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Kwee AKAL, Andrinopoulou ER, van der Veer T, Gallardo-Estrella L, Charbonnier JP, Humphries SM, Lynch DA, Tiddens HAWM, de Jong PA, Pompe E. Higher small pulmonary artery and vein volume on computed tomography is associated with mortality in current and former smokers. EBioMedicine 2024; 108:105366. [PMID: 39353280 DOI: 10.1016/j.ebiom.2024.105366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 09/12/2024] [Accepted: 09/13/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND In chronic obstructive pulmonary disease (COPD), vascular alterations have been shown to contribute to hypoxia and pulmonary hypertension, but the independent contribution of small vessel abnormalities to mortality remains unclear. METHODS We quantified artery and vein dimensions on computed tomography (CT) down to 0.2 mm. Small vessel volumes (<1 mmᴓ) were normalized by body surface area. In 7903 current and former smokers of the COPDGene study (53.2% male) the independent contribution of small artery and small vein volume to all-cause mortality was tested in multivariable Cox models. Additionally, we calculated the 95th percentile of small arteries and veins in 374 never smokers to create two groups: normal and high small artery or vein volume. We describe clinical, physiological and imaging characteristics of subjects with a high small artery and high small vein volume. FINDINGS Both high small artery and high small vein volumes were independently associated with mortality with an adjusted hazard ratio of 1.07 [1.01, 1.14] and 1.34 [1.21, 1.49] per mL/m2 increase, respectively. In COPDGene, 447 (5.7%) had high small artery volume and 519 (9.1%) subjects had high small vein volume and both had more emphysema, more air trapping and more severe coronary calcium. INTERPRETATION In smokers, abnormally high volumes in small arteries and veins are both relevant for mortality, which urges investigations into the aetiology of small pulmonary vessels and cardiac function in smokers. FUNDING Award Number U01-HL089897 and U01-HL089856 from the NHLBI. COPD Foundation with contributions from AstraZeneca, Boehringer Ingelheim, Genentech, GlaxoSmithKline, Novartis, Pfizer, Siemens, and Sunovion.
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Affiliation(s)
- Anastasia K A L Kwee
- University Medical Centre Utrecht and Utrecht University, Dept. Radiology, Utrecht, Netherlands.
| | - Eleni-Rosalina Andrinopoulou
- Erasmus Medical Centre, Dept. Biostatistics, Rotterdam, Netherlands; Erasmus Medical Centre, Dept. Epidemiology, Rotterdam, Netherlands
| | - Tjeerd van der Veer
- Leiden University Medical Centre, Dept. Pulmonology, Leiden, Netherlands; Erasmus Medical Centre, Dept. Pulmonology, Rotterdam, Netherlands
| | | | | | | | - David A Lynch
- National Jewish Health, Dept. Radiology, Denver, USA
| | - Harm A W M Tiddens
- Erasmus Medical Centre, Dept. Pulmonology, Rotterdam, Netherlands; Thirona B.V., Nijmegen, Netherlands; Erasmus MC-Sophia Children's Hospital, Dept. Paediatric Pulmonology and Allergology, Rotterdam, Netherlands
| | - Pim A de Jong
- University Medical Centre Utrecht and Utrecht University, Dept. Radiology, Utrecht, Netherlands
| | - Esther Pompe
- University Medical Centre Utrecht and Utrecht University, Dept. Radiology, Utrecht, Netherlands; Meander Medical Centre, Dept. Radiology, Amersfoort, Netherlands
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2
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Mu C, Li Q, Niu Y, Hu T, Li Y, Wang T, Yu X, Lv Y, Tang H, Jiang J, Xu H, Zheng Y, Han W. Chronic diesel exhaust exposure induced pulmonary vascular remodeling a potential trajectory for traffic related pulmonary hypertension. Respir Res 2024; 25:348. [PMID: 39342206 PMCID: PMC11439202 DOI: 10.1186/s12931-024-02976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND As one of the most common traffic-related pollutants, diesel exhaust (DE) confers high risk for cardiovascular and respiratory diseases. However, its impact on pulmonary vessels is still unclear. METHODS To explore the effects of DE exposure on pulmonary vascular remodeling, our study analyzed the number and volume of small pulmonary vessels in the diesel engine testers (the DET group) from Luoyang Diesel Engine Factory and the controls (the non-DET group) from the local water company, using spirometry and carbon content in airway macrophage (CCAM) in sputum. And then we constructed a rat model of chronic DE exposure, in which 12 rats were divided into the DE group (6 rats with 16-week DE exposure) and the control group (6 rats with 16-week clean air exposure). During right heart catheterization, right ventricular systolic pressure (RVSP) was assessed by manometry. Macrophage migration inhibitory factor (MIF) in lung tissues and bronchoalveolar lavage fluid (BALF) were measured by qRT-PCR and ELISA, respectively. Histopathological analysis for cardiovascular remodeling was also performed. RESULTS In DET cohort, the number and volume of small pulmonary vessels in CT were positively correlated with CCAM in sputum (P<0.05). Rat model revealed that chronic DE-exposed rats had elevated RVSP, along with increased wall thickness of pulmonary small vessels and right the ventricle. What's more, the MIF levels in BALF and lung tissues were higher in DE-exposed rats than the controls. CONCLUSION Apart from airway remodeling, DE also induces pulmonary vascular remodeling, which will lead to cardiopulmonary dysfunction.
