The contribution of pulmonary vessel volume measurements using thorax computed tomography (CT) to the diagnosis of pulmonary hypertension (PH)


Sarı O., Yarol R. C., Gezer N. S., Özgen Alpaydın A., Sevinç C., Özpelit E., ...More

European Congress of Radiology 2024, Vienna, Austria, 28 February - 03 March 2024, pp.1

  • Publication Type: Conference Paper / Full Text
  • Doi Number: 10.26044/ecr2024/c-10714
  • City: Vienna
  • Country: Austria
  • Page Numbers: pp.1
  • Dokuz Eylül University Affiliated: Yes

Abstract

Purpose


Pulmonary hypertension (PH) is a chronic progressive disease that may result in right heart failure and death [1]. PH is currently defined as a resting mean pulmonary arterial (PA) pressureof >20 mmHg at right heart catheterization [2]. In the suspicion of PH, contrast-enhanced chest CT examination is often performed to exclude the diagnosis of pulmonary embolism and assess lung parenchyma to determine the underlying etiology [3,4]. 

PA diameter measurement is also performed in chest CT. It has been reported that the finding of main pulmonary artery caliber greater than 29 mm measured 2 cm from the pulmonary valve has 84% sensitivity, 75% specificity, and 97% positive predictive value for the presence of pulmonary arterial hypertension, as confirmed with invasive imaging. However, the measurement is made from a single cross-section and neglects the contribution of the vessel geometry to the diagnosis. 

Pulmonary hypertension (PH) is a chronic progressive disease that may result in right heart failure and death. PH is currently defined as a resting mean pulmonary arterial (PA) pressure of >20 mmHg at right heart catheterization. In the suspicion of PH, contrast-enhanced chest CT examination is often performed to exclude the diagnosis of pulmonary embolism and assess lung parenchyma to determine the underlying etiology. 

PA diameter measurement is also performed in chest CT. It has been reported that the finding of main pulmonary artery caliber greater than 29 mm measured 2 cm from the pulmonary valve has 84% sensitivity, 75% specificity, and 97% positive predictive value for the presence of pulmonary arterial hypertension, as confirmed with invasive imaging. However, the measurement is made from a single cross-section and neglects the contribution of the vessel geometry to the diagnosis. 

The definitive diagnosis of PH is made by right heart catheterization, but this method is invasive. The aim of this study was to analyze the relationship between pulmonary artery volume measurements made by chest CT and pulmonary hypertension. 


Methods and materials

 

A total of 100 patients diagnosed with PH by catheter angiography between June 2007 and December 2022 in our hospital and who had a contrast-enhanced chest CT examination at the time of diagnosis were included in the study. Chest CT examinations were integrated into the 3D Slicer 5.2.1 program to be evaluated were evaluated retrospectively

Fig 1: Manual segmentation of pulmonary arteries with 3D Slicer
. Total PA volume, central PA volume, pulmonary trunk volume, right and left PA volumes were measured by manual segmentation.
Fig 2: 3-D volume presentation
Table 1: Pulmonary artery volume and 2-D measurements
Then, catheter angiography press information, echocardiographic systolic PA pressure, 5-year survival average, 6-minute gait test and BNP values were compared. The obtained data were analyzed statistically by using SPSS 24.0.

Results

Among 100 patients, 73 (73%) were female and 27 (27%) were male. According to WHO classification grouping of pulmonary hypertension 57 patients (57%) had group 1 PH, 4 (4%) patients had group 2 PH, 7 patients (7%) had group 3 PH, 26 patient (26%) had group 4 PH, 6 patients (6%) had group 5 PH.  

In the study, there was no statistically significant relationship between 5-year survival and any of the PA volumes. A weak correlation between total PA pressure and systolic PA pressure (r: 0.230) and a moderate correlation with mean PA pressure (r: 0.275) and diastolic pressure was determined.  

Total PA volume was weakly correlated with the average pulmonary arterial pressure and diastolic pulmonary arterial pressure and moderately correlated with the systolic pulmonary arterial pressure. Total PA volume and central PA volume were moderately correlated with mean and diastolic PA pressure and weakly correlated with systolic PA pressure. Pulmonary trunk volume was slightly more correlated with mean (r = 0.287) and diastolic PA pressure (r=0.324) values than total and central PA volumes

Right PA volume was weakly correlated with mean and diastolic PA pressure values while left pulmonary volume was only correlated with diastolic PA pressure.


Conclusion

 In our study, a correlation between PA volumes and PA pressure was shown by using contrast-enhanced chest CT suggesting that PA volume measurements may be used as a non-invasive method in the diagnosis and follow-up of PH.