitoring of PH.
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Affiliation(s)
- Christine Farrell
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Rowe
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Stefan L. Zimmerman
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M. Hassoun
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
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Soliveres E, Mc Entee K, Couvreur T, Fastrès A, Roels E, Merveille AC, Tutunaru AC, Clercx C, Bolen G. Utility of Computed Tomographic Angiography for Pulmonary Hypertension Assessment in a Cohort of West Highland White Terriers With or Without Canine Idiopathic Pulmonary Fibrosis. Front Vet Sci 2021; 8:732133. [PMID: 34631858 PMCID: PMC8495013 DOI: 10.3389/fvets.2021.732133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/20/2021] [Indexed: 11/25/2022] Open
Abstract
West Highland white terriers (WHWTs) affected with canine idiopathic pulmonary fibrosis (CIPF) are at risk of developing precapillary pulmonary hypertension (PH). In humans, thoracic computed tomography angiography (CTA) is commonly used to diagnose and monitor patients with lower airway diseases. In such patients, CTA helps to identify comorbidities, such as PH, that could negatively impact prognosis. Diameter of the pulmonary trunk (PT), pulmonary trunk-to-aorta ratio (PT/Ao), and right ventricle-to-left ventricle ratio (RV/LV) are CTA parameters commonly used to assess the presence of PH. Pulmonary vein-to-right pulmonary artery ratio (PV/PA) is a new echocardiographic parameter that can be used in dogs to diagnose PH. The primary aim of this study was to evaluate the use of various CTA parameters to diagnose PH. An additional aim was to evaluate the correlation of RV/LV measurements between different CTA planes. CTA and echocardiography were prospectively performed on a total of 47 WHWTs; 22 affected with CIPF and 25 presumed healthy control dogs. Dogs were considered to have PH if pulmonary vein-to-right pulmonary artery ratio (PV/PA) measured on 2D-mode echocardiography was less than to 0.7. WHWTs affected with CIPF had higher PT/Ao compared with control patients. In WHWTs affected with CIPF, PT size was larger in dogs with PH (15.4 mm) compared with dogs without PH (13 mm, p = 0.003). A cutoff value of 13.8 mm predicted PH in WHWTs affected with CIPF with a sensitivity of 90% and a specificity of 87% (AUC = 0.93). High correlations were observed between the different CTA planes of RV/LV. Results suggest that diameter of the PT measured by CTA can be used to diagnose PH in WHWTs with CIPF.
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Affiliation(s)
- Eugénie Soliveres
- Department of Clinical Sciences, Companion Animals, Faculty of Veterinary Medicine, Fundamental and Applied Research for Animals & Health (FARAH), University of Liège, Liège, Belgium
| | - Kathleen Mc Entee
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Couvreur
- Department of Radiology, Christian Hospital Center Liège, Liège, Belgium
| | - Aline Fastrès
- Department of Clinical Sciences, Companion Animals, Faculty of Veterinary Medicine, Fundamental and Applied Research for Animals & Health (FARAH), University of Liège, Liège, Belgium
| | - Elodie Roels
- Department of Clinical Sciences, Companion Animals, Faculty of Veterinary Medicine, Fundamental and Applied Research for Animals & Health (FARAH), University of Liège, Liège, Belgium
| | - Anne-Christine Merveille
- Department of Clinical Sciences, Companion Animals, Faculty of Veterinary Medicine, Fundamental and Applied Research for Animals & Health (FARAH), University of Liège, Liège, Belgium
| | - Alexandru-Cosmin Tutunaru
- Department of Clinical Sciences, Companion Animals, Faculty of Veterinary Medicine, Fundamental and Applied Research for Animals & Health (FARAH), University of Liège, Liège, Belgium
| | - Cécile Clercx
- Department of Clinical Sciences, Companion Animals, Faculty of Veterinary Medicine, Fundamental and Applied Research for Animals & Health (FARAH), University of Liège, Liège, Belgium
| | - Géraldine Bolen
- Department of Clinical Sciences, Companion Animals, Faculty of Veterinary Medicine, Fundamental and Applied Research for Animals & Health (FARAH), University of Liège, Liège, Belgium
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Zhou Y, Thanathi Mohamed Ameen MNA, Li W, Feng D, Yang H, Zou XL, Wu S, Zhang T. Main pulmonary artery enlargement predicts 90-day readmissions in Chinese COPD patients. J Thorac Dis 2021; 13:5731-5740. [PMID: 34795922 PMCID: PMC8575810 DOI: 10.21037/jtd-21-344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 08/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Numerous studies have shown pulmonary artery enlargement when measured by chest computed tomography (CT) could predict a worse outcome in chronic obstructive pulmonary disease (COPD) patients. Herein, we studied the prognostic implication of main pulmonary artery diameter (MPAD) in Chinese COPD patients. METHODS This is an observational case-control study. Patients with 90-day readmissions are case group and those without 90-day readmission are control group. The study comprised of 417 COPD patients who underwent chest CT in their initial admission due to acute exacerbation of COPD (AECOPD). We analyzed their clinical characteristics such as MPAD, arterial blood gas (ABG) results, other chest CT findings and comorbidities to identify the cause of readmission within 90 days. RESULTS Median age of our study population is 75 years old, and 79.6% of them are male. The median MPAD is 2.8 cm and 80.6% were also diagnosed with community acquired pneumonia (CAP) in their first admission. The median MPAD in patients with 90-day readmission was 3.1 cm while patients without 90-day readmission had median MPAD of 2.8 cm. Through multivariate logistic regression analysis CAP (P=0.019, OR: 3.105, 95% CI: 1.203-8.019) and MPAD (P<0.001, OR: 2.898, 95% CI: 1.824-4.605) were statistically significant. In the second stage of analysis, subgroup of patients diagnosed with CAP and AECOPD (pAECOPD) were analyzed, MPAD remained statistically significant (P<0.001, OR: 3.490, 95% CI: 1.929-6.316) and receiver operative characteristic (ROC) curve for pAECOPD patients; area under the curve (AUC) was 0.704 (95% CI: 0.631-0.778) with a MPAD cut off value of 2.9 cm (sensitivity 72%, specificity 53%). CONCLUSIONS Enlarged MPAD and pAECOPD in initial admission are independent risk factors for 90-day readmission. In our pAECOPD patient population, MPAD >2.9 cm are at increased risk of 90-day readmission.
