Use of small pulmonary vascular alterations to identify different types of pulmonary hypertension: a quantitative computed tomography analysis

BACKGROUND: The morphological alterations of small pulmonary vessels measured by computed tomography (CT) is increasingly used in evaluation of suspected pulmonary hypertension (PH). OBJECTIVE: To investigate the significance alterations of quantitative assessment of small pulmonary vessels on chest CT in distinguishing different types of PH and their severity. METHODS: We retrospectively analyzed a dataset of 120 healthy controls (HCs) and 91 PH patients, including 34 patients with connective tissue diseases-related PH (CTD-PH), 26 patients with idiopathic pulmonary arterial hypertension (iPAH), and 31 patients with chronic obstructive pulmonary disease-related PH (COPD-PH). The CTD-PH patients were divided into mild to moderate PH (CTD-LM-PH) group (n = 17) and severe PH (CTD-S-PH) group (n = 17). A total of 53 CTD patients without PH (CTD-nPH) were enrolled for comparison with the CTD-PH. We measured the cross-sectional area of small pulmonary vessels < 5 mm2 (%CSA <5) and between 5–10 mm2 (%CSA5–10) as a percentage of total lung area among the populations included above and compared %CSA in different types of PH groups and HCs group. The mean pulmonary arterial pressure (mPAP) was measured by right heart catheterization. RESULTS: The %CSA5–10 of COPD-PH, CTD-PH, and iPAH patients increased (0.21±0.09, 0.49±0.20 and 0.61±0.20, p < 0.02) sequentially, while the %CSA <5 of CTD-PH, iPAH, and COPD-PH patients decreased (0.79±0.65, 0.65±0.38 and 0.52±0.27, p < 0.05) sequentially. The %CSA5–10 was significantly higher in CTD-S-PH patients than CTD-LM-PH patients and CTD-nPH patients (0.51±0.21, 0.31±0.15 and 0.28±0.12, p < 0.01). The %CSA5–10 was positively correlated with mPAP in the CTD-PH group. CONCLUSIONS: The quantitative parameters %CSA <5 and %CSA5–10 assessed by chest CT are useful for distinguishing different types of PH. In addition, the %CSA5–10 can provide information for identification of CTD-PH severity.

A Pulmonary Vascular Extraction Algorithm from Chest CT/CTA Images

Segmentation of pulmonary vessels in CT/CTA images can help physicians better determine the patient’s condition and treatment. However, due to the complexity of CT images, existing methods have limitations in the segmentation of pulmonary vessels. In this paper, a method based on the separation of pulmonary vessels in CT/CTA images is investigated. The method is divided into two steps: in the first step, the lung parenchyma is extracted using the Unet++ algorithm, which can effectively reduce the oversegmentation rate; in the second step, the pulmonary vessels in the lung parenchyma are extracted using nnUnet. According to the obtained lung parenchyma segmentation results, the “AND” operation is performed on the original image and the lung parenchyma segmentation results, and only the blood vessels within the lung parenchyma are segmented, which reduces the interference of external tissues and improves the segmentation accuracy. The experimental data source used CT/CTA images acquired from the partner hospital. After the experiments were performed on a total of 67 sets of images, the accuracy of CT and CTA images reached 85.1% and 87.7%, respectively. The comparison of whether to segment the lung parenchyma and with other conventional methods was also performed, and the experimental results showed that the algorithm in this paper has high accuracy.

Thrombosis in COVID-19 Patients

The magnitude of thrombosis in Coronavirus disease 2019 (COVID-19) patients is yet to be understood fully. Thrombosis in COVID-19 patients depends on multiple factors like the severity of the disease, presence or absence of prophylactic anticoagulants, and the number of anticoagulants prescribed. Histologically, lung tissues from COVID patients show florid capillary endothelitis with microthrombi formation in alveolar capillaries and small pulmonary vessels. Inflammation and diffuse alveolar damage, extensive pulmonary macrophage activation and diffuse interstitial inflammation play an important role in microthrombi formation in the pulmonary vessels. If antithrombotic therapy is already prescribed before the diagnosis of COVID-19, it should be continued. For all hospitalized pregnant patients, prophylactic anticoagulant therapy is prescribed unless contraindicated. Anticoagulant therapy during labor requires special care. Appropriate therapeutic and prophylactic anticoagulant regimens must be initiated as and when required including in the post discharge phase.

