Siegel Yoel, Bleicher Drew, Gordon Michael Kurt, Fertel Debra
From the University of Miami School of Medicine, Jackson Memorial Hospital, Miami, FL.
J Comput Assist Tomogr. 2017 Sep/Oct;41(5):779-783. doi: 10.1097/RCT.0000000000000582.
Pulmonary hypertension (PH) is caused by etiologies that differ in pathophysiology. Patients with undiagnosed PH may have a computed tomography pulmonary angiography (CTPA) scan during workup. Static measurements on computed tomography correlate with PH; however, dynamic parameters have received less attention. We studied the correlation between CTPA dynamic parameters and PH and assessed whether these parameters differ among PH etiologies. We also propose a method for PH screening.
Patients who underwent right-heart catheterization and CTPA within 45 days of each other were included. Charts were reviewed for presence and etiology of PH. The time it took to reach the CTPA trigger threshold during bolus tracking (TT) was recorded and compared with pulmonary pressure measured on pulmonary artery catheterization. The correlation between TT values and pulmonary pressure was studied, as well as the sensitivity and specificity of TT for PH.
Twenty-seven patients with 28 examinations were included. A significant correlation was found between pulmonary pressure and TT, as well as TT and right ventricular decreased function, P < 0.01. Left heart failure showed the longest TT among PH subgroups and significantly longer TT in patients with both PH and right ventricular decreased function. Time to trigger demonstrated a sensitivity range of 75% to 92% and specificity between 56% and 88% for pulmonary pressure of 40 mm Hg or greater.
Dynamic parameters of flow measured on CTPA significantly correlate with pulmonary pressure and can potentially help screen for PH. Left heart failure seems to have the greatest impact on TT among patients with PH.
肺动脉高压（PH）由病理生理学不同的病因引起。未确诊的PH患者在检查过程中可能会进行计算机断层扫描肺动脉造影（CTPA）。计算机断层扫描的静态测量结果与PH相关；然而，动态参数受到的关注较少。我们研究了CTPA动态参数与PH之间的相关性，并评估这些参数在不同PH病因之间是否存在差异。我们还提出了一种PH筛查方法。
纳入在45天内先后接受右心导管检查和CTPA的患者。查阅病历以确定PH的存在及病因。记录团注追踪期间达到CTPA触发阈值所需的时间（TT），并与肺动脉导管检查测得的肺动脉压力进行比较。研究TT值与肺动脉压力之间的相关性，以及TT对PH的敏感性和特异性。
纳入27例患者，共进行了28次检查。发现肺动脉压力与TT以及TT与右心室功能降低之间存在显著相关性，P<0.01。在PH亚组中，左心衰竭患者的TT最长，在同时患有PH和右心室功能降低的患者中，TT显著更长。对于40mmHg或更高的肺动脉压力，触发时间的敏感性范围为75%至92%，特异性为56%至88%。
CTPA测量的血流动力学参数与肺动脉压力显著相关，并可能有助于筛查PH。在PH患者中，左心衰竭似乎对TT影响最大。
