Advertisement

La radiologia medica

, Volume 122, Issue 7, pp 495–504 | Cite as

A new CT-score as index of hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension

  • Maria Barbara LeoneEmail author
  • Marica Giannotta
  • Massimiliano Palazzini
  • Mariano Cefarelli
  • Sofia Martìn Suàrez
  • Enrico Gotti
  • Maria Letizia Bacchi Reggiani
  • Maurizio Zompatori
  • Nazzareno Galiè
CHEST RADIOLOGY

Abstract

Purpose

The aim of this study was to retrospectively assess the relationship between radiological and hemodynamic parameters in patients with chronic thromboembolic pulmonary hypertension (CTEPH). We introduced a new CT-score to evaluate hemodynamic changes, only employing CT-pulmonary angiography (CTPA).

Materials and methods

145 patients affected by CTEPH underwent hemodynamic and CTPA evaluation. Among these 145 patients, 69 underwent pulmonary endarterectomy (PEA) and performed a CTPA evaluation even after surgery. Hemodynamic assessment considered the values of mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR), obtained through right heart catheterization (RHC). Radiological evaluation included CTPA signs of pulmonary hypertension.

Results

A highly significant statistical correlation was observed between the new CT-score and both mPAP and PVR (p < 0.000) in the whole sample and also in the subgroup who underwent PEA. In addition, mPAP and PVR showed an important association with the severity of mosaic perfusion (p < 0.000). mPAP also correlated with main pulmonary artery diameter (p < 0.01); a significant association was found in both between PVR and tricuspid regurgitation(p < 0.000) and with PVR and presence of unilateral or bilateral pulmonary thromboembolic occlusion (p < 0.05).

Conclusion

Our results confirm the diagnostic role of CTPA in evaluating patients with CTEPH and in addition open a new horizon in assessing hemodynamic changes in patients with CTEPH, only employing a CTPA, especially when RHC is contraindicated or not possible.

Keywords

Chronic thromboembolic pulmonary hypertension CT-pulmonary angiography Right heart catheterization Pulmonary endarterectomy A new CT-score for CTEPH 

