Rahaghi Farbod N, Vegas-Sanchez-Ferrero Gonzalo, Minhas Jasleen K, Come Carolyn E, De La Bruere Isaac, Wells James M, González Germán, Bhatt Surya P, Fenster Brett E, Diaz Alejandro A, Kohli Puja, Ross James C, Lynch David A, Dransfield Mark T, Bowler Russel P, Ledesma-Carbayo Maria J, San José Estépar Raúl, Washko George R
Pulmonary and Critical Care Division of Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, PBB-CA 3, Boston, MA 02115.
Department of Radiology, Harvard School of Medicine, Boston, MA; Biomedical Image Technologies, Universidad Politécnica de Madrid & CIBER-BBN, Madrid, Spain.
Acad Radiol. 2017 May;24(5):594-602. doi: 10.1016/j.acra.2016.12.007. Epub 2017 Feb 15.
Imaging-based assessment of cardiovascular structure and function provides clinically relevant information in smokers. Non-cardiac-gated thoracic computed tomographic (CT) scanning is increasingly leveraged for clinical care and lung cancer screening. We sought to determine if more comprehensive measures of ventricular geometry could be obtained from CT using an atlas-based surface model of the heart.
Subcohorts of 24 subjects with cardiac magnetic resonance imaging (MRI) and 262 subjects with echocardiography were identified from COPDGene, a longitudinal observational study of smokers. A surface model of the heart was manually initialized, and then automatically optimized to fit the epicardium for each CT. Estimates of right and left ventricular (RV and LV) volume and free-wall curvature were then calculated and compared to structural and functional metrics obtained from MRI and echocardiograms.
CT measures of RV dimension and curvature correlated with similar measures obtained using MRI. RV and LV volume obtained from CT inversely correlated with echocardiogram-based estimates of RV systolic pressure using tricuspid regurgitation jet velocity and LV ejection fraction respectively. Patients with evidence of RV or LV dysfunction on echocardiogram had larger RV and LV dimensions on CT. Logistic regression models based on demographics and ventricular measures from CT had an area under the curve of >0.7 for the prediction of elevated right ventricular systolic pressure and ventricular failure.
These data suggest that non-cardiac-gated, non-contrast-enhanced thoracic CT scanning may provide insight into cardiac structure and function in smokers.
基于影像学的心血管结构和功能评估可为吸烟者提供临床相关信息。非心脏门控胸部计算机断层扫描（CT）在临床护理和肺癌筛查中的应用越来越广泛。我们试图确定使用基于图谱的心脏表面模型能否从CT中获得更全面的心室几何测量值。
从慢性阻塞性肺疾病基因研究（COPDGene）这一吸烟者纵向观察性研究中，确定了24例接受心脏磁共振成像（MRI）的受试者亚组和262例接受超声心动图检查的受试者亚组。手动初始化心脏表面模型，然后针对每个CT自动优化以拟合心外膜。然后计算右心室和左心室（RV和LV）容积及游离壁曲率的估计值，并与从MRI和超声心动图获得的结构和功能指标进行比较。
CT测量的RV尺寸和曲率与使用MRI获得的类似测量值相关。从CT获得的RV和LV容积分别与基于超声心动图使用三尖瓣反流射流速度估计的RV收缩压和LV射血分数呈负相关。超声心动图显示有RV或LV功能障碍证据的患者，其CT上的RV和LV尺寸更大。基于人口统计学和CT心室测量值的逻辑回归模型预测右心室收缩压升高和心室衰竭的曲线下面积>0.7。
这些数据表明，非心脏门控、非对比增强的胸部CT扫描可能有助于了解吸烟者的心脏结构和功能。