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Affiliation(s)
- Yuqi Zhou
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | | | - Wenjuan Li
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dingyun Feng
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hailing Yang
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Ling Zou
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaozhu Wu
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tiantuo Zhang
- Department of Pulmonary and Critical Care Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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29
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Goh ZM, Johns CS, Julius T, Barnes S, Dwivedi K, Elliot C, Sharkey M, Alkanfar D, Charalampololous T, Hill C, Rajaram S, Condliffe R, Kiely DG, Swift AJ. Unenhanced computed tomography as a diagnostic tool in suspected pulmonary hypertension: a retrospective cross-sectional pilot study. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16853.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Background: Computed tomography pulmonary angiography (CTPA) has been proposed to be diagnostic for pulmonary hypertension (PH) in multiple studies. However, the utility of the unenhanced CT measurements diagnosing PH has not been fully assessed. This study aimed to assess the diagnostic utility and reproducibility of cardiac and great vessel parameters on unenhanced computed tomography (CT) in suspected pulmonary hypertension (PH). Methods: In total, 42 patients with suspected PH who underwent unenhanced CT thorax and right heart catheterization (RHC) were included in the study. Three observers (a consultant radiologist, a specialist registrar in radiology, and a medical student) measured the parameters by using unenhanced CT. Diagnostic accuracy of the parameters was assessed by area under the receiver operating characteristic curve (AUC). Inter-observer variability between the consultant radiologist (primary observer) and the two secondary observers was determined by intra-class correlation analysis (ICC). Results: Overall, 35 patients were diagnosed with PH by RHC while 7 patients were not. Main pulmonary arterial (MPA) diameter was the strongest (AUC 0.79 to 0.87) and the most reproducible great vessel parameter. ICC comparing the MPA diameter measurement of the consultant radiologist to the specialist registrar’s and the medical student’s were 0.96 and 0.92, respectively. Right atrial area was the cardiac measurement with highest accuracy and reproducibility (AUC 0.76 to 0.79; ICC 0.980, 0.950) followed by tricuspid annulus diameter (AUC 0.76 to 0.79; ICC 0.790, 0.800). Conclusions: MPA diameter and right atrial areas showed high reproducibility. Diagnostic accuracies of these were within the range of acceptable to excellent, and might have clinical value. Tricuspid annular diameter was less reliable and less diagnostic and was therefore not a recommended diagnostic measurement.
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Turner VL, Jubran A, Kim JB, Maret E, Moneghetti KJ, Haddad F, Amsallem M, Codari M, Hinostroza V, Mastrodicasa D, Sailer AM, Kobayashi Y, Nishi T, Yeung AC, Watkins AC, Lee AM, Miller DC, Fischbein MP, Fearon WF, Willemink MJ, Fleischmann D. CTA pulmonary artery enlargement in patients with severe aortic stenosis: Prognostic impact after TAVR. J Cardiovasc Comput Tomogr 2021; 15:431-440. [PMID: 33795188 PMCID: PMC10017114 DOI: 10.1016/j.jcct.2021.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/09/2021] [Accepted: 03/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Identifying high-risk patients who will not derive substantial survival benefit from TAVR remains challenging. Pulmonary hypertension is a known predictor of poor outcome in patients undergoing TAVR and correlates strongly with pulmonary artery (PA) enlargement on CTA. We sought to evaluate whether PA enlargement, measured on pre-procedural computed tomography angiography (CTA), is associated with 1-year mortality in patients undergoing TAVR. METHODS We retrospectively included 402 patients undergoing TAVR between July 2012 and March 2016. Clinical parameters, including Society of Thoracic Surgeons (STS) score and right ventricular systolic pressure (RVSP) estimated by transthoracic echocardiography were reviewed. PA dimensions were measured on pre-procedural CTAs. Association between PA enlargement and 1-year mortality was analyzed. Kaplan-Meier and Cox proportional hazards regression analyses were performed. RESULTS The median follow-up time was 433 (interquartiles 339-797) days. A total of 56/402 (14%) patients died within 1 year after TAVR. Main PA area (area-MPA) was independently associated with 1-year mortality (hazard ratio per standard deviation equal to 2.04 [95%-confidence interval (CI) 1.48-2.76], p < 0.001). Area under the curve (95%-CI) of the clinical multivariable model including STS-score and RVSP increased slightly from 0.67 (0.59-0.75) to 0.72 (0.72-0.89), p = 0.346 by adding area-MPA. Although the AUC increased, differences were not significant (p = 0.346). Kaplan-Meier analysis showed that mortality was significantly higher in patients with a pre-procedural non-indexed area-MPA of ≥7.40 cm2 compared to patients with a smaller area-MPA (mortality 23% vs. 9%; p < 0.001). CONCLUSIONS Enlargement of MPA on pre-procedural CTA is independently associated with 1-year mortality after TAVR.
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Affiliation(s)
- Valery L Turner
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Ayman Jubran
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Juyong Brian Kim
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Eva Maret
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institute, Stockholm.
| | - Kegan J Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Marina Codari
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Virginia Hinostroza
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Domenico Mastrodicasa
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Anna M Sailer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yukari Kobayashi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Takeshi Nishi
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Alan C Yeung
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Amelia C Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Anson M Lee
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - D Craig Miller
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Michael P Fischbein
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - William F Fearon
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Martin J Willemink
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
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Pulmonary Artery Size Measurements: A Comparison Study Between Electrocardiogram-Gated and Nonelectrocardiogram-Gated Computed Tomography. J Comput Assist Tomogr 2021; 45:415-420. [PMID: 33797443 DOI: 10.1097/rct.0000000000001144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to determine the difference and correlation in pulmonary artery (PA) size when measured from the electrocardiogram (ECG)-gated computed tomography (CT) and non-ECG-gated CT. METHODS In the retrospective study, 279 patients who underwent both ECG-gated CT and non-ECG-gated CT were enrolled. Maximum and minimum diameters of main pulmonary artery (MPA), right pulmonary artery (RPA), and ascending aorta (AAO) were measured, whereas mean diameters of MPA and RPA were obtained. The same PA size parameters were also measured on non-ECG-gated CT. RESULTS There was a significant difference in maximum and minimum PA diameters between ECG-gated CT and non-ECG-gated CT, whereas mean PA diameters showed no statistically difference. The PA parameters showed a strong positive correlation between these 2 examinations. CONCLUSIONS The PA size was different between ECG-gated CT and non-ECG-gated CT, whereas the PA size parameters on non-ECG-gated CT could be used to predict those with ECG-gated CT, which allow for confident prediction of pulmonary hypertension and guide further surgical intervention.
