CT 肺动脉造影测量的室间隔角可无创性估计慢性血栓栓塞性肺动脉高压患者的肺血管阻力。
A septal angle measured on computed tomographic pulmonary angiography can noninvasively estimate pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension.
机构信息
Department of Radiology, Beijing Chao Yang Hospital of Capital Medical University, China.
出版信息
J Thorac Imaging. 2012 Sep;27(5):325-30. doi: 10.1097/RTI.0b013e3182541142.
PURPOSE
To explore the correlation between a septal angle measured on computed tomographic pulmonary angiography (CTPA) and pulmonary vascular resistance (PVR) determined by right heart catheterization in patients with chronic thromboembolic pulmonary hypertension (CTEPH).
MATERIALS AND METHODS
Eighty-six patients with CTEPH (54 men, mean age: 53.08±12.43 y) were retrospectively reviewed, and 86 sex-matched and age-matched individuals without pulmonary artery hypertension and pulmonary embolism were used as the control group. All patients with CTEPH underwent CTPA before right heart catheterization. Septal angle was measured on transverse CTPA images as the angle between the interventricular septum and the line joining the midpoint of the sternum to the thoracic vertebral spinous process. Hemodynamic PVR was calculated on the basis of the data from right heart catheterization.
RESULTS
Septal angle was 65.27±12.24 degrees and 39.43±9.79 degrees in the CTEPH group and control group, respectively, which was statistically significant (t=18.139, P=0.000). The septal angle correlated positively with PVR (r=0.629, P=0.000). By stepwise linear regression analysis, the septal angle was shown to be the only variable (r=0.578) that was independently associated with PVR levels, leading to the following equation: PVR=21.591×septal angle-374.641. By receiver operating characteristic analysis, septal angle ≥67.55 degrees had a sensitivity of 71.6% and a specificity of 73.4% for predicting PVR≥1000 dyne s/cm with an area under the curve of 0.739±0.055, which was higher than the area under the curve of right ventricular area/left ventricular area (0.627±0.061) and that of transverse diameter of right ventricle/transverse diameter of left ventricle (0.612±0.060).
CONCLUSION
The septal angle is a useful tool for estimating PVR in patients with CTEPH.
目的
探讨慢性血栓栓塞性肺动脉高压（CTEPH）患者 CT 肺动脉造影（CTPA）测量的中隔角与右心导管检查确定的肺血管阻力（PVR）之间的相关性。
材料和方法
回顾性分析 86 例 CTEPH 患者（54 名男性，平均年龄：53.08±12.43 岁），并选择 86 名性别和年龄匹配的无肺动脉高压和肺栓塞患者作为对照组。所有 CTEPH 患者均在右心导管检查前行 CTPA。在横断 CTPA 图像上测量中隔角，即室间隔与胸骨中点至胸椎棘突连线之间的夹角。根据右心导管检查数据计算血流动力学 PVR。
结果
CTEPH 组和对照组的中隔角分别为 65.27±12.24 度和 39.43±9.79 度，差异有统计学意义（t=18.139，P=0.000）。中隔角与 PVR 呈正相关（r=0.629，P=0.000）。逐步线性回归分析显示，中隔角是唯一与 PVR 水平独立相关的变量（r=0.578），得出以下方程：PVR=21.591×中隔角-374.641。通过接受者操作特征分析，中隔角≥67.55 度预测 PVR≥1000 达因·秒/厘米时的敏感性为 71.6%，特异性为 73.4%，曲线下面积为 0.739±0.055，高于右心室面积/左心室面积比（0.627±0.061）和右心室横径/左心室横径比（0.612±0.060）。
结论
中隔角是一种用于估计 CTEPH 患者 PVR 的有用工具。
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