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Affiliation(s)
- Chaohui Mu
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071, China
| | - Qinghai Li
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071, China
- Qingdao Key Lab for Common Diseases, Qingdao Hospital, University of Rehabilitation and Health Sciences, Qingdao, 266071, China
- School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Yong Niu
- National Institute of Occupational Health and Posing Control, China CDC, Beijing, 100050, China
| | - Ting Hu
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071, China
| | - Yanting Li
- School of Public Health, Qingdao University, Qingdao, 266071, China
| | - Tao Wang
- Qingdao Key Lab for Common Diseases, Qingdao Hospital, University of Rehabilitation and Health Sciences, Qingdao, 266071, China
| | - Xinjuan Yu
- Qingdao Key Lab for Common Diseases, Qingdao Hospital, University of Rehabilitation and Health Sciences, Qingdao, 266071, China
| | - Yiqiao Lv
- Department of Pulmonary and Critical Care Medicine, Qingdao Hospital, Dalian Medical University, Dalian, 116000, China
| | - Huiling Tang
- Department of Pulmonary and Critical Care Medicine, Qingdao Hospital, Dalian Medical University, Dalian, 116000, China
| | - Jing Jiang
- Department of Ultrasound, Qingdao Hospital, University of Rehabilitation and Health Sciences, Qingdao, 266071, China
| | - Haibin Xu
- Department of Radiology, Qingdao Hospital, University of Rehabilitation and Health Sciences, Qingdao, 266071, China
| | - Yuxin Zheng
- School of Public Health, Qingdao University, Qingdao, 266071, China.
| | - Wei Han
- Department of Pulmonary and Critical Care Medicine, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao, 266071, China.
- Qingdao Key Lab for Common Diseases, Qingdao Hospital, University of Rehabilitation and Health Sciences, Qingdao, 266071, China.
- School of Public Health, Qingdao University, Qingdao, 266071, China.
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3
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Weatherald J, Hemnes AR, Maron BA, Mielniczuk LM, Gerges C, Price LC, Hoeper MM, Humbert M. Phenotypes in pulmonary hypertension. Eur Respir J 2024; 64:2301633. [PMID: 38964779 DOI: 10.1183/13993003.01633-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/29/2024] [Indexed: 07/06/2024]
Abstract
The clinical classification of pulmonary hypertension (PH) has guided diagnosis and treatment of patients with PH for several decades. Discoveries relating to underlying mechanisms, pathobiology and responses to treatments for PH have informed the evolution in this clinical classification to describe the heterogeneity in PH phenotypes. In more recent years, advances in imaging, computational science and multi-omic approaches have yielded new insights into potential phenotypes and sub-phenotypes within the existing clinical classification. Identification of novel phenotypes in pulmonary arterial hypertension (PAH) with unique molecular profiles, for example, could lead to new precision therapies. Recent phenotyping studies have also identified groups of patients with PAH that more closely resemble patients with left heart disease (group 2 PH) and lung disease (group 3 PH), which has important prognostic and therapeutic implications. Within group 2 and group 3 PH, novel phenotypes have emerged that reflect a persistent and severe pulmonary vasculopathy that is associated with worse prognosis but still distinct from PAH. In group 4 PH (chronic thromboembolic pulmonary disease) and sarcoidosis (group 5 PH), the current approach to patient phenotyping integrates clinical, haemodynamic and imaging characteristics to guide treatment but applications of multi-omic approaches to sub-phenotyping in these areas are sparse. The next iterations of the PH clinical classification are likely to reflect several emerging PH phenotypes and improve the next generation of prognostication tools and clinical trial design, and improve treatment selection in clinical practice.