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Esposito A, Palmisano A, Toselli M, Vignale D, Cereda A, Rancoita PMV, Leone R, Nicoletti V, Gnasso C, Monello A, Biagi A, Turchio P, Landoni G, Gallone G, Monti G, Casella G, Iannopollo G, Nannini T, Patelli G, Di Mare L, Loffi M, Sergio P, Ippolito D, Sironi S, Pontone G, Andreini D, Mancini EM, Di Serio C, De Cobelli F, Ciceri F, Zangrillo A, Colombo A, Tacchetti C, Giannini F. Chest CT-derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy. Eur Radiol 2021; 31:4031-4041. [PMID: 33355697 PMCID: PMC7755582 DOI: 10.1007/s00330-020-07622-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/06/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Enlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients. METHODS This is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox's regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort. RESULTS In the derivation cohort, the median age was 69 (IQR, 58-77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59-77) years with 421 (66.5%) males. Enlarged MPAD (≥ 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253-2.418], p < 0.001) and multivariable regression analysis (HR [95%CI]: 1.592 [1.154-2.196], p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796-0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758-0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825]). CONCLUSION Enlarged MPAD (≥ 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19. KEY POINTS • Enlargement of main pulmonary artery diameter at chest CT performed within 72 h from the admission was associated with a higher rate of in-hospital mortality in COVID-19 patients. • Enlargement of main pulmonary artery diameter (≥ 31 mm) was an independent predictor of death in COVID-19 patients at adjusted and multivariable regression analysis. • The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients.
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Affiliation(s)
- Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy.
| | - Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Marco Toselli
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Davide Vignale
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Alberto Cereda
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Paola Maria Vittoria Rancoita
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Centro Universitario di Statistica per le Scienze Biomediche, Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Leone
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Valeria Nicoletti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Chiara Gnasso
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | | | | | | | - Giovanni Landoni
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Giacomo Monti
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Clelia Di Serio
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Centro Universitario di Statistica per le Scienze Biomediche, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Carlo Tacchetti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
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Sharma M, Burns AT, Yap K, Prior DL. The role of imaging in pulmonary hypertension. Cardiovasc Diagn Ther 2021; 11:859-880. [PMID: 34295710 DOI: 10.21037/cdt-20-295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/17/2020] [Indexed: 01/10/2023]
Abstract
Pulmonary hypertension (PH) is a debilitating and potentially life threatening condition in which increased pressure in the pulmonary arteries may result from a variety of pathological processes. These can include disease primarily involving the pulmonary vasculature, but more commonly PH may result from left-sided heart disease, including valvular heart disease. Chronic thromboembolic pulmonary hypertension (CTEPH) is an important disease to identify because it may be amenable to surgical pulmonary artery endarterectomy or balloon pulmonary angioplasty. Parenchymal lung diseases are also widespread in the community. Any of these disease processes may result in adverse remodeling of the right ventricle and progressive right heart (RH) failure as a common final pathway. Because of the breadth of pathological processes which cause PH, multiple imaging modalities play vital roles in ensuring accurate diagnosis and classification, which will lead to application of the most appropriate therapy. Multimodality imaging may also provide important prognostic information and has a role in the assessment of response to therapies which ultimately dictate clinical outcomes. This review provides an overview of the wide variety of established imaging techniques currently in use, but also examines many of the novel imaging techniques which may be increasingly utilized in the future to guide comprehensive care of patients with PH.
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Affiliation(s)
- Meenal Sharma
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Andrew T Burns
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - Kelvin Yap
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia
| | - David L Prior
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Australia.,Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne), Melbourne, Australia
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Chung JH, Adegunsoye A, Oldham JM, Vij R, Husain A, Montner SM, Karwoski RA, Bartholmai BJ, Strek ME. Vessel-related structures predict UIP pathology in those with a non-IPF pattern on CT. Eur Radiol 2021; 31:7295-7302. [PMID: 33847810 DOI: 10.1007/s00330-021-07861-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/23/2020] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To determine if a quantitative imaging variable (vessel-related structures [VRS]) could identify subjects with a non-IPF diagnosis CT pattern who were highly likely to have UIP histologically. METHODS Subjects with a multidisciplinary diagnosis of interstitial lung disease including surgical lung biopsy and chest CT within 1 year of each other were included in the study. Non-contrast CT scans were analyzed using the Computer-Aided Lung Informatics for Pathology Evaluation and Rating (CALIPER) program, which quantifies the amount of various abnormal CT patterns on chest CT. Quantitative data were analyzed relative to pathological diagnosis as well as the qualitative CT pattern. RESULTS CALIPER-derived volumes of reticulation (p = 0.012), honeycombing (p = 0.017), and VRS (p < 0.001) were associated with a UIP pattern on pathology on univariate analysis but only VRS was associated with a UIP pathology on multivariable analysis (p = 0.013). Using a VRS cut-off of 173 cm3, the sensitivity and specificity for pathological UIP were similar to those for standard qualitative CT assessment (55.9% and 80.4% compared to 60.6% and 80.4%, respectively). VRS differentiated pathological UIP cases in those with a non-IPF diagnosis CT category (p < 0.001) but not in other qualitative CT patterns (typical UIP, probable UIP, and indeterminate for UIP). The rate of pathological UIP in those with VRS greater than 173 cm3 (84.2%) was nearly identical to those who had a qualitative CT pattern of probable UIP (88.9%). CONCLUSIONS VRS may be an adjunct to CT in predicting pathology in patients with interstitial lung disease. KEY POINTS • Volume of vessel-related structures (VRS) was associated with usual interstitial pneumonia (UIP) on pathology. • This differentiation arose from those with CT scans with a non-IPF diagnosis imaging pattern. • Higher VRS has similar diagnostic ramifications for UIP as probable UIP, transitively suggesting in patients with high VRS, pathology may be obviated.
