Predictors of Pulmonary Hypertension on High-resolution Computed Tomography of the Chest in Systemic Sclerosis: A Retrospective Analysis

Purpose To evaluate the imaging features on high-resolution computed tomography (HRCT) of the chest and the clinical parameters that are associated with pulmonary hypertension in systemic sclerosis. We specifically investigated whether main pulmonary artery (MPA) diameter and burden of lung fibrosis are predictors of pulmonary hypertension in these patients. Methods We retrospectively retrieved the database information of patients with systemic sclerosis seen at our hospital between January 2007 and December 2008. A total of 75 patients had HRCT of the chest, pulmonary function testing (PFT), and echocardiography within 6 months of each other. The echocardiography images were reviewed by a level-3 echocardiographer, and 29 cases were excluded because of suboptimal evaluation of pulmonary artery (PA) pressure. Peak PA pressures and PFT of the remaining 46 cases (43 women and 3 men) were charted. The PFT included total lung capacity (TLC), diffusion capacity of lung for carbon monooxide (DLCO) and the ratio of forced expiratory volume in one second and forced vital capacity (FEV1/FVC). The HRCT of the chest of each patient was read by a chest radiologist. The extent of ground glass, reticulation, and honeycombing was objectively scored. The maximum diameter of the main pulmonary artery (MPAD) and ascending aorta were measured. The ratio of main pulmonary artery diameter and ascending aortic diameter (MPAD/AD) and ratio of main pulmonary artery diameter and body surface area (MPAD/BSA) were also calculated. Results Statistical analysis done by using a multivariate model showed that the calculated fibrotic score strongly correlated with peak PA pressures ( P < .001). MPAD ( P = .0175), and the ratio MPAD/AD ( P = .0102) also showed a statistically significant correlation with peak PA pressures. By using stepwise regression analysis, the fibrotic score was found to be the most reliable independent predictor of pulmonary hypertension. Conclusion HRCT-determined severity and extent of pulmonary fibrosis may be helpful in screening for pulmonary hypertension in patients with systemic sclerosis.

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Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

ERJ Open Research ◽

10.1183/23120541.00232-2019 ◽

2020 ◽

Vol 6 (1) ◽

pp. 00232-2019

Author(s):

Pailin Ratanawatkul ◽

Andrea Oh ◽

J. Caleb Richards ◽

Jeffrey J. Swigris

Keyword(s):

Computed Tomography ◽

Pulmonary Hypertension ◽

High Resolution ◽

Pulmonary Artery ◽

Predictive Value ◽

High Specificity ◽

Chronic Obstructive ◽

High Resolution Computed Tomography ◽

Entire Cohort ◽

Right Heart Catheterisation

BackgroundOn high-resolution computed tomography (HRCT), pulmonary artery (PA) dimensions may hint at the presence of pulmonary hypertension. We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension.MethodsWe retrospectively reviewed patients who had HRCT and RHC between 2010 and 2018. Analyses considered respiratory cycle, pulmonary hypertension diagnostic criteria, time between HRCT and RHC, and subgroup analysis in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD).ResultsOf 620 patients, 375 had pulmonary hypertension. For pulmonary hypertension (defined as mean PA pressure (mPAP) ≥25 mmHg) and from HRCT performed within 60 days of RHC, main PA diameter (MPAD) ≥29 mm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88%, 42%, 0.70 and 0.70, respectively, while ratio of the diameter of the PA to the diameter of the ascending aorta (PA:Ao) ≥1.0 showed 53%, 85%, 0.84 and 0.54, respectively. In general, results were similar when the interval between HRCT and RHC varied from 7 to 60 days and when measured on expiratory images. In ILD, the sensitivity of MPAD was higher; in COPD, the specificity of PA:Ao was higher. There was moderately positive correlation between mPAP and inspiratory MPAD, PA:Ao, right PA diameter (RPAD), left PA diameter (LPAD) and (RPAD+LPAD)/2 (r=0.48, 0.51, 0.34, 0.34 and 0.36, respectively), whereas there was weak negative correlation between mPAP and PA angle (r= −0.24).ConclusionsFindings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ≥29 mm had high sensitivity and PA:Ao ≥1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD.