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Affiliation(s)
- Jason Weatherald
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Edmonton, AB, Canada
| | - Anna R Hemnes
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bradley A Maron
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
- University of Maryland-Institute for Health Computing, Bethesda, MD, USA
| | - Lisa M Mielniczuk
- Division of Cardiology, Department of Medicine, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Christian Gerges
- Department of Internal Medicine, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Laura C Price
- National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Marius M Hoeper
- Department of Respiratory Medicine and Infectious Diseases, Hannover Medical School, Hannover, Germany
- German Center for Lung Research (DZL), Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Hannover, Germany
| | - Marc Humbert
- Université Paris-Saclay, Faculté de Médecine, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Department of Respiratory and Intensive Care Medicine, Publique Hôpitaux de Paris, Hôpital Bicêtre, ERN-LUNG, Le Kremlin-Bicêtre, France
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4
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Wu Y, Qi S, Wang M, Zhao S, Pang H, Xu J, Bai L, Ren H. Transformer-based 3D U-Net for pulmonary vessel segmentation and artery-vein separation from CT images. Med Biol Eng Comput 2023; 61:2649-2663. [PMID: 37420036 DOI: 10.1007/s11517-023-02872-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 06/20/2023] [Indexed: 07/09/2023]
Abstract
Transformer-based methods have led to the revolutionizing of multiple computer vision tasks. Inspired by this, we propose a transformer-based network with a channel-enhanced attention module to explore contextual and spatial information in non-contrast (NC) and contrast-enhanced (CE) computed tomography (CT) images for pulmonary vessel segmentation and artery-vein separation. Our proposed network employs a 3D contextual transformer module in the encoder and decoder part and a double attention module in skip connection to effectively finish high-quality vessel and artery-vein segmentation. Extensive experiments are conducted on the in-house dataset and the ISICDM2021 challenge dataset. The in-house dataset includes 56 NC CT scans with vessel annotations and the challenge dataset consists of 14 NC and 14 CE CT scans with vessel and artery-vein annotations. For vessel segmentation, Dice is 0.840 for CE CT and 0.867 for NC CT. For artery-vein separation, the proposed method achieves a Dice of 0.758 of CE images and 0.602 of NC images. Quantitative and qualitative results demonstrated that the proposed method achieved high accuracy for pulmonary vessel segmentation and artery-vein separation. It provides useful support for further research associated with the vascular system in CT images. The code is available at https://github.com/wuyanan513/Pulmonary-Vessel-Segmentation-and-Artery-vein-Separation .
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Affiliation(s)
- Yanan Wu
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China
- Department of Electronic Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Shouliang Qi
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China.
- Key Laboratory of Intelligent Computing in Medical Image, Ministry of Education, Northeastern University, Shenyang, China.
| | - Meihuan Wang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Shuiqing Zhao
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Haowen Pang
- College of Medicine and Biological Information Engineering, Northeastern University, Shenyang, China
| | - Jiaxuan Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, The National Center for Respiratory Medicine, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Long Bai
- Department of Electronic Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Hongliang Ren
- Department of Electronic Engineering, Faculty of Engineering, The Chinese University of Hong Kong, Hong Kong, China.
- Department of Biomedical Engineering (BME), National University of Singapore, Singapore, Singapore.
- Research Institute, National University of Suzhou, Suzhou, Jiangsu, China.
- Shun Hing Institute of Advanced Engineering, The Chinese University of Hong Kong (CUHK), Hong Kong, China.
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5
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Valentini A, Franchi P, Cicchetti G, Messana G, Chiffi G, Strappa C, Calandriello L, Del Ciello A, Farchione A, Preda L, Larici AR. Pulmonary Hypertension in Chronic Lung Diseases: What Role Do Radiologists Play? Diagnostics (Basel) 2023; 13:diagnostics13091607. [PMID: 37174998 PMCID: PMC10178805 DOI: 10.3390/diagnostics13091607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
Pulmonary hypertension (PH) is a pathophysiological disorder, defined by a mean pulmonary arterial pressure (mPAP) > 20 mmHg at rest, as assessed by right heart catheterization (RHC). PH is not a specific disease, as it may be observed in multiple clinical conditions and may complicate a variety of thoracic diseases. Conditions associated with the risk of developing PH are categorized into five different groups, according to similar clinical presentations, pathological findings, hemodynamic characteristics, and treatment strategy. Most chronic lung diseases that may be complicated by PH belong to group 3 (interstitial lung diseases, chronic obstructive pulmonary disease, combined pulmonary fibrosis, and emphysema) and are associated with the lowest overall survival among all groups. However, some of the chronic pulmonary diseases may develop PH with unclear/multifactorial mechanisms and are included in group 5 PH (sarcoidosis, pulmonary Langerhans' cell histiocytosis, and neurofibromatosis type 1). This paper focuses on PH associated with chronic lung diseases, in which radiological imaging-particularly computed tomography (CT)-plays a crucial role in diagnosis and classification. Radiologists should become familiar with the hemodynamical, physiological, and radiological aspects of PH and chronic lung diseases in patients at risk of developing PH, whose prognosis and treatment depend on the underlying disease.
