Rho Ji Young, Lynch David A, Suh Young Ju, Nah Jeung Weon, Zach Jordan A, Schroeder Joyce D, Cox Christian W, Bowler Russell P, Fenster Brett E, Dransfield Mark T, Wells James M, Hokanson John E, Curran-Everett Douglas, Williams Andre, Han MeiLan K, Crapo James D, Silverman Edwin K
Department of Radiology, CHA Bundang Medical Center, CHA University, Seongnam, Korea Department of Radiology, National Jewish Health, Denver, CO Department of Biomedical Science, School of Medicine, Inha University, Incheon CJ HealthCare Corp., Seoul, Korea Department of Clinical Trials, Kaiser Permanente, Denver Department of Radiology, University of Colorado, Aurora, CO Department of Radiology, Mayo Clinic, Rochester, MN Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health Division of Cardiology, National Jewish Health, Denver, CO Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL Department of Epidemiology, University of Colorado, Aurora Division of Biostatistics and Bioinformatics, National Jewish Health, Denver, CO Division of Pulmonary and Critical Care, University of Michigan Health System, Ann Arbor, MI Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA.
Medicine (Baltimore). 2018 Jan;97(3):e9542. doi: 10.1097/MD.0000000000009542.
To identify a predictive value for the exacerbation status of chronic obstructive pulmonary disease (COPD) subjects, we evaluated the relationship between pulmonary vascular measurements on chest CT and severe COPD exacerbation.Six hundred three subjects enrolled in the COPDGene population were included and divided into nonexacerbator (n = 313) and severe exacerbator (n = 290) groups, based on whether they had an emergency room visit and/or hospitalization for COPD exacerbation. We measured the diameter of the main pulmonary artery (MPA) and ascending aorta (AA) at 2 different sites of the MPA (the tubular midportion and bifurcation) on both axial images and multiplanar reconstructions. Using multiple logistic regression analyses, we evaluated the relationship between each CT-measured pulmonary vasculature and exacerbation status.Axial and multiplanar MPA to AA diameter ratios (PA:AA ratios) at the tubular midportion and the axial PA:AA ratios at the bifurcation indicated significant association with severe exacerbation. The strongest association was found with the axial PA:mean AA ratio at the bifurcation (adjusted odds ratio [OR] = 12.53, 95% confidence interval [CI] = 2.35-66.74, P = .003) and the axial PA:major AA ratio at the tubular midportion (adjusted OR = 10.72, 95% CI = 1.99-57.86, P = .006). No differences were observed in the MPA diameter. Receiver operating characteristic analysis of these variables indicates that they may serve as a good predictive value for severe exacerbation (area under the curve, 0.77-0.78). The range of cut-off value for PA:AA ratio was 0.8 to 0.87.CT-measured PA:AA ratios at either the bifurcation or the tubular site, measured either on axial or multiplanar images, are useful for identification of the risk of severe exacerbation, and consequently can be helpful in guiding the management of COPD. Although CT measurement was used at the level of pulmonary bifurcation in previous studies, we suggest that future studies should monitor the tubular site of the MPA for maximum diagnostic value of CT in pulmonary hypertension or severe COPD exacerbation, as the tubular site of the MPA remains relatively constant on CT images.
为了确定慢性阻塞性肺疾病（COPD）患者病情加重状态的预测价值，我们评估了胸部CT上肺血管测量值与严重COPD加重之间的关系。纳入了COPDGene队列中的603名受试者，并根据他们是否因COPD加重而进行过急诊就诊和/或住院治疗，将其分为非加重组（n = 313）和严重加重组（n = 290）。我们在轴位图像和多平面重建图像上，于主肺动脉（MPA）的2个不同部位（管状中部和分叉处）测量了MPA和升主动脉（AA）的直径。使用多因素逻辑回归分析，我们评估了每个CT测量的肺血管系统与加重状态之间的关系。在管状中部的轴位和多平面MPA与AA直径比（PA:AA比）以及分叉处的轴位PA:AA比与严重加重显著相关。最强的关联见于分叉处的轴位PA:平均AA比（校正比值比[OR]=12.53，95%置信区间[CI]=2.35 - 66.74，P = 0.003）和管状中部的轴位PA:主要AA比（校正OR = 10.72，95% CI = 1.99 - 57.86，P = 0.006）。MPA直径未观察到差异。对这些变量的受试者工作特征分析表明，它们可能对严重加重具有良好的预测价值（曲线下面积，0.77 - 0.78）。PA:AA比的截断值范围为0.8至0.87。在轴位或多平面图像上测量的分叉处或管状部位的CT测量PA:AA比，对于识别严重加重的风险是有用的，因此有助于指导COPD治疗。尽管先前的研究在肺分叉水平使用CT测量，但我们建议未来的研究应监测MPA的管状部位，以获得CT在肺动脉高压或严重COPD加重中的最大诊断价值，因为MPA的管状部位在CT图像上相对恒定。
