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Pulmonary Artery Diameter Does Not Correlate with Pulmonary Hypertension in Fibrosis Patients

December 18, 2008
Written by: , Filed in: Chest Radiology
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To evaluate how the main dPA correlates with the presence of PH in patients
with and without pulmonary fibrosis.

In pulmonary fibrosis patients, the main pulmonary artery diameter (dPA) does
not correlate with the presence of pulmonary hypertension (PH); in these
patients, dilatation of the main pulmonary artery can occur in the absence of
PH.

Design
Retrospective study.

Participants
Seventy-seven patients underwent both CT and right-sided heart
catheterization; 30 patients (group A) had pulmonary fibrosis, and 47 patients
(group B) did not. The CT and catheterization were performed within nine
months of one another. Patients with congenital heart disease were excluded.

Methodology
On CT, the widest short axis dPA was measured with electronic calipers on the
axial images at the level of bifurcation. On this same image, the widest short
axis ascending aorta diameter (dAA) was also measured. The degree of pulmonary
fibrosis was also quantified visually in each lung lobe.

Pulmonary fibrosis was defined as ground-glass or reticular opacity associated
with traction bronchiectasis or architectural distortion. Right-sided heart
catheterization was performed using standard methods with a Swan-Ganz PA
catheter, and pressure measurements were made.

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging

Results
In group A (patients with pulmonary fibrosis), there was no correlation
between dPA and mean pulmonary artery pressure (mPAP) or pulmonary vascular
resistance index (PVRi) (r P =0.22 and r =0.23, P =0.28).

In group B (patients without pulmonary fibrosis) there was strong correlation
between dPA and mPAP and PVRi (r =0.67, P <0.0001 and r =0.78, P <0.0001). The correlation was better in group A if the dPA/dAA ratio was used (r =0.54, P <0.005 for mPAP and r =0.48, P =0.04 for PVRi). The dPA/dAA ratio did not improve the correlation in group B compared with dPA alone. In group A, PA dilatation occurred in patients even if they did not have PH, and the degree of PA dilatation was unrelated to the visual quantification of the amount of pulmonary fibrosis or total lung capacity as measured by pulmonary function tests. Conclusions
Measurement of the dPA as a sign of PH in patients with pulmonary fibrosis is
not reliable, and it can occur in the absence of PH in this group of patients.

Reviewer’s Comments
The authors have very nicely demonstrated that evaluation of the main
pulmonary artery diameter alone as a sign of PH can be performed in patients
without pulmonary fibrosis, but cannot be performed in patients with pulmonary
fibrosis.

Author: Vineet R. Jain, MD

Reference
Devaraj A, Wells AU, et al. The Effect of Diffuse Pulmonary Fibrosis on the
Reliability of CT Signs of Pulmonary Hypertension.
Radiology;
2008;249 (December): 1042-1049:

Review for Practicing Radiologists The University of California, San Francisco School of Medicine, Department of Radiology and Biomedical Imaging Review for Practicing Radiologists an intensive clinical radiologic review and self-assessment covering the following radiology subspecialties: Vascular-Interventional, Breast, Neuro, Gastrointestinal and Pulmonary Imaging. The program is designed for radiologists in clinical practice. Click here to read more or order: Review for Practicing Radiologists --

 

Body Imaging: Abdominal, Thoracic and Vascular University of California, San Francisco, Department of Radiology Course Director: Judy Yee, MD This program is designed for the radiologist in clinical practice, and is intended to provide an overview and update on clinically relevant topics in diagnostic imaging and interventional techniques. Click here to read more or order: Body Imaging
.

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