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Affiliation(s)
- Adele Valentini
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Paola Franchi
- Department of Diagnostic Radiology, G. Mazzini Hospital, 64100 Teramo, Italy
| | - Giuseppe Cicchetti
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Gaia Messana
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Greta Chiffi
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Cecilia Strappa
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Lucio Calandriello
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Annemilia Del Ciello
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Alessandra Farchione
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
| | - Lorenzo Preda
- Division of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Diagnostic Imaging Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Anna Rita Larici
- Advanced Radiodiagnostic Center, Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, 00168 Rome, Italy
- Secton of Radiology, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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6
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Shahin Y, Alabed S, Alkhanfar D, Tschirren J, Rothman AMK, Condliffe R, Wild JM, Kiely DG, Swift AJ. Quantitative CT Evaluation of Small Pulmonary Vessels Has Functional and Prognostic Value in Pulmonary Hypertension. Radiology 2022; 305:431-440. [PMID: 35819325 PMCID: PMC9619204 DOI: 10.1148/radiol.210482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/21/2022] [Accepted: 05/05/2022] [Indexed: 11/11/2022]
Abstract
Background The in vivo relationship between peel pulmonary vessels, small pulmonary vessels, and pulmonary hypertension (PH) is not fully understood. Purpose To quantitatively assess peel pulmonary vessel volumes (PPVVs) and small pulmonary vessel volumes (SPVVs) as estimated from CT pulmonary angiography (CTPA) in different subtypes of PH compared with controls, their relationship to pulmonary function and right heart catheter metrics, and their prognostic value. Materials and Methods In this retrospective single-center study performed from January 2008 to February 2018, quantitative CTPA analysis of total SPVV (TSPVV) (0.4- to 2-mm vessel diameter) and PPVV (within 15, 30, and 45 mm from the lung surface) was performed. Results A total of 1823 patients (mean age, 69 years ± 13 [SD]; 1192 women [65%]) were retrospectively analyzed; 1593 patients with PH (mean pulmonary arterial pressure [mPAP], 43 mmHg ± 13 [SD]) were compared with 230 patient controls (mPAP, 19 mm Hg ± 3). The mean vessel volumes in pulmonary peels at 15-, 30-, and 45-mm depths were higher in pulmonary arterial hypertension (PAH) and PH secondary to lung disease compared with chronic thromboembolic PH (45-mm peel, mean difference: 6.4 mL [95% CI: 1, 11] [P < .001] vs 6.8 mL [95% CI: 1, 12] [P = .01]). Mean small vessel volumes at a diameter of less than 2 mm were lower in PAH and PH associated with left heart disease compared with controls (1.6-mm vessels, mean difference: -4.3 mL [95% CI: -8, -0.1] [P = .03] vs -6.8 mL [95% CI: -11, -2] [P < .001]). In patients with PH, the most significant positive correlation was noted with forced vital capacity percentage predicted (r = 0.30-0.40 [all P < .001] for TSPVVs and r = 0.21-0.25 [all P < .001] for PPVVs). Conclusion The volume of pulmonary small vessels is reduced in pulmonary arterial hypertension and pulmonary hypertension (PH) associated with left heart disease, with similar volume of peel vessels compared with controls. For chronic thromboembolic PH, the volume of peel vessels is reduced. In PH, small pulmonary vessel volume is associated with pulmonary function tests. Clinical trial registration no. NCT02565030 Published under a CC BY 4.0 license Online supplemental material is available for this article.