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Pulmonary hypertension and systemic sclerosis: the role of high-resolution computed tomography

La radiologia medica ◽

10.1007/s11547-013-0934-1 ◽

2013 ◽

Vol 118 (8) ◽

pp. 1360-1372 ◽

Cited By ~ 8

Author(s):

Maurizio Zompatori ◽

Maria Barbara Leone ◽

Marica Giannotta ◽

Nazzareno Galiè ◽

Massimiliano Palazzini ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Hypertension ◽

Systemic Sclerosis ◽

High Resolution ◽

High Resolution Computed Tomography

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HIGH-RESOLUTION COMPUTED TOMOGRAPHY BRONCHIAL LUMEN TO PULMONARY ARTERY DIAMETER RATIO IN ANESTHETIZED VENTILATED CATS WITH NORMAL LUNGS

Veterinary Radiology & Ultrasound ◽

10.1111/j.1740-8261.2011.01870.x ◽

2011 ◽

Vol 53 (1) ◽

pp. 34-37 ◽

Cited By ~ 17

Author(s):

Lauren E. Reid ◽

A. Ray Dillon ◽

John T. Hathcock ◽

Lawrence A. Brown ◽

Michael Tillson ◽

...

Keyword(s):

Computed Tomography ◽

High Resolution ◽

Pulmonary Artery ◽

Diameter Ratio ◽

High Resolution Computed Tomography ◽

Bronchial Lumen ◽

Pulmonary Artery Diameter ◽

Normal Lungs

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CHANGING OF PULMONARY ARTERY DIAMETER IN ACCORDANCE WITH SEVERITY OF COVID-19 (ASSESSMENT BASED ON NON-CONTRAST COMPUTER TOMOGRAPHY)

Digital Diagnostics ◽

10.17816/dd76726 ◽

2021 ◽

Author(s):

Alexander F. Aliev ◽

Nikita D. Kudryavtsev ◽

Alexey Vladimirovich Petraikin ◽

Zlata R. Artyukova ◽

Andrey S. Shkoda ◽

...

Keyword(s):

Computed Tomography ◽

Pulmonary Hypertension ◽

Pulmonary Artery ◽

Main Pulmonary Artery ◽

Age Groups ◽

Lung Parenchyma ◽

Lung Damage ◽

High Incidence ◽

The Relationship ◽

Pulmonary Artery Diameter

Backgraund: search for the causes of the severe course of COVID-19 by computed tomography of chest, in particular, to clarify the contribution of pulmonary hypertension in the severe course of COVID-19 Aims: To establish the relationship between the expansion of the pulmonary artery and an increase in the severity of COVID-19 pneumonia. Material and methods: This is a retrospective cohort study performed on a group of patients (n = 511, 267 male. Median 59, IQR 49.065.0, min 31 max 84 y.o.) treated in a COVID-19 temporary hospital. Chest CT was performed on a portable computed tomography Airo TruCT (Stryker, USA). The degree of damage of the lung parenchyma was assessed by the CT scale 1(25%); 2(25-50%) 3(50-75%), 4(75%). The diameters of the main pulmonary artery (PA), aorta (Ao) and PA/Ao ratio were measured. Results: The following statistically evident results were obtained: expansion of the pulmonary artery (PA) and PA/Ao ratio increased with rise of the degree of lung damage in COVID-19. Expansion of the aorta was significantly correlated with increasing age of the patients. Discussion: We suggested, this fact and noted expansion of PA in 52.0-65.5% of patients with severe COVID-19 (CT 3-4) is an indicator of a high incidence of pulmonary hypertension in this disease. This requires additional research. Conclusion: It has been shown that the expansion of the pulmonary artery and an increase in the ratio of PA/Ao diameters are associated with an increase in the severity of COVID-19 in all age groups. KEYWORDS COVID-19, pulmonary artery, pulmonary hypertension, aorta, computed tomography.

