Bacon Jenny Louise, Madden Brendan Patrick, Gissane Conor, Sayer Charles, Sheard Sarah, Vlahos Ioannis
Departments of Cardiothoracic Medicine (J.L.B., B.P.M.) and Thoracic Imaging (I.V.), St George's University Hospitals NHS Foundation Trust and St George's University of London, Blackshaw Road, London SW17 0QT, England; School of Sport, Health and Applied Science, St Mary's University, London, England (C.G.); and Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, England (C.S., S.S.).
Radiol Cardiothorac Imaging. 2020 Dec 17;2(6):e200009. doi: 10.1148/ryct.2020200009. eCollection 2020 Dec.
To evaluate pulmonary hypertension (PH) determination by dual-phase dual-energy CT pulmonary angiography vascular enhancement and perfused blood volume (PBV) quantification.
In this prospective study, consecutive participants who underwent both right heart catheterization and dual-phase dual-energy CT pulmonary angiography were included between 2012 and 2014. CT evaluation comprised a standard pulmonary arterial phase dual-energy CT pulmonary angiography acquisition (termed series 1) followed 7 seconds after series 1 completion by a second dual-energy CT pulmonary angiography acquisition limited to the central 10 cm of the pulmonary vasculature (termed series 2). In both series, enhancement in the main pulmonary artery (PAenh), the descending aorta (DAenh), and whole-lung PBV (WLenh) was calculated from dual-energy CT pulmonary angiography iodine images. Dual-energy CT pulmonary angiography and standard cardiovascular metrics were correlated to mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) with additional receiver operating characteristic curve analysis.
A total of 102 participants (median age, 70; range, 58-78 years; 60 women) were included. Sixty-five participants had PH defined by mPAP of greater than or equal to 25 mm Hg, and 51 participants had PH defined by PVR of greater than 3 Wood units. By either definition, participants with PH had higher PAenh/WLenh ratio and lower WLenh and DAenh in series 1 ( < .05) and higher PAenh and WLenh in series 2 ( < .05). Change in WLenh determined highest diagnostic accuracy to define disease by mPAP (area under the receiver operating characteristic curve [AUC], 0.78) and PVR (AUC, 0.79) and the best mPAP correlation ( = 0.62). PAenh series 2 correlated best with PVR ( = 0.49). Multiple linear regression analysis incorporating WLenh and series 1 DAenh improved PVR correlation ( = 0.56). Combining these dual-energy CT pulmonary angiography metrics with main pulmonary artery size and right-to-left ventricular ratio achieved the highest correlations (mPAP, = 0.71; PVR, = 0.64).
Dual-phase dual-energy CT pulmonary angiography enhancement quantification appears to improve mPAP and PVR prediction in noninvasive PH evaluation.See also the commentary by Kay in this issue.© RSNA, 2020.
通过双期双能量CT肺动脉造影血管强化及灌注血容量（PBV）定量评估肺动脉高压（PH）。
在这项前瞻性研究中，纳入了2012年至2014年间连续接受右心导管检查和双期双能量CT肺动脉造影的参与者。CT评估包括标准肺动脉期双能量CT肺动脉造影采集（称为系列1），在系列1完成7秒后，进行第二次双能量CT肺动脉造影采集，仅限于肺血管中央10 cm（称为系列2）。在两个系列中，均从双能量CT肺动脉造影碘图像计算主肺动脉强化（PAenh）、降主动脉强化（DAenh）和全肺PBV（WLenh）。双能量CT肺动脉造影和标准心血管指标与平均肺动脉压（mPAP）和肺血管阻力（PVR）相关，并进行额外的受试者操作特征曲线分析。
共纳入102名参与者（年龄中位数为70岁；范围为58 - 78岁；60名女性）。65名参与者的PH定义为mPAP大于或等于25 mmHg，51名参与者的PH定义为PVR大于3伍德单位。无论采用哪种定义，PH参与者在系列1中的PAenh/WLenh比值更高，WLenh和DAenh更低（P < 0.05），在系列2中的PAenh和WLenh更高（P < 0.05）。WLenh变化对通过mPAP（受试者操作特征曲线下面积[AUC]，0.78）和PVR（AUC，0.79）定义疾病的诊断准确性最高，且与mPAP的相关性最佳（r = 0.62）。系列2的PAenh与PVR的相关性最佳（r = 0.49）。纳入WLenh和系列1的DAenh的多元线性回归分析改善了与PVR的相关性（r = 0.56）。将这些双能量CT肺动脉造影指标与主肺动脉大小及右心室与左心室比值相结合，相关性最高（mPAP，r = 0.71；PVR，r = 0.64）。
双期双能量CT肺动脉造影强化定量似乎可改善无创性PH评估中mPAP和PVR的预测。另见本期Kay的评论。© RSNA，2020。