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Affiliation(s)
- Yousef Shahin
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
| | - Samer Alabed
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
| | - Dheyaa Alkhanfar
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
| | - Juerg Tschirren
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
| | - Alex M. K. Rothman
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
| | - Robin Condliffe
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
| | - James M. Wild
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
| | - David G. Kiely
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
| | - Andrew J. Swift
- From the Department of Infection, Immunity and Cardiovascular Disease
(Y.S., S.A., D.A., A.M.K.R., J.M.W., D.G.K., A.J.S.) and INSIGNEO, Institute for
in silico Medicine (D.G.K., A.J.S.), University of Sheffield, Glossop Rd,
Sheffield S10 2JF, England; Department of Clinical Radiology, Sheffield
Teaching Hospitals, Sheffield, England (Y.S., S.A., A.J.S.); VIDA Diagnostics,
Coralville, Iowa (J.T.); and Sheffield Pulmonary Vascular Disease Unit, Royal
Hallamshire Hospital, Sheffield, England (R.C., D.G.K.)
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7
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Tang G, Wang F, Liang Z, Liang C, Wang J, Yang Y, Tang W, Shi W, Tang G, Yang K, Wang Z, Li Q, Li H, Xu J, Chen D, Chen R. Correlations of Computed Tomography Measurement of Distal Pulmonary Vascular Pruning with Airflow Limitation and Emphysema in COPD Patients. Int J Chron Obstruct Pulmon Dis 2022; 17:2241-2252. [PMID: 36128016 PMCID: PMC9482777 DOI: 10.2147/copd.s362479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/28/2022] [Indexed: 11/25/2022] Open
Abstract
Background Pulmonary vascular alteration is an important feature of chronic obstructive pulmonary disease (COPD), which is characterized by distal pulmonary vascular pruning in angiography. We aimed to further investigate the clinical relevance of pulmonary vasculature in COPD patients using non-contrast computed tomography (CT). Methods Seventy-one control subjects and 216 COPD patients completed the questionnaires, spirometry, and computed tomography (CT) scans within 1 month and were included in the study. Small pulmonary vessels represented by percentage of cross-sectional area of pulmonary vessels smaller than 5 mm2 or 5–10 mm2 to the total lung fields (%CSA<5 or %CSA5–10, respectively) were measured using ImageJ software. Spearman correlation was used to investigate the relationship between %CSA<5 and airflow limitation. A receiver operating characteristic (ROC) curve was built to evaluate the value of %CSA<5 in discriminating COPD patients from healthy control subjects. Segmented regression was used to analyze the relationship between %CSA<5 and %LAA-950 (percentage of low-attenuation areas less than −950 HU). Results We found a significant correlation between %CSA<5 and forced expiratory volume in one second (FEV1) percentage of predicted value (%pred) (r = 0.564, P < 0.001). The area under the ROC curve for the value of %CSA<5 in distinguishing COPD was 0.816, with a cut-off value of 0.537 (Youden index J, 0.501; sensitivity, 78.24%; specificity, 71.83%). Since the relationship between %CSA<5 and %LAA-950 was not constant, performance of segmented regression was better than ordinary linear regression (adjusted R2, 0.474 vs 0.332, P < 0.001 and P < 0.001, respectively). As %CSA<5 decreased, %LAA-950 slightly increased until an inflection point (%CSA<5 = 0.524) was reached, after which the %LAA-950 increased apparently with a decrease in %CSA<5. Conclusion %CSA<5 was significantly correlated with both airflow limitation and emphysema, and we identified an inflection point for the relationship between %CSA<5 and %LAA-950.
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Affiliation(s)
- Guoyan Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Fengyan Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhenyu Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Cuixia Liang
- Neusoft Medical Systems Co., Ltd, Shenyang, People's Republic of China
| | - Jinling Wang
- Qingyuan Chronic Disease Prevention Hospital, Qingyuan Occupational Disease Prevention Hospital, Qingyuan, People's Republic of China
| | - Yuqiong Yang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Wanyi Tang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.,Qingyuan People's Hospital, the Sixth Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Weijuan Shi
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Guoqiang Tang
- Qingyuan Chronic Disease Prevention Hospital, Qingyuan Occupational Disease Prevention Hospital, Qingyuan, People's Republic of China
| | - Kai Yang
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, People's Republic of China
| | - Zihui Wang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Qiasheng Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Hualin Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jiaxuan Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Deyan Chen
- Neusoft Medical Systems Co., Ltd, Shenyang, People's Republic of China
| | - Rongchang Chen
- Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, Shenzhen, People's Republic of China
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8
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Abstract
PURPOSE OF REVIEW Pulmonary hypertension (PH) is a common complication of chronic obstructive lung disease (COPD), but clinical presentation is variable and not always 'proportional' to the severity of the obstructive disease. This review aims to analyze heterogeneity in clinical features of PH-COPD, providing a guide for diagnosis and management according to phenotypes. RECENT FINDINGS Recent works have focused on severe PH in COPD, providing insights into the characteristics of patients with predominantly vascular disease. The recently recognized 'pulmonary vascular phenotype', characterized by severe PH and mild airflow obstruction with severe hypoxemia, has markedly worse prognosis and may be a candidate for large trials with pulmonary vasodilators. In severe PH, which might be best described by a pulmonary vascular resistance threshold, there may also be a need to distinguish patients with mild COPD (pulmonary vascular phenotype) from those with severe COPD ('Severe COPD-Severe PH' phenotype). SUMMARY Correct phenotyping is key to appropriate management of PH associated with COPD. The lack of evidence regarding the use of pulmonary vasodilators in PH-COPD may be due to the existence of previously unrecognized phenotypes with different responses to therapy. This review offers the clinician caring for patients with COPD and PH a phenotype-focused approach to diagnosis and management, aimed at personalized care.
