Clinical Significance of Quantitative CT Measurement of Pulmonary Vascular Indexes in Chronic Obstructive Pulmonary Disease_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LiaoYixuan ,  ChenYahong , BaiYu , WangXiaohua , LinFan , LiMinxia

Department of Respiratory and Critical Care Medicine, Third Hospital, Peking University, Beijing, 100191, China;

Corresponding author：

ChenYahong, Email: chenyahong@vip.sina.com

Keywords：

Chronic obstructive pulmonary disease; Pulmonary artery; Computed tomography; Clinical indexes

DOI：

10.7507/1671-6205.2015131

Video：

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Objective To explore the clinical significance of quantitative CT measurement of pulmonary vascular indexes in chronic obstructive pulmonary disease (COPD). Methods Fifty-three stable COPD patients who were diagnosed in our hospital between May 2013 and February 2015 were recruited in the study. The HRCT results were analyzed, and the pulmonary vascular indexes were measured including the main pulmonary artery diameter (mPAD), axial diagonal mPAD, sagittal mPAD, right pulmonary artery diameter (RPAD), left pulmonary artery diameter (LPAD) and etc. The % CSA<5 (the percent of total cross-sectional area of the vascular with cross-sectional area less than 5 mm² to total area of the lung) was calculated with Image J 1.48. The % LAA[volume percentage of low attenuation areas (<-950 HU)] representing degree of emphysema was calculated with GE ADW 4.5. Lung function test and questionnaires including CAT, mMRC, SGRQ and frequency of acute exacerbation of COPD (AECOPD) were completed and collected. Results In COPD patients, the mPAD,axial diagonal mPAD, sagittal mPAD, RPAD and LPAD were positively correlated with % LAA respectively (r=0.36, 0.33, 0.43, 0.45, 0.33) and % CSA<5 was negatively correlated with % LAA (r=-0.37). mPAD was positively correlated with CAT, SGRQ and frequency of AECOPD respectively (r=0.52, 0.29, 0.35), and negatively correlated with FEV₁% pred (r=-0.30).% CSA<5 was negatively correlated with CAT, SGRQ and frequency of AECOPD, respectively (r=-0.29,-0.30,-0.29), and positively correlated with FEV₁% pred (r=0.28). The multivariate linear regression analysis revealed a linear relationship of mPAD with body mass index,% LAA and CAT. There was also linear relationships between axial diagonal mPAD, sagittal mPAD, RPAD and % LAA, CAT, respectively, and linear relationships between % CSA<5 and FEV₁% pred,% LAA. The P value were all less than 0.05. Conclusion Quantitative CT measurement of cross-sectional area of small pulmonary vessels and pulmonary artery diameter are associated with clinical indexes in COPD patients, which will provide a new appraoche for the disease assessment of COPD patients.

Citation： LiaoYixuan, ChenYahong, BaiYu, WangXiaohua, LinFan, LiMinxia. Clinical Significance of Quantitative CT Measurement of Pulmonary Vascular Indexes in Chronic Obstructive Pulmonary Disease. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(6): 529-533. doi: 10.7507/1671-6205.2015131 Copy

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2.	Matsuoka S, Yamashiro T, Washko GR, et al. Quantitative CT assessment of chronic obstructive pulmonary disease. Radiographics,2010,30:55-66.
3.	Coche E, Pawlak S, Dechambre S, et al. Peripheral pulmonary arteries:identification at multi-slice spiral CT with 3D reconstruction. Eur Radiol,2003,13:815-822.
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5.	Mahammedi A, Oshmyansky A, Hassoun PM, et al. Pulmonary artery measurements in pulmonary hypertension:the role of computed tomography. J Thorac Imaging,2013,28:96-103.
6.	张伟,俞同福,徐海,等.CT肺动脉成像对急性肺栓塞患者肺动脉高压严重程度的评估.放射学实践,2013,28:324-328.
7.	Matsuoka S, Washko GR, Dransfield MT, et al. Quantitative CT measurement of cross-sectional area of small pulmonary vessel in COPD:correlations with emphysema and airflow limitation. Acad Radiol,2010,17:93-99.
8.	Matsuura Y, Kawata N, Yanagawa N, et al. Quantitative assessment of cross-sectional area of small pulmonary vessels in patients with COPD using inspiratory and expiratory MDCT. Eur J Radiol, 2013,82:1804-1810.
9.	Matsuoka S, Yamashiro T, Diaz A, et al. The relationship between small pulmonary vascular alteration and aortic atherosclerosis in chronic obstructive pulmonary disease:quantitative CT analysis. Acad Radiol,2011,18:40-46.
10.	Uejima I, Matsuoka S, Yamashiro T, et al. Quantitative computed tomographic measurement of a cross-sectional area of a small pulmonary vessel in nonsmokers without airflow limitation. Japan J Radiol, 2011,29:251-255.
11.	Wells JM, Dransfield MT. Pathophysiology and clinical implications of pulmonary arterial enlargement in COPD. Int J Chron Obstruct Pulmon Dis,2013,8:509-821.
12.	Tuder RM, Flook BE, Voelkel NF. Increased gene expression for VEGF and the VEGF receptors KDR/Flk and Flt in lungs exposed to acute or to chronic hypoxia:modulation of gene expression by nitric oxide. J Clin Invest,1995,95:1798-1807.
13.	Tuder RM, Zhen L, Cho CY, et al. Oxidative stress and apoptosis interact and cause emphysema due to vascular endothelial growth factor receptor blockade. Am J Respir Cell Mol Biol,2003,29:88-97.
14.	Washko GR, Parraga G, Coxson HO. Quantitative pulmonary imaging using computed tomography and magnetic resonance imaging. Respirology,2012,17:432-444.
15.	Estepar RS, Kinney GL, Black-Shinn JL, et al. Computed tomographic measures of pulmonary vascular morphology in smokers and their clinical implications. Am J Respir Crit Care Med,2013,188:231-239.
16.	Wells JM, Washko GR, Han MK, et al. Pulmonary arterial enlargement and acute exacerbations of COPD. New Engl J Med,2012,367:913-921.

