Almubarek M, Louw E H, Griffith-Richards S, Ackermann C, Baines N, Thomson H, Pecoraro A J K, Koegelenberg C F N, Irusen E M, Allwood B W
Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Department of Radiology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Afr J Thorac Crit Care Med. 2025 Mar 28;31(1):e1948. doi: 10.7196/AJTCCM.2025.v31i1.1948. eCollection 2025.
Pulmonary hypertension (PH) after tuberculosis is increasingly recognised as important in high-burden tuberculosis settings. However, the ability of computed tomography (CT) imaging to accurately detect PH remains unclear.
To evaluate the performance of standard CT measurements in detecting PH in patients with post-tuberculosis lung disease (PTLD), and to determine the potential role of CT imaging as a screening tool in this population.
A retrospective study of patients with PTLD was conducted from January 2019 to September 2021. Adult patients with both a CT chest scan and an echocardiogram performed within 9 months of each other were enrolled. A diagnosis of PH by echocardiography was made if the right ventricular systolic pressure (RVSP) was ≥36 mmHg or the peak tricuspid regurgitant jet velocity (TRVmax) >2.8 m/s. Radiological criteria for PH included a pulmonary artery/ascending aorta (PA/AA) diameter ratio >1, pulmonary artery diameter (PAD) ≥29 mm (males) or ≥27 mm (females), and right ventricle/left ventricle (RV/LV) diameter ratio ≥1.28. Spirometry was also performed.
Of 173 patients with PTLD, 52 met the inclusion criteria. Significant correlations were found between the CT-measured PA/AA ratio and RVSP (p=0.0083) and TRVmax (p=0.0582), but not between the CT-measured RV/LV ratio and RVSP (p=0.1729) or TRVmax (p=0.0749). PAD was also significantly correlated with RVSP (p=0.0011) and TRVmax (p=0.0023). The PA/AA ratio identified patients with PH on echocardiography with ~100% sensitivity, 65% specificity and a positive predictive value of 39.1%, indicating a high potential for false-positive diagnosis. The forced vital capacity was 13.7% lower in patients with PH than in those without (p=0.044); however, the forced expiratory volume in 1 second was not statistically different.
A low PA/AA ratio can be used to rule out the diagnosis of PH in PTLD, but a high PA/AA ratio requires further investigation for PH.
This study investigated the use of computed tomography (CT) chest imaging to detect pulmonary hypertension (PH) in patients with post-tuberculosis lung disease (PTLD). It revealed significant correlations between the CT-measured pulmonary artery/ascending aorta (PA/AA) diameter ratio and pulmonary artery diameter (PAD), and echocardiographic measures of PH. Notably, a low PA/AA ratio effectively rules out PH, while a high ratio warrants further investigation. These findings suggest that CT imaging, particularly PA/AA ratio measurements, could serve as a valuable initial screening tool for ruling out PH in patients with PTLD, particularly in settings with limited access to echocardiography. However, a high PA/AA in PTLD requires confirmation of PH by other means, owing to a low positive predictive value.
在结核病高负担地区，结核病后肺动脉高压（PH）越来越被认为是一个重要问题。然而，计算机断层扫描（CT）成像准确检测PH的能力仍不明确。
评估标准CT测量在检测结核病后肺部疾病（PTLD）患者PH方面的性能，并确定CT成像作为该人群筛查工具的潜在作用。
对2019年1月至2021年9月期间的PTLD患者进行了一项回顾性研究。纳入在9个月内同时进行胸部CT扫描和超声心动图检查的成年患者。如果右心室收缩压（RVSP）≥36 mmHg或三尖瓣反流峰值流速（TRVmax）>2.8 m/s，则通过超声心动图诊断为PH。PH的放射学标准包括肺动脉/升主动脉（PA/AA）直径比>1、肺动脉直径（PAD）≥29 mm（男性）或≥27 mm（女性）以及右心室/左心室（RV/LV）直径比≥1.28。还进行了肺功能测定。
173例PTLD患者中，52例符合纳入标准。CT测量的PA/AA比与RVSP（p=0.0083）和TRVmax（p=0.0582）之间存在显著相关性，但CT测量的RV/LV比与RVSP（p=0.1729）或TRVmax（p=0.0749）之间无显著相关性。PAD也与RVSP（p=0.0011）和TRVmax（p=0.0023）显著相关。PA/AA比在超声心动图诊断为PH的患者中具有约100%的敏感性、65%的特异性和39.1%的阳性预测值，表明假阳性诊断的可能性较高。PH患者的用力肺活量比无PH患者低13.7%（p=0.044）；然而，1秒用力呼气量无统计学差异。
低PA/AA比可用于排除PTLD患者的PH诊断，但高PA/AA比需要进一步检查以排除PH。
本研究调查了计算机断层扫描（CT）胸部成像在检测结核病后肺部疾病（PTLD）患者肺动脉高压（PH）中的应用。研究发现CT测量的肺动脉/升主动脉（PA/AA）直径比和肺动脉直径（PAD）与PH的超声心动图测量之间存在显著相关性。值得注意的是，低PA/AA比可有效排除PH，而高PA/AA比则需要进一步检查。这些发现表明，CT成像，特别是PA/AA比测量，可作为排除PTLD患者PH的有价值的初步筛查工具，特别是在超声心动图检查受限的情况下。然而，由于阳性预测值较低，PTLD中高PA/AA比需要通过其他方法确认PH。
