评估一种新开发的 2D 参数化实质血流技术，该技术采用自动血管抑制算法，用于接受球囊肺动脉成形术的慢性血栓栓塞性肺动脉高压患者。

Evaluation of a newly developed 2D parametric parenchymal blood flow technique with an automated vessel suppression algorithm in patients with chronic thromboembolic pulmonary hypertension undergoing balloon pulmonary angioplasty.

机构信息

Department of Diagnostic and Interventional Radiology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.

Clinic for Pneumology, Member of the German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.

出版信息

Clin Radiol. 2019 Jun;74(6):437-444. doi: 10.1016/j.crad.2018.12.023. Epub 2019 Mar 16.

DOI:10.1016/j.crad.2018.12.023

PMID:30890260

Abstract

AIM

To evaluate the feasibility of two-dimensional parametric parenchymal blood flow (2D-PPBF) to quantify perfusion changes in the lung parenchyma following balloon pulmonary angioplasty (BPA) for treatment of chronic thromboembolic pulmonary hypertension.

MATERIALS AND METHODS

Overall, 35 consecutive interventions in 18 patients with 98 treated pulmonary arteries were included. To quantify changes in pulmonary blood flow using 2D-PPBF, the acquired digital subtraction angiography (DSA) series were post-processed using dedicated software. A reference region of interest (ROI; arterial inflow) in the treated pulmonary artery and a distal target ROI, including the whole lung parenchyma distal to the targeted stenosis, were placed in corresponding areas on DSA pre- and post-BPA. Half-peak density (HPD), wash-in rate (WIR), arrival to peak (AP), area under the curve (AUC), and mean transit time (MTT) were assessed. The ratios of the reference ROI to the target ROI (HPD/HPD, WIR/WIR; AP/AP, AUC/AUC, MTT/MTT) were calculated. The relative differences of the 2D-PPBF parameters were correlated to changes in the pulmonary flow grade score.

RESULTS

The pulmonary flow grade score improved significantly after BPA (1 versus 3; p<0.0001). Likewise, the mean HPD/HPD (-10.2%; p<0.0001), AP/AP (-24.4%; p=0.0007), and MTT/MTT (-3.5%; p=0.0449) decreased significantly, whereas WIR/WIR (+82.4%) and AUC/AUC (+58.6%) showed a significant increase (p<0.0001). Furthermore, a significant correlation between changes of the pulmonary flow grade score and changes of HPD/HPD (ρ=-0.21, p=0.04), WIR/WIR (ρ=0.43, p<0.0001), AP/AP (ρ=-0.22, p=0.03), AUC/AUC (ρ=0.48, p<0.0001), and MTT/MTT (ρ=-0.39, p<0.0001) could be observed.

CONCLUSION

The 2D-PPBF technique is feasible for the quantification of perfusion changes following BPA and has the potential to improve monitoring of BPA.

摘要

目的

评估二维参数性肺实质血流（2D-PPBF）定量评估球囊肺动脉成形术（BPA）治疗慢性血栓栓塞性肺动脉高压后肺实质灌注变化的可行性。

材料与方法

共纳入 18 例患者的 35 例连续介入治疗，共处理 98 处肺动脉。为了使用 2D-PPBF 定量评估肺血流变化，通过专用软件对采集的数字减影血管造影（DSA）系列进行后处理。在 BPA 前后的 DSA 上，将处理过的肺动脉中的感兴趣区（ROI；动脉流入）和包括靶向狭窄远端的整个肺实质的远端靶标 ROI 分别置于相应区域。评估半峰密度（HPD）、灌注率（WIR）、达峰时间（AP）、曲线下面积（AUC）和平均通过时间（MTT）。计算参考 ROI 与靶标 ROI 的比值（HPD/HPD、WIR/WIR；AP/AP、AUC/AUC、MTT/MTT）。2D-PPBF 参数的相对差异与肺血流分级评分的变化相关。

结果

BPA 后肺血流分级评分显著改善（1 级变为 3 级；p<0.0001）。同样，HPD/HPD（-10.2%；p<0.0001）、AP/AP（-24.4%；p=0.0007）和 MTT/MTT（-3.5%；p=0.0449）显著降低，而 WIR/WIR（+82.4%）和 AUC/AUC（+58.6%）显著增加（p<0.0001）。此外，肺血流分级评分的变化与 HPD/HPD（ρ=-0.21，p=0.04）、WIR/WIR（ρ=0.43，p<0.0001）、AP/AP（ρ=-0.22，p=0.03）、AUC/AUC（ρ=0.48，p<0.0001）和 MTT/MTT（ρ=-0.39，p<0.0001）的变化之间存在显著相关性。