1. Matsuoka S, Washko GR, Yamashiro T, et al. Pulmonary hypertension and computed tomography measurement of small pulmonary vessels in severe emphysema. Am J Respir Crit Care Med,2010,181:218-225.
2. Matsuoka S, Yamashiro T, Washko GR, et al. Quantitative CT assessment of chronic obstructive pulmonary disease. Radiographics,2010,30:55-66.
3. Coche E, Pawlak S, Dechambre S, et al. Peripheral pulmonary arteries:identification at multi-slice spiral CT with 3D reconstruction. Eur Radiol,2003,13:815-822.
4. 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2013年修订版).中华结核和呼吸杂志,2013,36:255-264.
5. Mahammedi A, Oshmyansky A, Hassoun PM, et al. Pulmonary artery measurements in pulmonary hypertension:the role of computed tomography. J Thorac Imaging,2013,28:96-103.
6. 张伟,俞同福,徐海,等.CT肺动脉成像对急性肺栓塞患者肺动脉高压严重程度的评估.放射学实践,2013,28:324-328.
7. Matsuoka S, Washko GR, Dransfield MT, et al. Quantitative CT measurement of cross-sectional area of small pulmonary vessel in COPD:correlations with emphysema and airflow limitation. Acad Radiol,2010,17:93-99.
8. Matsuura Y, Kawata N, Yanagawa N, et al. Quantitative assessment of cross-sectional area of small pulmonary vessels in patients with COPD using inspiratory and expiratory MDCT. Eur J Radiol, 2013,82:1804-1810.
9. Matsuoka S, Yamashiro T, Diaz A, et al. The relationship between small pulmonary vascular alteration and aortic atherosclerosis in chronic obstructive pulmonary disease:quantitative CT analysis. Acad Radiol,2011,18:40-46.
10. Uejima I, Matsuoka S, Yamashiro T, et al. Quantitative computed tomographic measurement of a cross-sectional area of a small pulmonary vessel in nonsmokers without airflow limitation. Japan J Radiol, 2011,29:251-255.
11. Wells JM, Dransfield MT. Pathophysiology and clinical implications of pulmonary arterial enlargement in COPD. Int J Chron Obstruct Pulmon Dis,2013,8:509-821.
12. Tuder RM, Flook BE, Voelkel NF. Increased gene expression for VEGF and the VEGF receptors KDR/Flk and Flt in lungs exposed to acute or to chronic hypoxia:modulation of gene expression by nitric oxide. J Clin Invest,1995,95:1798-1807.
13. Tuder RM, Zhen L, Cho CY, et al. Oxidative stress and apoptosis interact and cause emphysema due to vascular endothelial growth factor receptor blockade. Am J Respir Cell Mol Biol,2003,29:88-97.
14. Washko GR, Parraga G, Coxson HO. Quantitative pulmonary imaging using computed tomography and magnetic resonance imaging. Respirology,2012,17:432-444.
15. Estepar RS, Kinney GL, Black-Shinn JL, et al. Computed tomographic measures of pulmonary vascular morphology in smokers and their clinical implications. Am J Respir Crit Care Med,2013,188:231-239.
16. Wells JM, Washko GR, Han MK, et al. Pulmonary arterial enlargement and acute exacerbations of COPD. New Engl J Med,2012,367:913-921.

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