Adams Dustin S, Marolf Angela J, Valdés-Martínez Alejandro, Randall Elissa K, Bachand Annette M
Colorado State University, Department of Environmental and Radiological Health Sciences (ERHS), Fort Collins, CO, 80523.
Vet Radiol Ultrasound. 2017 Jul;58(4):454-462. doi: 10.1111/vru.12494. Epub 2017 Mar 29.
Doppler echocardiography is a noninvasive method for estimating and grading pulmonary arterial hypertension. No current literature associates significance of radiographic findings with severity of pulmonary arterial hypertension. We hypothesized that the number and conspicuity of radiographic findings suggestive of pulmonary arterial hypertension would be greater based on the severity of pulmonary arterial hypertension. Dogs with pulmonary arterial hypertension and normal control dogs were included in this retrospective, case control study. Three radiologists blinded to echocardiographic results scored thoracic radiographs for right ventricular and main pulmonary artery enlargement and pulmonary lobar artery enlargement, tortuosity, and blunting by multiple methods. Presence or absence of each finding was scored in an additive fashion and averaged for each grade of pulmonary arterial hypertension severity. Seventy-one dogs (60 dogs with pulmonary arterial hypertension and 11 control dogs) of which some had multiple studies were included: 20 mild, 21 moderate, 25 severe, and 11 absent pulmonary arterial hypertension. The following radiographic findings were significantly associated with increasing pulmonary arterial hypertension severity: right ventricular enlargement by "reverse D" and "3/5-2/5 cardiac ratio" methods, main pulmonary artery enlargement, and caudal lobar artery enlargement by the "3rd rib" method. Mean scores for severe pulmonary arterial hypertension and normal dogs were significantly different (P-value < 0.0001). Mean scores between different pulmonary arterial hypertension grades increased with severity but were not statistically significant. Individually and in combination, radiographic findings performed poorly in differentiating severity of pulmonary arterial hypertension. Findings indicated that thoracic radiographs should be utilized in conjunction with Doppler echocardiography in a complete diagnostic work-up for dogs with suspected pulmonary arterial hypertension.
多普勒超声心动图是一种用于评估和分级肺动脉高压的非侵入性方法。目前尚无文献将影像学表现的意义与肺动脉高压的严重程度联系起来。我们假设，根据肺动脉高压的严重程度，提示肺动脉高压的影像学表现的数量和明显程度会更高。患有肺动脉高压的犬和正常对照犬被纳入这项回顾性病例对照研究。三位对超声心动图结果不知情的放射科医生采用多种方法对胸部X光片进行评分，评估右心室和主肺动脉增大以及肺叶动脉增大、迂曲和变钝的情况。每个表现的有无以累加方式评分，并对肺动脉高压严重程度的每个等级求平均值。共纳入71只犬（60只患有肺动脉高压，11只对照犬），其中一些犬进行了多次检查：20只轻度、21只中度、25只重度和11只无肺动脉高压。以下影像学表现与肺动脉高压严重程度增加显著相关：通过“反D征”和“3/5 - 2/5心比例”方法评估的右心室增大、主肺动脉增大以及通过“第3肋骨”方法评估的尾叶动脉增大。重度肺动脉高压犬和正常犬的平均评分有显著差异（P值<0.0001）。不同肺动脉高压等级之间的平均评分随严重程度增加，但无统计学意义。影像学表现单独或联合使用时，在区分肺动脉高压严重程度方面表现不佳。研究结果表明，在对疑似肺动脉高压的犬进行完整诊断检查时，胸部X光片应与多普勒超声心动图结合使用。
