Jujo Takayuki, Tanabe Nobuhiro, Sugiura Toshihiko, Naito Akira, Shigeta Ayako, Kitazono-Saitoh Miyako, Sakao Seiichiro, Tatsumi Koichiro
Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
Respir Investig. 2016 Jan;54(1):69-74. doi: 10.1016/j.resinv.2015.08.008. Epub 2015 Oct 20.
Partial anomalous pulmonary venous return (PAPVR) is characterized by an abnormal connection of the pulmonary vein (PV). The left-to-right shunt results in an increased pulmonary blood flow, which may be followed by developing pulmonary hypertension (PH). We found that computed tomography (CT) scans may be misinterpreted, potentially leaving anomalous PVs undetected when reviewing diagnostic findings of PAPVR patients. The purpose of this study was to delineate this risk and assess the usefulness of our interpretation methods.
We retrospectively reviewed the records of 8 patients diagnosed with PAPVR, diagnosed with right heart catheterization (RHC) findings, at our department between 1991 and 2013. Our CT screening method for assessing anomalous PVs consisted of two points: 1) confirming that four PVs were connected to the left atrium (LA) and 2) checking that the vena cava was not connected with anomalous PVs. The accuracy of this method was analyzed in a blinded manner.
In 4 patients, anomalous PVs delineated on enhanced CT scan images obtained before RHC were undetected. The sensitivity and specificity of detecting PAPVRs using our protocol were 0.800 and 0.978, respectively. Four of 8 patients went on to develop PH. Age at the time of diagnosis was positively correlated with mean pulmonary arterial pressure (r=0.929, p=0.002).
There is a potential risk of CT scan misinterpretation when looking for anomalous PVs. Careful interpretation of CT findings that focus on PVs may be useful for detecting PAPVR and obtaining a PH differential diagnosis.
部分性肺静脉异位回流（PAPVR）的特征是肺静脉（PV）连接异常。左向右分流导致肺血流量增加，随后可能发展为肺动脉高压（PH）。我们发现，在回顾PAPVR患者的诊断结果时，计算机断层扫描（CT）可能会被误读，从而可能导致未检测到异常的肺静脉。本研究的目的是描述这种风险并评估我们的解读方法的有效性。
我们回顾性分析了1991年至2013年期间在我科诊断为PAPVR且经右心导管检查（RHC）确诊的8例患者的记录。我们评估异常肺静脉的CT筛查方法包括两点：1）确认四条肺静脉与左心房（LA）相连；2）检查腔静脉是否与异常肺静脉相连。以盲法分析该方法的准确性。
在4例患者中，RHC之前获得的增强CT扫描图像上显示的异常肺静脉未被检测到。使用我们的方案检测PAPVR的敏感性和特异性分别为0.800和0.978。8例患者中有4例随后发展为PH。诊断时的年龄与平均肺动脉压呈正相关（r=0.929，p=0.002）。
在寻找异常肺静脉时，CT扫描存在被误读的潜在风险。仔细解读聚焦于肺静脉的CT结果可能有助于检测PAPVR并进行PH鉴别诊断。