Abbreviations and acronyms

AV

Azygos vein

BAH

Bronchial arteries hypertrophy

CC

Collateral circles

CPB

Cardio-pulmonary bypass

CS

Coronary sinus

CTEPH

Chronic thromboembolic pulmonary hypertension

CTPA

Computed tomography pulmonary angiography

ISB

Interventricular septum bowing

LV

Left ventricle diameter

MP

Mosaic perfusion

PEA

Pulmonary endarterectomy

PA

Pulmonary artery

PE

Pulmonary embolism

PH

Pulmonary hypertension

RA

Right atrium

RV

Right ventricle

RVFWT

Right ventricle free wall thickness

SD

Standard deviation

SVC

Superior vena cava

TR

Tricuspid regurgitation

Notes

Compliance with ethical standards

No funds were used for the present study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Reesink HJ, Marcus JT, Tulevski II et al (2007) Reverse right ventricular remodeling after pulmonary endarterectomy in patients with chronic thromboembolic pulmonary hypertension: utility of magnetic resonance imaging to demonstrate restoration of the right ventricle. J Thorac Cardiovasc Surg 133:58–64CrossRefPubMedGoogle Scholar
  2. 2.
    Berman M, Gopalan D, Sharples L et al (2014) Right ventricular reverse remodeling after pulmonary endarterectomy: magnetic resonance imaging and clinical and right heart catheterization assessment. Pulm Circ 4:36–44CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Marshall PS, Kerr KM, Auger WR (2013) Chronic thromboembolic pulmonary hypertension. Clin Chest Med 34:779–797CrossRefPubMedGoogle Scholar
  4. 4.
    Taboada D, Pepke-Zaba J, Jenkins DP et al (2014) Outcome of pulmonary endarterectomy in symptomatic chronic thromboembolic disease. Eur Respir J 44:1635–1645CrossRefPubMedGoogle Scholar
  5. 5.
    Wijesuriya S, Chandratreya L, Medford AR (2013) Chronic pulmonary emboli and radiologic mimics on CT pulmonary angiography a diagnostic challenge. Chest 143:1460–1471CrossRefPubMedGoogle Scholar
  6. 6.
    Peňa E, Dennie C, Veinot J et al (2012) Pulmonary hypertension: how the radiologist can help. RadioGraphics 32:9–32CrossRefPubMedGoogle Scholar
  7. 7.
    Ameli-Renani S, Rahman F, Nair A et al (2014) Dual-energy CT for imaging of pulmonary hypertension: challenges and opportunities. RadioGraphics 34:1769–1790CrossRefPubMedGoogle Scholar
  8. 8.
    Castañer E, Gallardo X, Ballesteros E et al (2009) CT Diagnosis of chronic pulmonary thromboembolism. RadioGraphics 29:31–53CrossRefPubMedGoogle Scholar
  9. 9.
    Schoepf UJ, Costello P (2004) CT angiography for diagnosis of pulmonary embolism: state of the art. Radiology 230:329–337CrossRefPubMedGoogle Scholar
  10. 10.
    Miller GA, Sutton GC, Kerr IH et al (1971) Comparison of streptokinase and heparin in treatment of isolated acute massive pulmonary embolism. Br Med J 2:681–684CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Walsh PN, Greenspan RH, Simon M et al (1973) An angiographic severity index for pulmonary embolism. Circulation 47–48(suppl 2):101–108Google Scholar
  12. 12.
    Qanadli SD, El Hajjam M, Vieillard-Baron A et al (2001) New CT index to quantify arterial obstruction in pulmonary embolism: comparison with angiographic index and echocardiography. Am J Roentgenol 176:1415–1420CrossRefGoogle Scholar
  13. 13.
    Mastora I, Remy-Jardin M, Masson P et al (2003) Severity of acute pulmonary embolism: evaluation of a new spiral CT angiographic score in correlation with echocardiographic data. Eur Radiol 13:29–35CrossRefPubMedGoogle Scholar
  14. 14.
    Ghaye B, Ghuysen A, Bruyere PJ et al (2006) Can CT pulmonary angiography allow assessment of severity and prognosis in patients presenting with pulmonary embolism? What the radiologist needs to know. RadioGraphics 26:23–40CrossRefPubMedGoogle Scholar
  15. 15.
    Groves AM, Win T, Charman SC et al (2004) Semi-quantitative assessment of tricuspid regurgitation on contrast-enhanced multidetector CT. Clin Radiol 59:715–719CrossRefPubMedGoogle Scholar
  16. 16.
    Jamieson SW, Kapelanski DP (2000) Pulmonary endarterectomy. Curr Probl Surg 37:165–252CrossRefPubMedGoogle Scholar
  17. 17.
    Jenkins DP, Madani M, Mayer E et al (2013) Surgical treatment of chronic thromboembolic pulmonary hypertension. Eur Respir J 41:735–742CrossRefPubMedGoogle Scholar
  18. 18.
    Fedullo PF, Auger WR, Kerr KM et al (2001) Chronic thromboembolic pulmonary hypertension. N Engl J Med 345:1465–1472CrossRefPubMedGoogle Scholar
  19. 19.
    Iino M, Dymarkowski S, Chaothawee L et al (2008) Time course of reversed cardiac remodeling after pulmonary endarterectomy in patients with chronic pulmonary thromboembolism. Eur Radiol 18:792–799CrossRefPubMedGoogle Scholar
  20. 20.
