Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Treatment Response Evaluation by Computed Tomography Pulmonary Vasculature Analysis in Patients With Chronic Thromboembolic Pulmonary Hypertension

  • Yu-Sen Huang (Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Zheng-Wei Chen (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Wen-Jeng Lee (Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Cho-Kai Wu (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Ping-Hung Kuo (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Hsao-Hsun Hsu (Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Shu-Yu Tang (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Cheng-Hsuan Tsai (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Mao-Yuan Su (Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Chi-Lun Ko (Departments of Nuclear Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Juey-Jen Hwang (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Yen-Hung Lin (Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine) ;
  • Yeun-Chung Chang (Department of Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine)
  • Received : 2022.09.09
  • Accepted : 2023.01.28
  • Published : 2023.04.01
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Abstract

Objective: To quantitatively assess the pulmonary vasculature using non-contrast computed tomography (CT) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) pre- and post-treatment and correlate CT-based parameters with right heart catheterization (RHC) hemodynamic and clinical parameters. Materials and Methods: A total of 30 patients with CTEPH (mean age, 57.9 years; 53% female) who received multimodal treatment, including riociguat for ≥ 16 weeks with or without balloon pulmonary angioplasty and underwent both non-contrast CT for pulmonary vasculature analysis and RHC pre- and post-treatment were included. The radiographic analysis included subpleural perfusion parameters, including blood volume in small vessels with a cross-sectional area ≤ 5 mm2 (BV5) and total blood vessel volume (TBV) in the lungs. The RHC parameters included mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac index (CI). Clinical parameters included the World Health Organization (WHO) functional class and 6-minute walking distance (6MWD). Results: The number, area, and density of the subpleural small vessels increased after treatment by 35.7% (P < 0.001), 13.3% (P = 0.028), and 39.3% (P < 0.001), respectively. The blood volume shifted from larger to smaller vessels, as indicated by an 11.3% increase in the BV5/TBV ratio (P = 0.042). The BV5/TBV ratio was negatively correlated with PVR (r = -0.26; P = 0.035) and positively correlated with CI (r = 0.33; P = 0.009). The percent change across treatment in the BV5/TBV ratio correlated with the percent change in mPAP (r = -0.56; P = 0.001), PVR (r = -0.64; P < 0.001), and CI (r = 0.28; P = 0.049). Furthermore, the BV5/TBV ratio was inversely associated with the WHO functional classes I-IV (P = 0.004) and positively associated with 6MWD (P = 0.013). Conclusion: Non-contrast CT measures could quantitatively assess changes in the pulmonary vasculature in response to treatment and were correlated with hemodynamic and clinical parameters.

Keywords

Acknowledgement

We would like to express our thanks to the staff of the Core Lab at the Department of Medical Research, National Taiwan University Hospital, for their technical support. We would like to express our gratitude to the National Taiwan University Hospital-Statistical Consulting Unit (NTUH-SCU) for statistical consultation and analyses.

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