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Affiliation(s)
- Jonathan H Chung
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
| | - Ayodeji Adegunsoye
- Section of Pulmonary/Critical Care, Department of Medicine, The University of Chicago Medical Center, 5841 South Maryland Ave., Chicago, IL, 60637, USA
| | - Justin M Oldham
- Section of Pulmonary/Critical Care, Department of Medicine, The University of California at Davis, 2825 J St., Suite 400, Sacramento, CA, 95816, USA
| | - Rekha Vij
- Section of Pulmonary/Critical Care, Department of Medicine, The University of Chicago Medical Center, 5841 South Maryland Ave., Chicago, IL, 60637, USA
| | - Aliya Husain
- Department of Pathology, The University of Chicago Medical Center, 5841 South Maryland Ave., Chicago, IL, 60637, USA
| | - Steven M Montner
- Department of Radiology, The University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Ronald A Karwoski
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Brian J Bartholmai
- Department of Radiology, Mayo Clinic, 200 First St. SW, Rochester, MN, 55905, USA
| | - Mary E Strek
- Section of Pulmonary/Critical Care, Department of Medicine, The University of Chicago Medical Center, 5841 South Maryland Ave., Chicago, IL, 60637, USA
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Dwivedi K, Sharkey M, Condliffe R, Uthoff JM, Alabed S, Metherall P, Lu H, Wild JM, Hoffman EA, Swift AJ, Kiely DG. Pulmonary Hypertension in Association with Lung Disease: Quantitative CT and Artificial Intelligence to the Rescue? State-of-the-Art Review. Diagnostics (Basel) 2021; 11:diagnostics11040679. [PMID: 33918838 PMCID: PMC8070579 DOI: 10.3390/diagnostics11040679] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/05/2021] [Indexed: 12/24/2022] Open
Abstract
Accurate phenotyping of patients with pulmonary hypertension (PH) is an integral part of informing disease classification, treatment, and prognosis. The impact of lung disease on PH outcomes and response to treatment remains a challenging area with limited progress. Imaging with computed tomography (CT) plays an important role in patients with suspected PH when assessing for parenchymal lung disease, however, current assessments are limited by their semi-qualitative nature. Quantitative chest-CT (QCT) allows numerical quantification of lung parenchymal disease beyond subjective visual assessment. This has facilitated advances in radiological assessment and clinical correlation of a range of lung diseases including emphysema, interstitial lung disease, and coronavirus disease 2019 (COVID-19). Artificial Intelligence approaches have the potential to facilitate rapid quantitative assessments. Benefits of cross-sectional imaging include ease and speed of scan acquisition, repeatability and the potential for novel insights beyond visual assessment alone. Potential clinical benefits include improved phenotyping and prediction of treatment response and survival. Artificial intelligence approaches also have the potential to aid more focused study of pulmonary arterial hypertension (PAH) therapies by identifying more homogeneous subgroups of patients with lung disease. This state-of-the-art review summarizes recent QCT developments and potential applications in patients with PH with a focus on lung disease.
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Affiliation(s)
- Krit Dwivedi
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK; (M.S.); (R.C.); (S.A.); (P.M.); (J.M.W.); (A.J.S.); (D.G.K.)
- Correspondence:
| | - Michael Sharkey
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK; (M.S.); (R.C.); (S.A.); (P.M.); (J.M.W.); (A.J.S.); (D.G.K.)
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Robin Condliffe
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK; (M.S.); (R.C.); (S.A.); (P.M.); (J.M.W.); (A.J.S.); (D.G.K.)
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Johanna M. Uthoff
- Department of Computer Science, University of Sheffield, Sheffield S1 4DP, UK; (J.M.U.); (H.L.)
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK; (M.S.); (R.C.); (S.A.); (P.M.); (J.M.W.); (A.J.S.); (D.G.K.)
| | - Peter Metherall
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK; (M.S.); (R.C.); (S.A.); (P.M.); (J.M.W.); (A.J.S.); (D.G.K.)
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Haiping Lu
- Department of Computer Science, University of Sheffield, Sheffield S1 4DP, UK; (J.M.U.); (H.L.)
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield S1 3JD, UK
| | - Jim M. Wild
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK; (M.S.); (R.C.); (S.A.); (P.M.); (J.M.W.); (A.J.S.); (D.G.K.)
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield S1 3JD, UK
| | - Eric A. Hoffman
- Advanced Pulmonary Physiomic Imaging Laboratory, University of Iowa, C748 GH, Iowa City, IA 52242, USA;
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK; (M.S.); (R.C.); (S.A.); (P.M.); (J.M.W.); (A.J.S.); (D.G.K.)
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield S1 3JD, UK
| | - David G. Kiely
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2RX, UK; (M.S.); (R.C.); (S.A.); (P.M.); (J.M.W.); (A.J.S.); (D.G.K.)
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield S1 3JD, UK
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Granot Y, Rozenbaum Z, Ziv-Baran T, Berliner S, Adam SZ, Topilsky Y, Aviram G. Detection of severe pulmonary hypertension based on computed tomography pulmonary angiography. Int J Cardiovasc Imaging 2021; 37:2577-2588. [PMID: 33826018 DOI: 10.1007/s10554-021-02231-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
Pulmonary hypertension (PH) is often diagnosed late in the disease course. As many patients may undergo computed tomography pulmonary angiography (CTPA) for exclusion of pulmonary embolism (PE), we aimed to create a model that can detect the existence of PH and grade its severity. Consecutive patients who underwent CTPA which was negative for PE, and echocardiography study within 24 h, were included. The CT parameters evaluated to assess PH were: the diameters of the main pulmonary artery (MPA), ascending aorta (AA), calculation of each heart chamber volume, and the severity of reflux of contrast material. Randomly, 70% of patients were included in the model creation group, and 30% were used to validate the model. The final study group included 740 patients, 268 male patients, median age 72 years. 374 patients (51%) had PH, of them 94 (13%) had severe PH on the echocardiography. Right atrium (RA) and Left atrium (LA) volume indices were the strongest parameter to indicate PH (area under the curve, AUC = 0.738 and 0.736, respectively), while Right ventricle (RV) and RA volume indices were the strongest parameter to identify severe PH (AUC = 0.735 and 0.715, respectively) with MPA diameter being the least influential indicator (AUC = 0.623). Using the patients age, gender, and multiple CTPA parameters, we created a model for predicting the existence of severe PH. After validation, the model demonstrated 91% sensitivity and a negative predictive value of 97%. Applying our models, CTPA can be used to identify severe PH immediately after the completion of CTPA exam.
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Affiliation(s)
- Yoav Granot
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Affiliated to the Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
| | - Zach Rozenbaum
- Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shlomo Berliner
- Department of Internal Medicine, Tel Aviv Medical Center, Tel Aviv, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Z Adam
- Department of Radiology, Tel Aviv Medical Center, Tel Aviv, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, Affiliated to the Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, 6423906, Tel Aviv, Israel
| | - Galit Aviram
- Department of Radiology, Tel Aviv Medical Center, Tel Aviv, Affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Raju SN, Pandey NN, Sharma A, Malhi AS, Deepti S, Kumar S. Pulmonary Arterial Dilatation: Imaging Evaluation Using Multidetector Computed Tomography. Indian J Radiol Imaging 2021; 31:409-420. [PMID: 34556926 PMCID: PMC8448224 DOI: 10.1055/s-0041-1734225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Pulmonary artery dilatation comprises a heterogeneous group of disorders. Early diagnosis is important as the presentation may be incidental, chronic, or acute and life threatening depending upon the etiology. Cross-sectional imaging plays an important role, with CT pulmonary angiography being regarded as the first line investigation in the evaluation of pulmonary artery pathologies. Moreover, effects of pulmonary artery lesions on proximal and distal circulation can also be ascertained with the detection of associated conditions. Special attention should also be given to the left main coronary artery and the trachea-bronchial tree as they may be extrinsically compressed by the dilated pulmonary artery. In context of an appropriate clinical background, CT pulmonary angiography also helps in treatment planning, prognostication, and follow-up of these patients. This review mainly deals with imaging evaluation of the pulmonary arterial dilatations on CT with emphasis on the gamut of etiologies in the adult as well as pediatric populations.