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Affiliation(s)
| | - Lucilla Piccari
- Department of Pulmonary Medicine, Hospital del Mar, Barcelona, Spain
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9
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Prognostic Significance of Small Pulmonary Vessel Alteration Measured by Chest Computed Tomography in Connective Tissue Diseases With Pulmonary Arterial Hypertension. J Thorac Imaging 2022; 37:336-343. [DOI: 10.1097/rti.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Alkhanfar D, Shahin Y, Alandejani F, Dwivedi K, Alabed S, Johns C, Lawrie A, Thompson AAR, Rothman AMK, Tschirren J, Uthoff JM, Hoffman E, Condliffe R, Wild JM, Kiely DG, Swift AJ. Severe pulmonary hypertension associated with lung disease is characterised by a loss of small pulmonary vessels on quantitative computed tomography. ERJ Open Res 2022; 8:00503-2021. [PMID: 35586449 PMCID: PMC9108962 DOI: 10.1183/23120541.00503-2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 02/10/2022] [Indexed: 11/28/2022] Open
Abstract
Background Pulmonary hypertension (PH) in patients with chronic lung disease (CLD) predicts reduced functional status, clinical worsening and increased mortality, with patients with severe PH-CLD (≥35 mmHg) having a significantly worse prognosis than mild to moderate PH-CLD (21-34 mmHg). The aim of this cross-sectional study was to assess the association between computed tomography (CT)-derived quantitative pulmonary vessel volume, PH severity and disease aetiology in CLD. Methods Treatment-naïve patients with CLD who underwent CT pulmonary angiography, lung function testing and right heart catheterisation were identified from the ASPIRE registry between October 2012 and July 2018. Quantitative assessments of total pulmonary vessel and small pulmonary vessel volume were performed. Results 90 patients had PH-CLD including 44 associated with COPD/emphysema and 46 with interstitial lung disease (ILD). Patients with severe PH-CLD (n=40) had lower small pulmonary vessel volume compared to patients with mild to moderate PH-CLD (n=50). Patients with PH-ILD had significantly reduced small pulmonary blood vessel volume, compared to PH-COPD/emphysema. Higher mortality was identified in patients with lower small pulmonary vessel volume. Conclusion Patients with severe PH-CLD, regardless of aetiology, have lower small pulmonary vessel volume compared to patients with mild-moderate PH-CLD, and this is associated with a higher mortality. Whether pulmonary vessel changes quantified by CT are a marker of remodelling of the distal pulmonary vasculature requires further study.
