Universidade da Beira Interior, Covilhã, Portugal.
Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust: Liverpool, Liverpool, UK.
BMC Med Imaging. 2022 Mar 18;22(1):49. doi: 10.1186/s12880-022-00774-w.
The acceptance of coronary CT angiogram (CCTA) scans in the management of stable angina has led to an exponential increase in studies performed and reported incidental findings, including pulmonary nodules (PN). Using low-dose CT scans, volumetry tools are used in growth assessment and risk stratification of PN between 5 and 8 mm in diameter. Volumetry of PN could also benefit from the increased temporal resolution of CCTA scans, potentially expediting clinical decisions when an incidental PN is first detected on a CCTA scan, and allow for better resource management and planning in a Radiology department. This study aims to investigate how cardiopulmonary hemodynamic factors impact the volumetry of PN using CCTA scans. These factors include the cardiac phase, vascular distance from the main pulmonary artery (MPA) to the nodule, difference of the MPA diameter between systole and diastole, nodule location, and cardiomegaly presence.
Two readers reviewed all CCTA scans performed from 2016 to 2019 in a tertiary hospital and detected PN measuring between 5 and 8 mm in diameter. Each observer measured each nodule using two different software packages and in systole and diastole. A multiple linear regression model was applied, and inter-observer and inter-software agreement were assessed using intraclass correlation.
A total of 195 nodules from 107 patients were included in this retrospective, cross-sectional and observational study. The regression model identified the vascular distance (p < 0.001), the difference of the MPA diameter between systole and diastole (p < 0.001), and the location within the lower or posterior thirds of the field of view (p < 0.001 each) as affecting the volume measurement. The cardiac phase was not significant in the model. There was a very high inter-observer agreement but no reasonable inter-software agreement between measurements.
PN volumetry using CCTA scans seems to be sensitive to cardiopulmonary hemodynamic changes independently of the cardiac phase. These might also be relevant to non-gated scans, such as during PN follow-up. The cardiopulmonary hemodynamic changes are a new limiting factor to PN volumetry. In addition, when a patient experiences an acute or deteriorating cardiopulmonary disease during PN follow-up, these hemodynamic changes could affect the PN growth estimation.
冠状动脉 CT 血管造影（CCTA）扫描在稳定型心绞痛管理中的应用导致了检查数量的指数级增长，并报告了更多偶然发现，包括肺结节（PN）。使用低剂量 CT 扫描，可使用体积测量工具评估直径在 5 至 8 毫米之间的 PN 的生长情况，并进行风险分层。CCTA 扫描的时间分辨率提高后，PN 的体积测量也可能受益，当首次在 CCTA 扫描中偶然发现 PN 时，这可能会加快临床决策，同时还能改善放射科的资源管理和规划。本研究旨在探讨使用 CCTA 扫描时心肺血流动力学因素如何影响 PN 的体积测量。这些因素包括心脏相位、从主肺动脉（MPA）到结节的血管距离、收缩期和舒张期 MPA 直径的差异、结节位置和心脏增大情况。
两位观察者回顾了 2016 年至 2019 年在一家三级医院进行的所有 CCTA 扫描，并检测了直径在 5 至 8 毫米之间的 PN。每位观察者使用两种不同的软件包在收缩期和舒张期测量每个结节。应用多元线性回归模型，使用组内相关评估观察者间和软件间的一致性。
本回顾性、横断面和观察性研究共纳入了 107 名患者的 195 个结节。回归模型确定了血管距离（p<0.001）、收缩期和舒张期 MPA 直径差异（p<0.001）以及位于视野下三分之一或后三分之一（p<0.001 各）的位置是影响体积测量的因素。心脏相位在模型中没有意义。观察者间的一致性非常高，但两种软件间的一致性没有达到合理的程度。
使用 CCTA 扫描进行 PN 体积测量似乎对独立于心脏相位的心肺血流动力学变化敏感。这些变化可能也与非门控扫描有关，例如在 PN 随访期间。心肺血流动力学变化是 PN 体积测量的新限制因素。此外，当患者在 PN 随访期间出现急性或进行性心肺疾病时，这些血流动力学变化可能会影响 PN 生长的估计。