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Affiliation(s)
- Sreenivasa Narayana Raju
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder Singh Malhi
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Siddharthan Deepti
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Zhu QQ, Gong T, Huang GQ, Niu ZF, Yue T, Xu FY, Chen C, Wang GB. Pulmonary artery trunk enlargement on admission as a predictor of mortality in in-hospital patients with COVID-19. Jpn J Radiol 2021; 39:589-597. [PMID: 33751417 PMCID: PMC7982766 DOI: 10.1007/s11604-021-01094-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the prognostic value of pulmonary artery (PA) trunk enlargement on the admission of in-hospital patients with severe COVID-19 infection by unenhanced CT image. MATERIALS AND METHODS In-hospital patients confirmed COVID-19 from January 18, 2020, to March 7, 2020, were retrospectively enrolled. PA trunk diameters on admission and death events were collected to calculate the optimum cutoff using a receiver operating characteristic curve. According to the cutoff, the subjects on admission were divided into two groups. Then the in-hospital various parameters were compared between the two groups to assess the predictive value of PA trunk diameter. RESULTS In the 180 enrolled in-hospital patients (46.99 ± 14.95 years; 93 (51.7%) female, 14 patients (7.8%) died during their hospitalization. The optimum cutoff PA trunk diameter to predict in-hospital mortality was > 29 mm with a sensitivity of 92.59% and a specificity of 91.11%. Kaplan-Meier survival curves for PA trunk diameter on admission showed that a PA trunk diameter > 29 mm was a significant predictor of subsequent death (log-rank < 0.001, median survival time of PA > 29 mm was 28 days). CONCLUSION PA trunk enlargement can be a useful predictive factor for distinguishing between mild and severe COVID-19 disease progression.
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Affiliation(s)
- Qing-Qing Zhu
- Department of Radiology, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, No. 324 Jinwu Rd, Jinan, 250021, Shandong, China
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Rd, Hangzhou, 310016, Zhejiang, China
| | - Tao Gong
- Department of Radiology, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, No. 324 Jinwu Rd, Jinan, 250021, Shandong, China
| | - Guo-Quan Huang
- Department of Radiology, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, No. 324 Jinwu Rd, Jinan, 250021, Shandong, China
- Department of Radiology, Wuhu City Second People's Hospital, No. 259 Jiuhua Rd, Wuhu, 241000, Anhui, China
| | - Zhong-Feng Niu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Rd, Hangzhou, 310016, Zhejiang, China
| | - Ting Yue
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Rd, Hangzhou, 310016, Zhejiang, China
| | - Fang-Yi Xu
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Rd, Hangzhou, 310016, Zhejiang, China
| | - Chao Chen
- Department of Radiology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3, Qingchun East Rd, Hangzhou, 310016, Zhejiang, China
| | - Guang-Bin Wang
- Department of Radiology, Shandong Medical Imaging Research Institute, Cheeloo College of Medicine, Shandong University, No. 324 Jinwu Rd, Jinan, 250021, Shandong, China.
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Baruah D, Sonavane S, Goodman L, Nath H, Presberg K, Shahir K. Correlation of Computed Tomography Test Bolus Dynamics and Conventional Computed Tomography Parameters With Pulmonary Vascular Resistance in Patients With Pulmonary Arterial Hypertension. Cureus 2021; 13:e13577. [PMID: 33815985 PMCID: PMC8009445 DOI: 10.7759/cureus.13577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Pulmonary vascular resistance (PVR) is a measurement obtained with invasive right heart catheterization (RHC) that is commonly used for management of patients with pulmonary arterial hypertension (PAH). Computed tomography pulmonary angiography (CTPA) is also done as part of the workup for PAH in some cases. The aim of our study was to assess the correlation of contrast dynamic changes in the main pulmonary artery (MPA) on CTPA with PVR obtained with RHC. Methods: This is an IRB-approved retrospective study performed in two separate institutions (Medical College of Wisconsin and University of Alabama) between January 2010 and December 2013. During CTPA done as test bolus, serial images are acquired at the level of MPA after intravenous injection of contrast to determine timing of the CT acquisition. Since the PVR changes with the degree of PAH, we hypothesize that will be reflected in the contrast kinetics in MPA. A correlation of standard CT metrics (MPA diameter, right pulmonary artery [PA] diameter, left PA diameter, MPA/aorta ratio, and right ventricle/left ventricle [RV/LV] ratio) and dynamic (full width at half maximum) CTPA parameters in patients with known PAH was performed with PVR obtained from RHC done within 30 days. Statistical analysis was performed by Pearson correlation coefficient. Results: Among 221 patients in our database, 37 patients fulfilled the selection criteria. There was a strong correlation between full width half maximum (FWHM) and mean pulmonary artery pressure (mPAP) (r=0.69, p value<0.00001), PVR (r=0.8, p value<0.00001) and indexed PVR (PVRI) (r=0.75, p value<0.00001). Conclusion: FWHM obtained from CTPA strongly correlates with RHC parameters and is potentially more helpful than static measurements for follow-up of patients with known PAH to assess response to treatment or progression.
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Affiliation(s)
- Dhiraj Baruah
- Radiodiagnosis, Medical University of South Carolina, Charleston, USA
| | | | | | - Hrudaya Nath
- Radiology, University of Alabama, Birmingham, USA
| | - Kenneth Presberg
- Pulmonary Medicine, Medical College of Wisconsin, Milwaukee, USA
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Triantafyllou GA, O'Corragain O, Rivera-Lebron B, Rali P. Risk Stratification in Acute Pulmonary Embolism: The Latest Algorithms. Semin Respir Crit Care Med 2021; 42:183-198. [PMID: 33548934 DOI: 10.1055/s-0041-1722898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pulmonary embolism (PE) is a common clinical entity, which most clinicians will encounter. Appropriate risk stratification of patients is key to identify those who may benefit from reperfusion therapy. The first step in risk assessment should be the identification of hemodynamic instability and, if present, urgent patient consideration for systemic thrombolytics. In the absence of shock, there is a plethora of imaging studies, biochemical markers, and clinical scores that can be used to further assess the patients' short-term mortality risk. Integrated prediction models incorporate more information toward an individualized and precise mortality prediction. Additionally, bleeding risk scores should be utilized prior to initiation of anticoagulation and/or reperfusion therapy administration. Here, we review the latest algorithms for a comprehensive risk stratification of the patient with acute PE.