Analysis of bronchial and vascular patterns in left upper lobes to explore the genesis of mediastinal lingular artery and its influence on pulmonary anatomical variation

Background For thoracic surgeons, three-dimensional computed tomography bronchography and angiography (3-DCTBA) is a convenient way to analyze pulmonary variations before segmentectomy. Mediastinal lingular artery (MLA) is one of the representative variations. Methods The 3-DCTBA data of left upper lobe (LUL) were collected from patients who underwent pulmonary surgery from January 2018 to December 2019. We reviewed the patterns of bronchi and pulmonary vessels and grouped them according to different classifications. Results Among all the 404 cases of 3-DCTBA, mediastinal lingular artery (MLA) was found in 107 cases (26.49%). The patterns of B3 and the vein in left upper division (LUD) are distinct between mediastinal (M-type) group and interlobar (IL-type) group. The patterns of bronchi and veins in lingular division, as well as the pattern of pulmonary artery in LUD, have no differences between M-type and IL-type groups. Conclusions Mediastinal lingular artery is speculated to originate from the variation of B3, and the MLA independently influences the venous pattern in LUD in turn.

Sex-dependent change in the reactivity of isolated pulmonary arteries of gonadectomized rats under the intermittent hypoxia of different degree

Introduction. Pulmonary vasoconstriction is one of factors of hypoxic pulmonary hypertension (HPH). The progression of this disease depends on the degree of hypoxiа and seх. The aim of this study was to investigate the reactivity of isolated pulmonary vessels of male and female rats with HPH to vasoactive factors. Materials and methods. The experiments were on male and female of Wistar rats 190–200 g, which were gonadectomized. All animals were divided into 4 groups. One group of males and female rats was kept in a vivarium (21 % О2 ). To simulate HPH, other rats were exposed to hypobaric hypoxia for 10 hours a day at an oxygen content in the inhaled air equal to 13 % (pP O2 103.7 mmHg) or 10 % (pP O2 78,2 mmHg), or 8 % (pP O2 63,5 mmHg) as compared to its content at 21 % (pP О2 159 mmHg). After that, a third-order pulmonary vessel was perfused at a constant flow rate with vasoconstrictors and vasodilators. The reaction was recorded by the change in perfusion pressure. Results. In females with HРН 10 %O2 , constricting response to serotonin were greater than in males. In normotensive males, the dilatory response to sodium nitroprusside (NP) was less than in female. Exposure to hypoxia induced an increase in NP responses. Conclusion. Increased reactivity of pulmonary vessels to serotonin is a factor of pathogenesis of HPH in females, in contrast to males. Increased reactivity to NO donor in males exposed to hypoxia сan be used for a pharmacological target for HPH.

Overexpression of Msx1 in Mouse Lung Leads to Loss of Pulmonary Vessels Following Vascular Hypoxic Injury

Pulmonary arterial hypertension (PAH) is a progressive lung disease caused by thickening of the pulmonary arterial wall and luminal obliteration of the small peripheral arteries leading to increase in vascular resistance which elevates pulmonary artery pressure that eventually causes right heart failure and death. We have previously shown that transcription factor Msx1 (mainly expressed during embryogenesis) is strongly upregulated in transformed lymphocytes obtained from PAH patients, especially IPAH. Under pathological conditions, Msx1 overexpression can cause cell dedifferentiation or cell apoptosis. We hypothesized that Msx1 overexpression contributes to loss of small pulmonary vessels in PAH. In IPAH lung, MSX1 protein localization was strikingly increased in muscularized remodeled pulmonary vessels, whereas it was undetectable in control pulmonary arteries. We developed a transgenic mouse model overexpressing MSX1 (MSX1OE) by about 4-fold and exposed these mice to normoxic, sugen hypoxic (3 weeks) or hyperoxic (100% 02 for 3 weeks) conditions. Under normoxic conditions, compared to controls, MSX1OE mice demonstrated a 30-fold and 2-fold increase in lung Msx1 mRNA and protein expression, respectively. There was a significant retinal capillary dropout (p < 0.01) in MSX1OE mice, which was increased further (p < 0.03) with sugen hypoxia. At baseline, the number of pulmonary vessels in MSX1OE mice was similar to controls. In sugen-hypoxia-treated MSX1OE mice, the number of small (0–25 uM) and medium (25–50 uM) size muscularized vessels increased approximately 2-fold (p < 0.01) compared to baseline controls; however, they were strikingly lower (p < 0.001) in number than in sugen-hypoxia-treated control mice. In MSX1OE mouse lung, 104 genes were upregulated and 67 genes were downregulated compared to controls. Similarly, in PVECs, 156 genes were upregulated and 320 genes were downregulated from siRNA to MSX1OE, and in PVSMCs, 65 genes were upregulated and 321 genes were downregulated from siRNA to MSX1OE (with control in the middle). Many of the statistically significant GO groups associated with MSX1 expression in lung, PVECs, and PVSMCs were similar, and were involved in cell cycle, cytoskeletal and macromolecule organization, and programmed cell death. Overexpression of MSX1 suppresses many cell-cycle-related genes in PVSMCs but induces them in PVECs. In conclusion, overexpression of Msx1 leads to loss of pulmonary vessels, which is exacerbated by sugen hypoxia, and functional consequences of Msx1 overexpression are cell-dependent.

