A Novel Dual Energy Computed Tomography Score Correlates With Postoperative Outcomes in Chronic Thromboembolic Pulmonary Hypertension.

IF 2 4区 医学 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Journal of Thoracic Imaging Pub Date : 2024-05-01 Epub Date: 2023-07-07 DOI:10.1097/RTI.0000000000000724
Rahul D Renapurkar, Jennifer Bullen, Alain Rizk, Mostafa Abozeed, Wadih Karim, Mnahi Bin Saeedan, Michael Z Tong, Gustavo A Heresi
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引用次数: 0

Abstract

Purpose: To compare dual-energy computed tomography (DECT) based qualitative and quantitative parameters in chronic thromboembolic pulmonary hypertension with various postoperative primary and secondary endpoints.

Materials and methods: This was a retrospective analysis of 64 patients with chronic thromboembolic pulmonary hypertension who underwent DECT. First, a clot score was calculated by assigning the following score: pulmonary trunk-5, each main pulmonary artery-4, each lobar-3, each segmental-2, and subsegmental-1 per lobe; the sum total was then calculated. The perfusion defect (PD) score was calculated by assigning 1 point to each segmental PD. The combined score was calculated by adding clot and PD scores. For quantitative evaluation, we calculated perfused blood volume (PBV) (%) of each lung and the sum of both lungs. Primary endpoints included testing association between combined score and total PBV with change in mean pulmonary arterial pressure ([mPAP], change calculated as preop minus postop values). Secondary endpoints included explorative analysis of the correlation between combined score and PBV with change in preoperative and postoperative pulmonary vascular resistance, change in preoperative 6-minute walk distance (6MWD), and immediate postoperative complications such as reperfusion edema, ECMO placement, stroke, death and mechanical ventilation for more than 48 hours, all within 1 month of surgery.

Results: Higher combined scores were associated with larger decreases in mPAP ( =0.27, P =0.036). On average, the decrease in mPAP (pre mPAP-post mPAP) increased by 2.2 mm Hg (95% CI: -0.6, 5.0) with each 10 unit increase in combined score. The correlation between total PBV and change in mPAP was small and not statistically significant. During an exploratory analysis, higher combined scores were associated with larger increases in 6MWD at 6 months postprocedure ( =0.55, P =0.002).

Conclusion: Calculation of DECT-based combined score offers potential in the evaluation of hemodynamic response to surgery. This response can also be objectively quantified.

新型双能量计算机断层扫描评分与慢性血栓栓塞性肺动脉高压的术后效果相关。
目的:比较基于双能计算机断层扫描(DECT)的慢性血栓栓塞性肺动脉高压的定性和定量参数与各种术后主要和次要终点:这是对 64 名接受 DECT 检查的慢性血栓栓塞性肺动脉高压患者的回顾性分析。首先,通过以下评分计算血栓评分:肺动脉干-5 分,每个主肺动脉-4 分,每个肺叶-3 分,每个肺段-2 分,每个肺叶亚段-1 分;然后计算总和。灌注缺损(PD)得分的计算方法是:每个节段的灌注缺损得 1 分。血块和 PD 分数相加后计算出综合分数。为了进行定量评估,我们计算了每个肺的灌注血量(PBV)(%)和两个肺的总和。主要终点包括测试综合评分和总灌注血量与平均肺动脉压([mPAP],以术前值减去术后值计算)变化之间的关联。次要终点包括对综合评分和 PBV 与术前和术后肺血管阻力变化、术前 6 分钟步行距离(6MWD)变化以及术后 1 个月内再灌注水肿、ECMO 置入、中风、死亡和机械通气超过 48 小时等术后即刻并发症之间的相关性进行探索性分析:综合评分越高,mPAP 下降幅度越大(=0.27,P=0.036)。综合评分每增加 10 个单位,mPAP(术前 mPAP-术后 mPAP)平均下降 2.2 mm Hg(95% CI:-0.6,5.0)。总 PBV 与 mPAP 变化之间的相关性较小,且无统计学意义。在探索性分析中,综合评分越高,术后 6 个月时 6MWD 的增加幅度越大(=0.55,P =0.002):结论:计算基于 DECT 的综合评分可用于评估手术后的血流动力学反应。结论:计算基于 DECT 的综合评分在评估手术后的血流动力学反应方面具有潜力,这种反应也可以客观量化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Thoracic Imaging
Journal of Thoracic Imaging 医学-核医学
CiteScore
7.10
自引率
9.10%
发文量
87
审稿时长
6-12 weeks
期刊介绍: Journal of Thoracic Imaging (JTI) provides authoritative information on all aspects of the use of imaging techniques in the diagnosis of cardiac and pulmonary diseases. Original articles and analytical reviews published in this timely journal provide the very latest thinking of leading experts concerning the use of chest radiography, computed tomography, magnetic resonance imaging, positron emission tomography, ultrasound, and all other promising imaging techniques in cardiopulmonary radiology. Official Journal of the Society of Thoracic Radiology: Japanese Society of Thoracic Radiology Korean Society of Thoracic Radiology European Society of Thoracic Imaging.
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