Renapurkar Rahul D, Bullen Jennifer, Rizk Alain, Abozeed Mostafa, Karim Wadih, Bin Saeedan Mnahi, Tong Michael Z, Heresi Gustavo A
Section of Thoracic Imaging, Imaging Institute.
Quantitative Health Sciences.
J Thorac Imaging. 2024 May 1;39(3):178-184. doi: 10.1097/RTI.0000000000000724. Epub 2023 Jul 7.
To compare dual-energy computed tomography (DECT) based qualitative and quantitative parameters in chronic thromboembolic pulmonary hypertension with various postoperative primary and secondary endpoints.
This was a retrospective analysis of 64 patients with chronic thromboembolic pulmonary hypertension who underwent DECT. First, a clot score was calculated by assigning the following score: pulmonary trunk-5, each main pulmonary artery-4, each lobar-3, each segmental-2, and subsegmental-1 per lobe; the sum total was then calculated. The perfusion defect (PD) score was calculated by assigning 1 point to each segmental PD. The combined score was calculated by adding clot and PD scores. For quantitative evaluation, we calculated perfused blood volume (PBV) (%) of each lung and the sum of both lungs. Primary endpoints included testing association between combined score and total PBV with change in mean pulmonary arterial pressure ([mPAP], change calculated as preop minus postop values). Secondary endpoints included explorative analysis of the correlation between combined score and PBV with change in preoperative and postoperative pulmonary vascular resistance, change in preoperative 6-minute walk distance (6MWD), and immediate postoperative complications such as reperfusion edema, ECMO placement, stroke, death and mechanical ventilation for more than 48 hours, all within 1 month of surgery.
Higher combined scores were associated with larger decreases in mPAP ( =0.27, P =0.036). On average, the decrease in mPAP (pre mPAP-post mPAP) increased by 2.2 mm Hg (95% CI: -0.6, 5.0) with each 10 unit increase in combined score. The correlation between total PBV and change in mPAP was small and not statistically significant. During an exploratory analysis, higher combined scores were associated with larger increases in 6MWD at 6 months postprocedure ( =0.55, P =0.002).
Calculation of DECT-based combined score offers potential in the evaluation of hemodynamic response to surgery. This response can also be objectively quantified.
比较基于双能计算机断层扫描（DECT）的定性和定量参数在慢性血栓栓塞性肺动脉高压患者中的情况，并与各种术后主要和次要终点进行对比。
这是一项对64例接受DECT检查的慢性血栓栓塞性肺动脉高压患者的回顾性分析。首先，通过赋予以下分值计算血栓评分：肺动脉主干-5分，每支主肺动脉-4分，每个肺叶-3分，每个肺段-2分，每个亚段-1分/叶；然后计算总分。灌注缺损（PD）评分通过为每个肺段的PD赋予1分来计算。综合评分通过将血栓评分和PD评分相加得出。为进行定量评估，我们计算了每侧肺以及双侧肺的灌注血容量（PBV）（%）。主要终点包括测试综合评分和总PBV与平均肺动脉压变化（[mPAP]，变化计算为术前值减去术后值）之间的关联。次要终点包括对综合评分与PBV之间的相关性进行探索性分析，以及术前和术后肺血管阻力的变化、术前6分钟步行距离（6MWD）的变化，以及术后1个月内的即时术后并发症，如再灌注水肿、体外膜肺氧合（ECMO）置入、中风、死亡和机械通气超过48小时。
较高的综合评分与mPAP的更大降幅相关（=0.27，P =0.036）。平均而言，综合评分每增加10个单位，mPAP的降幅（术前mPAP - 术后mPAP）增加2.2 mmHg（95% CI：-0.6，5.0）。总PBV与mPAP变化之间的相关性较小且无统计学意义。在探索性分析中，较高的综合评分与术后6个月时6MWD的更大增加相关（=0.55，P =0.002）。
基于DECT的综合评分计算在评估手术的血流动力学反应方面具有潜力。这种反应也可以进行客观量化。