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Affiliation(s)
- Georgios A Triantafyllou
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Oisin O'Corragain
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
| | - Belinda Rivera-Lebron
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, Pennsylvania
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Chaturvedi A, Baran TM, Ambrosini R, Krishnamoorthy V. Improving CT assessment for pulmonary hypertension in patients with severe aortic stenosis, correlation with right heart catheterization. Clin Imaging 2021; 77:122-129. [PMID: 33676129 DOI: 10.1016/j.clinimag.2021.01.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/27/2020] [Accepted: 01/28/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE To identify CT parameters useful for assessment of pulmonary hypertension (PH) in patients with severe aortic stenosis (AS). MATERIALS AND METHODS Retrospective study of 165 patients who had undergone right heart catheterization (RHC), and CTA of the thorax for preoperative aortic valve replacement (TAVR) planning. These were divided into groups based on mean pulmonary artery (PA) pressure (mPAP) of 25 mm Hg on RHC (85 cases and 80 controls). Diameters of main pulmonary artery diameter (MPAD), left pulmonary artery (LPA), right pulmonary artery (RPA), and maximal long axis and short axis diameters of the right atrium (RA) and ventricle (RV) were measured on the axial plane. Univariate and multivariate statistical analysis was utilized to identify metrics predictive of PH. RESULTS MPAD, LPA, and RPA were higher in subjects with mPAP >25 mm Hg (p < 0.0001 for all). Thresholds of 30.5 mm for MPAD (68.4% sensitivity, 82.7% specificity), and 27.5 mm for LPA and RPA (LPA: 51.9% sensitivity, 78.8% specificity; RPA: 62.0% sensitivity, 78.8% specificity) provided the best discrimination of elevated mPAP. Compared to literature values for MPAD (28.9 mm in men and 26.9 mm in women), these thresholds provide lower sensitivity but greatly increased specificity. Inclusion of RA enlargement to MPAD increased specificity to 98.5%, while inclusion of RV enlargement increased specificity to 100%. CONCLUSION Threshold to identify PH in patients with AS using PA enlargement is higher than previously reported range for normal. Inclusion of RA and RV enlargement improves the ability of CT to more accurately identify PH in patients with AS.
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Affiliation(s)
- Abhishek Chaturvedi
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA.
| | - Timothy M Baran
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Robert Ambrosini
- Imaging Science, University of Rochester Medical Center, Rochester, NY, USA
| | - Vijay Krishnamoorthy
- Department of Medicine: Cardiology, University of Rochester Medical Center, Rochester, NY, USA
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Kooranifar S, Naghshin R, Sezavar SH, Hajsadeghi S, Talebzadeh SM. Diagnostic value of chest spiral CT scan and Doppler echocardiography compared to right heart catheterization to predict pulmonary arterial hypertension in patients with scleroderma. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021074. [PMID: 33682822 PMCID: PMC7975950 DOI: 10.23750/abm.v92i1.9216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/01/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Because of invasive nature of catheterization, using other noninvasive tools is more preferred to assess pulmonary arterial hypertension (PAH). The present study assessed the value of chest spiral CT scan and Doppler echocardiography compared to right heart catheterization (RHC) to predict PAH in patients with scleroderma. METHODS This cross-sectional study was performed on 15 patients with limited scleroderma. All subjects underwent Doppler echocardiography (to assess PAP) and chest spiral CT scan without injection (to assess pulmonary trunk length or PUL), followed by RHC to assess PAH. RESULTS Comparing PUL in spiral CT scan with PAP in RHC yielded a sensitivity of 75.0% and a specificity of 100% for predicting PAH. Similarly, comparing PAP value in echocardiography with PAP in RHC achieved a sensitivity of 100% and a specificity of 63.6% to discriminate PAH from normal PAP condition. Analysis of the area under the ROC curve showed high power of CT scan to predict PAH (AUC = 1.000). The best cutoff point for PUL to predict PAH was 29.95 yielding a sensitivity of 100% and a specificity of 100%. Also, ROC curve analysis showed high value of echocardiography to discriminate PAH from normal PAP status (AUC = 0.841) that considering a cutoff value of 22.88 for PAP assessed by echocardiography reached to a sensitivity of 72.7% and a specificity of 100%. Conclusion: Both chest spiral CT scan and Doppler echocardiography are very useful to diagnose PAH and its severity in patients with scleroderma.
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Affiliation(s)
- Siavash Kooranifar
- Department of Pulmonary Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran..
| | - Roozbeh Naghshin
- Department of Pulmonary Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran..
| | - Seyed Hashem Sezavar
- Department of Cardiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Shokoufeh Hajsadeghi
- Department of Cardiology, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mehdi Talebzadeh
- Department of Pulmonary Medicine, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran..
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Zambrano BA, McLean N, Zhao X, Tan JL, Zhong L, Figueroa CA, Lee LC, Baek S. Patient-Specific Computational Analysis of Hemodynamics and Wall Mechanics and Their Interactions in Pulmonary Arterial Hypertension. Front Bioeng Biotechnol 2021; 8:611149. [PMID: 33634080 PMCID: PMC7901991 DOI: 10.3389/fbioe.2020.611149] [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: 09/28/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
Vascular wall stiffness and hemodynamic parameters are potential biomechanical markers for detecting pulmonary arterial hypertension (PAH). Previous computational analyses, however, have not considered the interaction between blood flow and wall deformation. Here, we applied an established computational framework that utilizes patient-specific measurements of hemodynamics and wall deformation to analyze the coupled fluid-vessel wall interaction in the proximal pulmonary arteries (PA) of six PAH patients and five control subjects. Specifically, we quantified the linearized stiffness (E), relative area change (RAC), diastolic diameter (D), regurgitant flow, and time-averaged wall shear stress (TAWSS) of the proximal PA, as well as the total arterial resistance (R t ) and compliance (C t ) at the distal pulmonary vasculature. Results found that the average proximal PA was stiffer [median: 297 kPa, interquartile range (IQR): 202 kPa vs. median: 75 kPa, IQR: 5 kPa; P = 0.007] with a larger diameter (median: 32 mm, IQR: 5.25 mm vs. median: 25 mm, IQR: 2 mm; P = 0.015) and a reduced RAC (median: 0.22, IQR: 0.10 vs. median: 0.42, IQR: 0.04; P = 0.004) in PAH compared to our control group. Also, higher total resistance (R t ; median: 6.89 mmHg × min/l, IQR: 2.16 mmHg × min/l vs. median: 3.99 mmHg × min/l, IQR: 1.15 mmHg × min/l; P = 0.002) and lower total compliance (C t ; median: 0.13 ml/mmHg, IQR: 0.15 ml/mmHg vs. median: 0.85 ml/mmHg, IQR: 0.51 ml/mmHg; P = 0.041) were observed in the PAH group. Furthermore, lower TAWSS values were seen at the main PA arteries (MPAs) of PAH patients (median: 0.81 Pa, IQR: 0.47 Pa vs. median: 1.56 Pa, IQR: 0.89 Pa; P = 0.026) compared to controls. Correlation analysis within the PAH group found that E was directly correlated to the PA regurgitant flow (r = 0.84, P = 0.018) and inversely related to TAWSS (r = -0.72, P = 0.051). Results suggest that the estimated elastic modulus E may be closely related to PAH hemodynamic changes in pulmonary arteries.