    Jamieson SW, Kapelanski DP, Sakakibara N et al (2003) Pulmonary endarterectomy: experience and lessons learned in 1500 cases. Ann Thorac Surg 76:1457–1462CrossRefPubMedGoogle Scholar
  21. 21.
    Dartevelle P, Fadel E, Mussot S, Chapelier A, Herve P, de Perrot M, Cerrina J, Ladurie FL, Lehouerou D, Humbert M et al (2004) Chronic thromboembolic pulmonary htpertension. Eur Respir J 23:637–648CrossRefPubMedGoogle Scholar
  22. 22.
    Heinrich M, Uder M, Tscholl D et al (2005) CT scan findings in chronic thromboembolic pulmonary hypertension predictors of hemodynamic improvement after pulmonary thromboendarterectomy. Chest 127:1606–1613CrossRefPubMedGoogle Scholar
  23. 23.
    Kauczor HU, Schwickert HC, Mayer E et al (1994) Spiral CT of bronchial arteries in chronic thromboembolism. J Comput Assist Tomogr 18:855–861CrossRefPubMedGoogle Scholar
  24. 24.
    Bergin CJ, Sirlin C, Deutsch R et al (2000) Predictors of patient response to pulmonary thromboendarterectomy. Am J Roentgenol 174:509–515CrossRefGoogle Scholar
  25. 25.
    Oikonomou A, Dennie CJ, Müller NL et al (2004) Chronic thromboembolic pulmonary arterial hypertension correlation of postoperative results of thromboendarterectomy with preoperative helical contrast-enhanced computed tomography. J Thorac Imaging 19:67–73CrossRefPubMedGoogle Scholar
  26. 26.
    Liu M, Ma Z, Guo X et al (2011) Computed tomographic pulmonary angiography in the assessment of severity of chronic thromboembolic pulmonary hypertension and right ventricular dysfunction. Eur J Radiol 80:e462–e469CrossRefPubMedGoogle Scholar
  27. 27.
    Kuriyama K, Gamsu G, Stern RG et al (1984) CT-determined pulmonary artery diameters in predicting pulmonary hypertension. Invest Radiol 19:16–22CrossRefPubMedGoogle Scholar
  28. 28.
    Haimovici JB, Trotman-Dickenson B, Halpern EF et al (1997) Relationship between pulmonary artery diameter at computed tomography and pulmonary artery pressures at right-sided heart catheterization. Massachusetts General Hospital Lung Transplantation Program. Acad Radiol 4:327–334CrossRefPubMedGoogle Scholar
  29. 29.
    Edwards PD, Bull RK, Coulden R et al (1998) CT measurement of main pulmonary artery diameter. Br J Radiol 71:1018–1020CrossRefPubMedGoogle Scholar
  30. 30.
    Mahammedi A, Oshmyansky A, Hassoun PM (2013) Pulmonary artery measurements in pulmonary hypertension. The role of computed tomography. J Thorac Imaging 28:96–103CrossRefPubMedGoogle Scholar
  31. 31.
    Chan AL, Juarez MM, Shelton DK et al (2011) Novel computed tomographic chest metrics to detect pulmonary hypertension. BMC Med Imaging 11:7CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Corson N, Armato SG, Labby ZE et al (2014) CT-based pulmonary artery measurements for the assessment of pulmonary hypertension. Acad Radiol 21:523–530CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Schmidt HC, Kauczor HU, Schild HH et al (1996) Pulmonary hypertension in patients with chronic pulmonary thromboembolism: chest radiograph and CT evaluation before and after surgery. Eur Radiol 6:817–825CrossRefPubMedGoogle Scholar
  34. 34.
    Sato M, Ando M, Kaneko K et al (2013) Respiratory and hemodynamic changes in patients with chronic thromboembolic pulmonary hypertension 1 year after pulmonary endarterectomy. Ann Vasc Dis 6:578–582CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Corsico AG, D’Armini AM, Cerveri I et al (2008) Long-term outcome after pulmonary endarterectomy. Am J Respir Crit Care Med 178:419–424CrossRefPubMedGoogle Scholar
  36. 36.
    Liu M, Ma Z, Guo X et al (2013) Cardiovascular parameters of computed tomographic pulmonary angiography to assess pulmonary vascular resistance in patients with chronic thromboembolic pulmonary hypertension. Int J Cardiol 164:295–300CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Medical Radiology 2017

Authors and Affiliations

  • Maria Barbara Leone
    • 1
    Email author
  • Marica Giannotta
    • 1
  • Massimiliano Palazzini
    • 3
  • Mariano Cefarelli
    • 2
  • Sofia Martìn Suàrez
    • 2
  • Enrico Gotti
    • 3
  • Maria Letizia Bacchi Reggiani
    • 4
  • Maurizio Zompatori
    • 1
  • Nazzareno Galiè
    • 3
  1. 1.Department of Specialized, Diagnostic and Experimental MedicineUniversity of Bologna, Sant’Orsola-Malpighi HospitalBolognaItaly
  2. 2.Heart and Lung Transplantation Program, Cardiac Surgery DepartmentS. Orsola-Malpighi HospitalBolognaItaly
  3. 3.Institute of CardiologyS. Orsola-Malpighi HospitalBolognaItaly
  4. 4.Department of Cardiovascular DiseasesUniversity of Bologna, S. Orsola-Malpighi HospitalBolognaItaly

Personalised recommendations