Baruah Dhiraj, Sonavane Sushilkumar, Goodman Lawrence, Nath Hrudaya, Presberg Kenneth, Shahir Kaushik
Radiodiagnosis, Medical University of South Carolina, Charleston, USA.
Radiology, Mayo Clinic, Jacksonville, USA.
Cureus. 2021 Feb 26;13(2):e13577. doi: 10.7759/cureus.13577.
Pulmonary vascular resistance (PVR) is a measurement obtained with invasive right heart catheterization (RHC) that is commonly used for management of patients with pulmonary arterial hypertension (PAH). Computed tomography pulmonary angiography (CTPA) is also done as part of the workup for PAH in some cases. The aim of our study was to assess the correlation of contrast dynamic changes in the main pulmonary artery (MPA) on CTPA with PVR obtained with RHC.
This is an IRB-approved retrospective study performed in two separate institutions (Medical College of Wisconsin and University of Alabama) between January 2010 and December 2013. During CTPA done as test bolus, serial images are acquired at the level of MPA after intravenous injection of contrast to determine timing of the CT acquisition. Since the PVR changes with the degree of PAH, we hypothesize that will be reflected in the contrast kinetics in MPA. A correlation of standard CT metrics (MPA diameter, right pulmonary artery [PA] diameter, left PA diameter, MPA/aorta ratio, and right ventricle/left ventricle [RV/LV] ratio) and dynamic (full width at half maximum) CTPA parameters in patients with known PAH was performed with PVR obtained from RHC done within 30 days. Statistical analysis was performed by Pearson correlation coefficient.
Among 221 patients in our database, 37 patients fulfilled the selection criteria. There was a strong correlation between full width half maximum (FWHM) and mean pulmonary artery pressure (mPAP) (r=0.69, p value<0.00001), PVR (r=0.8, p value<0.00001) and indexed PVR (PVRI) (r=0.75, p value<0.00001).
FWHM obtained from CTPA strongly correlates with RHC parameters and is potentially more helpful than static measurements for follow-up of patients with known PAH to assess response to treatment or progression.
肺血管阻力（PVR）是通过有创右心导管检查（RHC）获得的一项测量指标，常用于肺动脉高压（PAH）患者的管理。在某些情况下，计算机断层扫描肺动脉造影（CTPA）也作为PAH检查的一部分进行。我们研究的目的是评估CTPA上主肺动脉（MPA）的对比剂动态变化与通过RHC获得的PVR之间的相关性。
这是一项经机构审查委员会批准的回顾性研究，于2010年1月至2013年12月在两个不同机构（威斯康星医学院和阿拉巴马大学）进行。在作为测试团注进行CTPA期间，静脉注射对比剂后在MPA水平获取系列图像，以确定CT采集的时间。由于PVR随PAH程度变化，我们假设这将反映在MPA的对比剂动力学中。对已知PAH患者的标准CT指标（MPA直径、右肺动脉[PA]直径、左PA直径、MPA/主动脉比值和右心室/左心室[RV/LV]比值）与动态（半高宽）CTPA参数进行相关性分析，这些参数与在30天内进行的RHC获得的PVR相关。采用Pearson相关系数进行统计分析。
在我们数据库中的221例患者中，37例符合入选标准。半高宽（FWHM）与平均肺动脉压（mPAP）（r = 0.69，p值<0.00001）、PVR（r = 0.8，p值<0.00001）和指数化PVR（PVRI）（r = 0.75，p值<0.00001）之间存在强相关性。
CTPA获得的FWHM与RHC参数密切相关，对于已知PAH患者的随访以评估治疗反应或病情进展，可能比静态测量更有帮助。