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Affiliation(s)
- Byron A. Zambrano
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, United States
| | - Nathan McLean
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Xiaodan Zhao
- National Heart Centre Singapore, Singapore, Singapore
| | - Ju-Le Tan
- National Heart Centre Singapore, Singapore, Singapore
| | - Liang Zhong
- National Heart Centre Singapore, Singapore, Singapore
- Duke-National University of Singapore, Singapore, Singapore
| | - C. Alberto Figueroa
- Departments of Biomedical Engineering and Surgery, University of Michigan, Ann Arbor, MI, United States
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
| | - Seungik Baek
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, United States
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Li X, Zhang C, Sun X, Yang X, Zhang M, Wang Q, Zhu Y. Prognostic factors of pulmonary hypertension associated with connective tissue disease: pulmonary artery size measured by chest CT. Rheumatology (Oxford) 2021; 59:3221-3228. [PMID: 32221604 DOI: 10.1093/rheumatology/keaa100] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Pulmonary artery enlargement is a common manifestation of chest CT in patients with pulmonary arterial hypertension (PAH). The exact clinical significance of this phenomenon has not been clarified in connective tissue disease (CTD)-associated PAH (CTD-PAH). We aimed to explore the association between the dilatation of pulmonary artery and prognosis of CTD-PAH patients. METHODS We retrospectively investigated 140 CTD-PAH patients diagnosed by echocardiography from 2009 to 2018. A chest multi-slice CT was performed on all the patients. Main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), ascending aorta (AAo) and descending aorta (DAo) diameters were measured. The ratios MPA/AAo and MPA/DAo were also calculated. The primary end point was all-cause mortality. RESULTS During the observational period of 3.44 (0.23) years, 36 patients were followed to death. Cox univariate proportional hazard analysis showed that age, gender, MPA diameter, LPA diameter and RPA diameter were related to the risk of 5-year all-cause mortality in patients with CTD-PAH. In Cox multivariate proportional hazard analysis, MPA diameter and gender were predictors of all-cause mortality in CTD-PAH patients. An all-cause mortality risk prediction model revealed that baseline MPA diameter has the ability to predict 5-year all-cause mortality in CTD-PAH patients. Kaplan-Meier analysis showed that the 5-year survival rate was significantly lower in patients with MPA ≥37.70 mm (P ≤ 0.00012) compared with MPA ≤ 37.70 mm. CONCLUSION MPA diameter ≥37.70 mm measured by chest multi-slice CT was a potential independent risk factor of the poor long-term prognosis in Chinese CTD-PAH patients.
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Affiliation(s)
- Xiaodi Li
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing.,Department of Rheumatology, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi
| | - Chunfang Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Xiaoxuan Sun
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Xiaoman Yang
- Department of Cardiology, Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Miaojia Zhang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Qiang Wang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Yinsu Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing
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Harder EM, Vanderpool R, Rahaghi FN. Advanced Imaging in Pulmonary Vascular Disease. Clin Chest Med 2021; 42:101-112. [PMID: 33541604 DOI: 10.1016/j.ccm.2020.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Although the diagnosis of pulmonary hypertension requires invasive testing, imaging serves an important role in the screening, classification, and monitoring of patients with pulmonary vascular disease (PVD). The development of advanced imaging techniques has led to improvements in the understanding of disease pathophysiology, noninvasive assessment of hemodynamics, and stratification of patient risk. This article discusses the current role of advanced imaging and the emerging novel techniques for visualizing the lung parenchyma, mediastinum, and heart in PVD.
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Affiliation(s)
- Eileen M Harder
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA.
| | - Rebecca Vanderpool
- Division of Translational and Regenerative Medicine, Department of Medicine, University of Arizona, 1656 East Mabel Street, Tucson, AZ 85721, USA. https://twitter.com/rrvdpool
| | - Farbod N Rahaghi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, 15 Francis Street, Boston, MA 02115, USA
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Preprocedure CT Findings of Right Heart Failure as a Predictor of Mortality After Transcatheter Aortic Valve Replacement. AJR Am J Roentgenol 2021; 216:57-65. [DOI: 10.2214/ajr.20.22894] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bacon JL, Madden BP, Gissane C, Sayer C, Sheard S, Vlahos I. Vascular and Parenchymal Enhancement Assessment by Dual-Phase Dual-Energy CT in the Diagnostic Investigation of Pulmonary Hypertension. Radiol Cardiothorac Imaging 2020; 2:e200009. [PMID: 33778636 DOI: 10.1148/ryct.2020200009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 08/30/2020] [Accepted: 10/20/2020] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate pulmonary hypertension (PH) determination by dual-phase dual-energy CT pulmonary angiography vascular enhancement and perfused blood volume (PBV) quantification. Materials and Methods In this prospective study, consecutive participants who underwent both right heart catheterization and dual-phase dual-energy CT pulmonary angiography were included between 2012 and 2014. CT evaluation comprised a standard pulmonary arterial phase dual-energy CT pulmonary angiography acquisition (termed series 1) followed 7 seconds after series 1 completion by a second dual-energy CT pulmonary angiography acquisition limited to the central 10 cm of the pulmonary vasculature (termed series 2). In both series, enhancement in the main pulmonary artery (PAenh), the descending aorta (DAenh), and whole-lung PBV (WLenh) was calculated from dual-energy CT pulmonary angiography iodine images. Dual-energy CT pulmonary angiography and standard cardiovascular metrics were correlated to mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) with additional receiver operating characteristic curve analysis. Results A total of 102 participants (median age, 70; range, 58-78 years; 60 women) were included. Sixty-five participants had PH defined by mPAP of greater than or equal to 25 mm Hg, and 51 participants had PH defined by PVR of greater than 3 Wood units. By either definition, participants with PH had higher PAenh/WLenh ratio and lower WLenh and DAenh in series 1 (P < .05) and higher PAenh and WLenh in series 2 (P < .05). Change in WLenh determined highest diagnostic accuracy to define disease by mPAP (area under the receiver operating characteristic curve [AUC], 0.78) and PVR (AUC, 0.79) and the best mPAP correlation (r = 0.62). PAenh series 2 correlated best with PVR (r = 0.49). Multiple linear regression analysis incorporating WLenh and series 1 DAenh improved PVR correlation (r = 0.56). Combining these dual-energy CT pulmonary angiography metrics with main pulmonary artery size and right-to-left ventricular ratio achieved the highest correlations (mPAP, r = 0.71; PVR, r = 0.64). Conclusion Dual-phase dual-energy CT pulmonary angiography enhancement quantification appears to improve mPAP and PVR prediction in noninvasive PH evaluation.Supplemental material is available for this article.See also the commentary by Kay in this issue.© RSNA, 2020.
