Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
Respir Res. 2022 Dec 1;23(1):325. doi: 10.1186/s12931-022-02239-8.
Without aggressive treatment, pulmonary arterial hypertension (PAH) has a 5-year mortality of approximately 40%. A patient's response to vasodilators at diagnosis impacts the therapeutic options and prognosis. We hypothesized that analyzing perfusion images acquired before and during vasodilation could identify characteristic differences between PAH and control subjects.
We studied 5 controls and 4 subjects with PAH using HRCT and NN PET imaging of pulmonary perfusion and ventilation. The total spatial heterogeneity of perfusion (CV) and its components in the vertical (CV) and cranio-caudal (CV) directions, and the residual heterogeneity (CV), were assessed at baseline and while breathing oxygen and nitric oxide (O + iNO). The length scale spectrum of CV was determined from 10 to 110 mm, and the response of regional perfusion to O + iNO was calculated as the mean of absolute differences. Vertical gradients in perfusion (Q) were derived from perfusion images, and ventilation-perfusion distributions from images of NN washout kinetics.
O + iNO significantly enhanced perfusion distribution differences between PAH and controls, allowing differentiation of PAH subjects from controls. During O + iNO, CV was significantly higher in controls than in PAH (0.08 (0.055-0.10) vs. 6.7 × 10 (2 × 10-0.02), p < 0.001) with a considerable gap between groups. Q and CV showed smaller differences: - 7.3 vs. - 2.5, p = 0.002, and 0.12 vs. 0.06, p = 0.01. CV had the largest effect size among the primary parameters during O + iNO. CV, and its length scale spectrum were similar in PAH and controls. Ventilation-perfusion distributions showed a trend towards a difference between PAH and controls at baseline, but it was not statistically significant.
Perfusion imaging during O2 + iNO showed a significant difference in the heterogeneity associated with the vertical gradient in perfusion, distinguishing in this small cohort study PAH subjects from controls.
未经积极治疗，肺动脉高压（PAH）患者的 5 年死亡率约为 40%。患者在诊断时对血管扩张剂的反应会影响治疗选择和预后。我们假设分析血管扩张前后的灌注图像可以识别 PAH 与对照组之间的特征差异。
我们使用 HRCT 和 NN PET 对 5 名对照组和 4 名 PAH 患者的肺灌注和通气进行成像。在基线和呼吸氧气和一氧化氮（O2+iNO）时，评估灌注的总空间异质性（CV）及其在垂直（CV）和头尾（CV）方向上的分量，以及残留异质性（CV）。从 10 到 110 毫米确定 CV 的长度谱，计算 O2+iNO 对区域灌注的反应作为绝对差异的平均值。从灌注图像中提取垂直灌注梯度（Q），从 NN 洗脱动力学的图像中提取通气-灌注分布。
O2+iNO 显著增强了 PAH 与对照组之间的灌注分布差异，使 PAH 患者与对照组能够区分开来。在 O2+iNO 期间，对照组的 CV 明显高于 PAH（0.08（0.055-0.10）与 6.7×10（2×10-0.02），p<0.001），两组之间存在较大差距。Q 和 CV 的差异较小：-7.3 与-2.5，p=0.002，0.12 与 0.06，p=0.01。在 O2+iNO 期间，CV 是主要参数中具有最大效应量的参数。CV 及其长度谱在 PAH 和对照组中相似。在基线时，通气-灌注分布显示出 PAH 和对照组之间存在差异的趋势，但没有统计学意义。
在 O2+iNO 期间进行的灌注成像显示，与灌注垂直梯度相关的异质性存在显著差异，在这项小型队列研究中，将 PAH 患者与对照组区分开来。
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