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Affiliation(s)
- Dheyaa Alkhanfar
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - Yousef Shahin
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Dept of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Faisal Alandejani
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Krit Dwivedi
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Samer Alabed
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Dept of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Chris Johns
- Dept of Clinical Radiology, Sheffield Teaching Hospitals, Sheffield, UK
| | - Allan Lawrie
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A A Roger Thompson
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Alexander M K Rothman
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Johanna M Uthoff
- Dept of Computer Science, University of Sheffield, Sheffield, UK
| | - Eric Hoffman
- Dept of Radiology, University of Iowa, Iowa City, IA, USA
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jim M Wild
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK
| | - David G Kiely
- INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK.,Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,These authors contributed equally
| | - Andrew J Swift
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.,INSIGNEO, Institute for In Silico Medicine, University of Sheffield, Sheffield, UK.,These authors contributed equally
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11
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Sun X, Meng X, Zhang P, Wang L, Ren Y, Xu G, Yang T, Liu M. Quantification of pulmonary vessel volumes on low-dose computed tomography in a healthy male Chinese population: the effects of aging and smoking. Quant Imaging Med Surg 2022; 12:406-416. [PMID: 34993089 DOI: 10.21037/qims-21-160] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/24/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study sought to determine pulmonary vascular volumes (PVVs) on low-dose computed tomography (LDCT) in a healthy male Chinese population and analyze the effects of aging and smoking on PVVs. METHODS A total of 1,320 healthy male participants (comprising 720 non-smokers, 445 smokers, and 155 ex-smokers) who underwent LDCT were retrospectively included in this study. Their demographic data and smoking status data were collected. An automatic integration segmentation approach for LDCT was used to segment pulmonary vessels semi-automatically. The PVVs of the whole lung, left lung, and right lung on LDCT were calculated, and correlations between PVVs and age and smoking status were then compared. RESULTS The inter-rater correlation coefficient of the whole lung, left lung, and right lung PVVs was 0.98 [95% confidence interval (CI): 0.95-0.99], 0.97 (95% CI: 0.93-0.98), and 0.97 (95% CI: 0.94-0.99), respectively. The intra-class correlation coefficient of the whole lung left lung, and right lung PVVs was 0.98 (95% CI: 0.95-0.99), 0.96 (95% CI: 0.95-0.99), and 0.96 (95% CI: 0.92-0.98), respectively. In non-smokers, PVVs decreased with age. The PVVs of heavy smokers were higher than those of light smokers, ex-smokers, and non-smokers. The PVVs of ex-smokers were comparable to those of light smokers. CONCLUSIONS The PVVs measured on LDCT tended to decrease with age in healthy male non-smokers gradually. Compared to non-smokers, the PVVs of smokers increased, even with the normal lung function.
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Affiliation(s)
- Xuebiao Sun
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Xiapei Meng
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Peiyao Zhang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Lei Wang
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
| | - Yanhong Ren
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Guodong Xu
- Institute of Clinical Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Ting Yang
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Min Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing, China
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12
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Xu C, Zhang Y, Zhang N, Sun X, Liu Q, Wang Q, Zhu Y. Use of small pulmonary vascular alterations to identify different types of pulmonary hypertension: a quantitative computed tomography analysis. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2022; 30:185-193. [PMID: 34864713 DOI: 10.3233/xst-211001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The morphological alterations of small pulmonary vessels measured by computed tomography (CT) is increasingly used in evaluation of suspected pulmonary hypertension (PH). OBJECTIVE To investigate the significance alterations of quantitative assessment of small pulmonary vessels on chest CT in distinguishing different types of PH and their severity. METHODS We retrospectively analyzed a dataset of 120 healthy controls (HCs) and 91 PH patients, including 34 patients with connective tissue diseases-related PH (CTD-PH), 26 patients with idiopathic pulmonary arterial hypertension (iPAH), and 31 patients with chronic obstructive pulmonary disease-related PH (COPD-PH). The CTD-PH patients were divided into mild to moderate PH (CTD-LM-PH) group (n = 17) and severe PH (CTD-S-PH) group (n = 17). A total of 53 CTD patients without PH (CTD-nPH) were enrolled for comparison with the CTD-PH. We measured the cross-sectional area of small pulmonary vessels < 5 mm2 (%CSA <5) and between 5-10 mm2 (%CSA5-10) as a percentage of total lung area among the populations included above and compared %CSA in different types of PH groups and HCs group. The mean pulmonary arterial pressure (mPAP) was measured by right heart catheterization. RESULTS The %CSA5-10 of COPD-PH, CTD-PH, and iPAH patients increased (0.21±0.09, 0.49±0.20 and 0.61±0.20, p < 0.02) sequentially, while the %CSA <5 of CTD-PH, iPAH, and COPD-PH patients decreased (0.79±0.65, 0.65±0.38 and 0.52±0.27, p < 0.05) sequentially. The %CSA5-10 was significantly higher in CTD-S-PH patients than CTD-LM-PH patients and CTD-nPH patients (0.51±0.21, 0.31±0.15 and 0.28±0.12, p < 0.01). The %CSA5-10 was positively correlated with mPAP in the CTD-PH group. CONCLUSIONS The quantitative parameters %CSA <5 and %CSA5-10 assessed by chest CT are useful for distinguishing different types of PH. In addition, the %CSA5-10 can provide information for identification of CTD-PH severity.