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Affiliation(s)
- Jenny Louise Bacon
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Brendan Patrick Madden
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Conor Gissane
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Charles Sayer
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Sarah Sheard
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
| | - Ioannis Vlahos
- Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.)
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Lange TJ, Borst M, Ewert R, Halank M, Klose H, Leuchte H, Meyer FJ, Seyfarth HJ, Skowasch D, Wilkens H, Held M. [Current Aspects of Definition and Diagnosis of Pulmonary Hypertension]. Pneumologie 2020; 74:847-863. [PMID: 32663892 DOI: 10.1055/a-1199-1548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
At the 6th World Symposium on Pulmonary Hypertension (WSPH), which took place from February 27 until March 1, 2018 in Nice, scientific progress over the past 5 years in the field of pulmonary hypertension (PH) was presented by 13 working groups. The results of the discussion were published as proceedings towards the end of 2018. One of the major changes suggested by the WSPH was the lowering of the diagnostic threshold for PH from ≥ 25 to > 20 mmHg mean pulmonary arterial pressure, measured by right heart catheterization at rest. In addition, the pulmonary vascular resistance was introduced into the definition of PH, which underlines the importance of cardiac output determination at the diagnostic right heart catheterization.In this article, we discuss the rationale and possible consequences of a changed PH definition in the context of the current literature. Further, we provide a current overview on non-invasive and invasive methods for diagnosis, differential diagnosis, and prognosis of PH, including exercise tests.
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Affiliation(s)
- T J Lange
- Uniklinik Regensburg, Klinik für Innere Medizin II, Bereich Pneumologie, Regensburg
| | - M Borst
- Medizinische Klinik I, Caritas-Krankenhaus, Bad Mergentheim
| | - R Ewert
- Pneumologie, Uniklinik Greifswald, Greifwald
| | - M Halank
- Universitätsklinikum Carl Gustav Carus, Medizinische Klinik 1, Bereich Pneumologie, Dresden
| | - H Klose
- Universitätsklinikum Hamburg-Eppendorf, Abteilung für Pneumologie, Hamburg
| | - H Leuchte
- Klinik der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Lehrkrankenhaus der LMU München, München
| | - F J Meyer
- Lungenzentrum München (Bogenhausen-Harlaching), München Klinik gGmbH, München
| | - H-J Seyfarth
- Bereich Pneumologie, Universitätsklinikum Leipzig, Leipzig
| | - D Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik II, Sektion Pneumologie, Bonn
| | - H Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg
| | - M Held
- Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Standort Missioklinik, Würzburg
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49
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Occult pulmonary arterial hypertension in patients with previous pulmonary tuberculosis. Afr J Thorac Crit Care Med 2020; 26. [PMID: 34240037 PMCID: PMC8203089 DOI: 10.7196/ajtccm.2020.v26i4.110] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background
Pulmonary tuberculosis (TB) still causes a significant public healthcare burden. Despite successful treatment, TB can lead to permanent lung damage and pulmonary hypertension (PH). PH can also occur in the absence of significant lung damage, leading clinicians to question whether pulmonary TB may cause pulmonary arterial hypertension (PAH), an entity that has not been otherwise described.
Objectives
To determine the prevalence of PAH in patients previously treated for TB.
Methods
We recruited 20 participants who were previously treated for TB and had no other underlying risk factors for the development of PH. The participants underwent electrocardiography (ECG), chest radiography, lung function tests and echocardiography (ECHO). Data from these non-invasive investigations were evaluated to determine findings that were suggestive of PH.
Results
At a median duration of 30 months from diagnosis of TB, no participant had echocardiography findings that were suggestive of
PH (pulmonary artery pressure (PAP) ≥40 mmHg). However, there was a negative correlation between the time from diagnosis and right ventricular dysfunction assessed by measuring a tricuspid annular plane systolic excursion (r=–0.5136; p=0.0205). Furthermore, one-third of the participants (n=7) had one or more ECG features supporting PH and 85% of the participants (n=17) demonstrated at least one chest X-ray (CXR) feature of PH.
Conclusion
Although our study did not demonstrate ECHO findings supporting PH, ECG and CXR modalities were suggestive. Therefore, future studies consisting of larger cohorts and including the use of other sensitive modalities such as computed tomography are warranted. Moreover, these studies will need to determine whether the entity of PAH secondary to previously treated pulmonary TB exists.
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Truong U, Meinel K, Haddad F, Koestenberger M, Carlsen J, Ivy D, Jone PN. Update on noninvasive imaging of right ventricle dysfunction in pulmonary hypertension. Cardiovasc Diagn Ther 2020; 10:1604-1624. [PMID: 33224776 DOI: 10.21037/cdt-20-272] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pulmonary hypertension (PH) is a progressive disease affecting patients across the life span. The pathophysiology primarily involves the pulmonary vasculature and right ventricle (RV), but eventually affects the left ventricular (LV) function as well. Safe, accurate imaging modalities are critical for diagnosis, serial monitoring, and tailored therapy. While cardiac catheterization remains the conventional modality for establishing diagnosis and serial monitoring, noninvasive imaging has gained considerable momentum in providing accurate assessment of the entire RV-pulmonary axis. In this state-of-the-art review, we will discuss the most recent developments in echocardiography, magnetic resonance imaging, and computed tomography in PH evaluation from pediatric to adult population.
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Affiliation(s)
- Uyen Truong
- Division of Pediatric Cardiology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Katharina Meinel
- Division of Pediatric Cardiology, Medical University of Graz, Graz, Austria
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA
| | | | - Jørn Carlsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dunbar Ivy
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Pei-Ni Jone
- Division of Pediatric Cardiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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