MECHANISMS OF THE THERAPEUTIC EFFECT OF HYPERBARIC OXYGEN ON THE GAS EXCHANGE FUNCTION OF THE LUNGS IN SARS-CO-2-ASSOCIATED PNEUMONIA

The article discusses some mechanisms of the therapeutic effect of hyperbaric oxygenation in COVID-19: the effect of hyperbaric oxygen on the contractility of endotheliocytes of pulmonary capillaries, thrombogenic and arthrombogenic potential of pulmonary vessels.

Idiopathic fibrous mediastinitis with refractory pleural effusion: a case report and literature review

Fibrous mediastinitis is a rare progressive disease characterized by invasive proliferation of fibrous tissue in the mediastinum. This tissue proliferation leads to compression of the mediastinal structures in the thoracic cavity, including the pulmonary vessels, esophagus, and trachea, causing corresponding symptoms and complications such as pulmonary hypertension. In clinical practice, the diagnosis of fibrous mediastinitis is often delayed or missed because of the rarity and variable clinical manifestations of this condition. This article presents a case of idiopathic fibrous mediastinitis that manifested as pleural effusion of unknown etiology along with a review of the relevant literature.

Diagnostic Performance of a Contrast-Enhanced Ultra-Low-Dose High-Pitch CT Protocol with Reduced Scan Range for Detection of Pulmonary Embolisms

(1) Background: To evaluate the diagnostic performance of a simulated ultra-low-dose (ULD), high-pitch computed tomography pulmonary angiography (CTPA) protocol with low tube current (mAs) and reduced scan range for detection of pulmonary embolisms (PE). (2) Methods: We retrospectively included 130 consecutive patients (64 ± 16 years, 69 female) who underwent clinically indicated high-pitch CTPA examination for suspected acute PE on a 3rd generation dual-source CT scanner (SOMATOM FORCE, Siemens Healthineers, Forchheim, Germany). ULD datasets with a realistic simulation of 25% mAs, reduced scan range (aortic arch—basal pericardium), and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 5 were created. The effective radiation dose (ED) of both datasets (standard and ULD) was estimated using a dedicated dosimetry software solution. Subjective image quality and diagnostic confidence were evaluated independently by three reviewers using a 5-point Likert scale. Objective image quality was compared using noise measurements. For assessment of diagnostic accuracy, patients and pulmonary vessels were reviewed binarily for affection by PE, using standard CTPA protocol datasets as the reference standard. Percentual affection of pulmonary vessels by PE was computed for disease severity (modified Qanadli score). (3) Results: Mean ED in ULD protocol was 0.7 ± 0.3 mSv (16% of standard protocol: 4.3 ± 1.7 mSv, p < 0.001, r > 0.5). Comparing ULD to standard protocol, subjective image quality and diagnostic confidence were comparably good (p = 0.486, r > 0.5) and image noise was significantly lower in ULD (p < 0.001, r > 0.5). A total of 42 patients (32.2%) were affected by PE. ULD protocol had a segment-based false-negative rate of only 0.1%. Sensitivity for detection of any PE was 98.9% (95% CI, 97.2–99.7%), specificity was 100% (95% CI, 99.8–100%), and overall accuracy was 99.9% (95% CI, 98.6–100%). Diagnoses correlated strongly between ULD and standard protocol (Chi-square (1) = 42, p < 0.001) with a decrease in disease severity of only 0.48% (T = 1.667, p = 0.103). (4) Conclusions: Compared to a standard CTPA protocol, the proposed ULD protocol proved reliable in detecting and ruling out acute PE with good levels of image quality and diagnostic confidence, as well as significantly lower image noise, at 0.7 ± 0.3 mSv (84% dose reduction).