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AB0605 CLINICAL PROFILE AND CHEST HIGH-RESOLUTION COMPUTED TOMOGRAPHY (HRCT) FINDINGS IN PATIENTS WITH CONNECTIVE TISSUE DISEASES AND INTERSTITIAL LUNG DISEASE: EXPERIENCE OF A SINGLE REFERENCE RHEUMATOLOGY CENTER

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3758 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1598.2-1599

Author(s):

I. Rusu ◽

L. Muntean ◽

M. M. Tamas ◽

I. Felea ◽

L. Damian ◽

...

Keyword(s):

Computed Tomography ◽

Systemic Sclerosis ◽

High Resolution ◽

Interstitial Lung Disease ◽

Connective Tissue ◽

Lung Disease ◽

Interstitial Pneumonia ◽

Connective Tissue Diseases ◽

High Resolution Computed Tomography ◽

Hrct Patterns

Background:Interstitial lung disease (ILD) is a common manifestation of connective tissue diseases (CTDs), and is associated with significant morbidity and mortality. Chest high-resolution computed tomography (HRCT) play an important role in the diagnosis of ILD and may provide prognostic information.Objectives:We aimed to characterize the clinical profile and chest HRCT abnormalities and patterns of patients diagnosed with CTDs and ILD.Methods:In this retrospective, observational study we included 80 consecutive patients with CTDs and ILD referred to a tertiary rheumatology center between 2015 and 2019. From hospital charts we collected clinical data, immunologic profile, chest HRCT findings. HRCT patterns were defined according to new international recommendations.Results:Out of 80 patients, 64 (80%) were women, with a mean age of 55 years old. The most common CTD associated with ILD was systemic sclerosis (38.8%), followed by polymyositis (22.5%) and rheumatoid arthritis (18.8%). The majority of patients had dyspnea on exertion (71.3%), bibasilar inspiratory crackles were present in 56.3% patients and 10% had clubbing fingers. Antinuclear antibodies (ANA) were present in 78.8% patients, and the most frequently detected autoantibodies against extractable nuclear antigen were anti-Scl 70 (28.8%), followed by anti-SSA (anti-Ro, 17.5%), anti-Ro52 (11.3%) and anti-Jo (7.5%). Intravenous cyclophosphamide therapy for 6-12 months was used in 35% of patients, while 5% of patients were treated with mycophenolate mofetil.The most frequent HRCT abnormalities were reticular abnormalities and ground glass opacity. Non-specific interstitial pneumonia (NSIP) was identified in 46.3% CTDs patients. A pattern suggestive of usual interstitial pneumonia (UIP) was present in 32.5% patients, mainly in patients with systemic sclerosis. In 21.3% patients the HRCT showed reticulo-nodular pattern, micronodules and other abnormalities, not diagnostic for UIP or NSIP pattern.Conclusion:Nonspecific interstitial pneumonia (NSIP) is the most common HRCT pattern associated with CTDs. Further prospective longitudinal studies are needed in order to determine the clinical and prognostic significance of various HRCT patterns encountered in CTD-associated ILD and for better patient management.References:[1]Ohno Y, Koyama H, Yoshikaua T, Seki S. State-of-the-Art Imaging of the Lung for Connective Tissue Disease (CTD). Curr Rheumatol Rep. 2015;17(12):69.[2]Walsh SLF, Devaraj A, Enghelmeyer JI, Kishi K, Silva RS, Patel N, et al. Role of imaging in progressive-fibrosing interstitial lung diseases. Eur Respir Rev. 2018;27(150)Disclosure of Interests:None declared

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