基于ct的慢性血栓栓塞性肺动脉高压肺血管容量的空间异质性和分布

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-09-04 DOI:10.1016/j.ejrad.2025.112405

Andrew J. Synn , Pietro Nardelli , Rahul Renapurkar , Luisa Quesada , Gonzalo Vegas Sanchez-Ferrero , James C. Ross , Rubén San José Estépar , Andetta R. Hunsaker , Aaron B. Waxman , Jane A. Leopold , George R. Washko , Raúl San José Estépar , Gustavo A. Heresi , Farbod N. Rahaghi

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引用次数: 0

摘要

基于图像的血管生物标志物可能有助于加快慢性血栓栓塞性肺动脉高压（CTEPH）的评估，尽管有有效的治疗方法，但慢性血栓栓塞性肺动脉高压仍然难以诊断。我们试图确定CTEPH、肺动脉高压（PAH）和对照组在胸部CT上的血管异质性和中心分布是否存在差异。材料/方法回顾性纳入2011-2018年行右心导管置管及胸部CT检查的108例患者。使用自动CT图像分析计算所有动脉、所有静脉和小动脉/静脉的体积（面积<； 5 mm2）。血管异质性通过将每个肺划分为等容量段并计算各段的变异系数（CV）来评估。通过测量中央/周围肺区（最内/最外分别为第五区）的血管体积和计算中央与周围的体积比来评估中心再分布。我们构建了多变量线性回归模型来比较CTEPH组和对照组/PAH组的血管异质性和再分布。结果108例患者中，CTEPH 21例，PAH 47例，对照组40例。对于血管异质性，我们发现CTEPH患者与对照组相比，cv值始终较高（即更大的异质性）。在调整后的模型中，对于小动脉容量，CTEPH组的CV高0.09个单位（95% CI: 0.04-0.14, p = 0.0004）。同样，CTEPH的CVs高于PAH （p = 0.001）。对于血管再分布，我们发现与对照组/PAH相比，CTEPH的中心再分布更大；对于小动脉容量，CTEPH患者的中心-外周比值比对照组高1.52个单位（95% CI: 0.78-2.26, p = 0.0001）。结论CT技术可以定量测量肺血管的异质性和中心分布，并有助于CTEPH的图像特征。

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Spatial heterogeneity and distribution of CT-Based pulmonary vascular volumes in chronic thromboembolic pulmonary hypertension

Rationale/Objectives

Image-based vascular biomarkers may help expedite evaluation of chronic thromboembolic pulmonary hypertension (CTEPH), which remains difficult to diagnose despite available effective therapies. We sought to determine if vascular heterogeneity and central redistribution on chest CT differed between CTEPH, pulmonary arterial hypertension (PAH), and control groups.

Materials/Methods

We retrospectively included 108 patients who underwent right heart catheterization and chest CT (2011–2018). Automated CT image analysis was used to calculate volumes of all arteries, all veins, and small arteries/veins (area < 5 mm²). Vascular heterogeneity was assessed by partitioning each lung into isovolumetric segments and calculating coefficients of variation (CV) across segments. Central redistribution was assessed by measuring vascular volumes in central/peripheral lung zones (innermost/outermost fifth, respectively) and calculating central-to-peripheral volume ratios. We constructed multivariable linear regression models to compare vascular heterogeneity and redistribution between CTEPH and control/PAH groups.

Results

Of 108 patients, 21 had CTEPH, 47 had PAH, and 40 were controls. For vascular heterogeneity, we found consistently higher CVs (i.e. greater heterogeneity) in CTEPH vs. controls. For small arterial volume, CV was 0.09 units higher (95 % CI: 0.04–0.14, p = 0.0004) in the CTEPH group in adjusted models. Similarly, CVs were higher in CTEPH vs. PAH (p = 0.001). For vascular redistribution, we found greater central redistribution in CTEPH compared to controls/PAH; for small arterial volume, central-to-peripheral ratio was 1.52 units higher in CTEPH vs. controls (95 % CI: 0.78–2.26, p = 0.0001).

Conclusion

Volumetric measures of heterogeneity and central distribution of pulmonary vessels can be quantified using CT techniques and may contribute to an image-based signature of CTEPH.

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来源期刊

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.