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2016 ; 6
(1
): 70-81
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Pulmonary vascular morphology as an imaging biomarker in chronic thromboembolic
pulmonary hypertension
#MMPMID27162616
Rahaghi FN
; Ross JC
; Agarwal M
; González G
; Come CE
; Diaz AA
; Vegas-Sánchez-Ferrero G
; Hunsaker A
; San José Estépar R
; Waxman AB
; Washko GR
Pulm Circ
2016[Mar]; 6
(1
): 70-81
PMID27162616
show ga
Patients with chronic thromboembolic pulmonary hypertension (CTEPH) have
morphologic changes to the pulmonary vasculature. These include pruning of the
distal vessels, dilation of the proximal vessels, and increased vascular
tortuosity. Advances in image processing and computer vision enable objective
detection and quantification of these processes in clinically acquired computed
tomographic (CT) scans. Three-dimensional reconstructions of the pulmonary
vasculature were created from the CT angiograms of 18 patients with CTEPH
diagnosed using imaging and hemodynamics as well as 15 control patients referred
to our Dyspnea Clinic and found to have no evidence of pulmonary vascular
disease. Compared to controls, CTEPH patients exhibited greater pruning of the
distal vasculature (median density of small-vessel volume: 2.7 [interquartile
range (IQR): 2.5-3.0] vs. 3.2 [3.0-3.8]; P = 0.008), greater dilation of proximal
arteries (median fraction of blood in large arteries: 0.35 [IQR: 0.30-0.41] vs.
0.23 [0.21-0.31]; P = 0.0005), and increased tortuosity in the pulmonary arterial
tree (median: 4.92% [IQR: 4.85%-5.21%] vs. 4.63% [4.39%-4.92%]; P = 0.004). CTEPH
was not associated with dilation of proximal veins or increased tortuosity in the
venous system. Distal pruning of the vasculature was correlated with the cardiac
index (R = 0.51, P = 0.04). Quantitative models derived from CT scans can be used
to measure changes in vascular morphology previously described subjectively in
CTEPH. These measurements are also correlated with invasive metrics of pulmonary
hemodynamics, suggesting that they may be used to assess disease severity.
Further work in a larger cohort may enable the use of such measures as a
biomarker for diagnostic, phenotyping, and prognostic purposes.