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Affiliation(s)
- Chengxiao Xu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yue Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ning Zhang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoxuan Sun
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingwen Liu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qiang Wang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yinsu Zhu
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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13
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Cao X, Gao X, Yu N, Shi M, Wei X, Huang X, Xu S, Pu J, Jin C, Guo Y. Potential Value of Expiratory CT in Quantitative Assessment of Pulmonary Vessels in COPD. Front Med (Lausanne) 2021; 8:761804. [PMID: 34722596 PMCID: PMC8551380 DOI: 10.3389/fmed.2021.761804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 09/16/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: To investigate the associations between intrapulmonary vascular volume (IPVV) depicted on inspiratory and expiratory CT scans and disease severity in COPD patients, and to determine which CT parameters can be used to predict IPVV. Methods: We retrospectively collected 89 CT examinations acquired on COPD patients from an available database. All subjects underwent both inspiratory and expiratory CT scans. We quantified the IPVV, airway wall thickness (WT), the percentage of the airway wall area (WA%), and the extent of emphysema (LAA%−950) using an available pulmonary image analysis tool. The underlying relationship between IPVV and COPD severity, which was defined as mild COPD (GOLD stage I and II) and severe COPD (GOLD stage III and IV), was analyzed using the Student's t-test (or Mann-Whitney U-test). The correlations of IPVV with pulmonary function tests (PFTs), LAA%−950, and airway parameters for the third to sixth generation bronchus were analyzed using the Pearson or Spearman's rank correlation coefficients and multiple stepwise regression. Results: In the subgroup with only inspiratory examinations, the correlation coefficients between IPVV and PFT measures were −0.215 ~ −0.292 (p < 0.05), the correlation coefficients between IPVV and WT3−6 were 0.233 ~ 0.557 (p < 0.05), and the correlation coefficient between IPVV and LAA%−950 were 0.238 ~ 0.409 (p < 0.05). In the subgroup with only expiratory scan, the correlation coefficients between IPVV and PFT measures were −0.238 ~ −0.360 (p < 0.05), the correlation coefficients between IPVV and WT3−6 were 0.260 ~ 0.566 (p < 0.05), and the correlation coefficient between IPVV and LAA%−950 were 0.241 ~ 0.362 (p < 0.05). The multiple stepwise regression analyses demonstrated that WT were independently associated with IPVV (P < 0.05). Conclusion: The expiratory CT scans can provide a more accurate assessment of COPD than the inspiratory CT scans, and the airway wall thickness maybe an independent predictor of pulmonary vascular alteration in patients with COPD.
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Affiliation(s)
- Xianxian Cao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Diagnostic Imaging, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaoyan Gao
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Medical Imaging Center, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Nan Yu
- Department of Radiology, The Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Meijuan Shi
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xia Wei
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xiaoqi Huang
- Department of Radiology, The Affiliated Hospital of Yan'an University, Yan'an, China
| | - Shudi Xu
- Department of Respiratory Medicine, The Ninth Hospital of Xi'an Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jiantao Pu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Chenwang Jin
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Youmin Guo
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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14
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Suehs CM, Solovei L, Hireche K, Vachier I, Mariano Goulart D, Gamon L, Charriot J, Serre I, Molinari N, Bourdin A, Bommart S. Complication and lung function impairment prediction using perfusion and computed tomography air trapping (CLIPPCAIR): protocol for the development and validation of a novel multivariable model for the prediction of post-resection lung function. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1092. [PMID: 34423004 PMCID: PMC8339869 DOI: 10.21037/atm-21-214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/21/2021] [Indexed: 12/24/2022]
Abstract
Background Recent advancements in computed tomography (CT) scanning and post processing have provided new means of assessing factors affecting respiratory function. For lung cancer patients requiring resection, and especially those with respiratory comorbidities such as chronic obstructive pulmonary disease (COPD), the ability to predict post-operative lung function is a crucial step in the lung cancer operability assessment. The primary objective of the CLIPPCAIR study is to use novel CT data to develop and validate an algorithm for the prediction of lung function remaining after pneumectomy/lobectomy. Methods Two sequential cohorts of non-small cell lung cancer patients requiring a pre-resection CT scan will be recruited at the Montpellier University Hospital, France: a test population (N=60) on which predictive models will be developed, and a further model validation population (N=100). Enrolment will occur during routine pre-surgical consults and follow-up visits will occur 1 and 6 months after pneumectomy/lobectomy. The primary outcome to be predicted is forced expiratory volume in 1 second (FEV1) six months after lung resection. The baseline CT variables that will be used to develop the primary multivariable regression model are: expiratory to inspiratory ratios of mean lung density (MLDe/i for the total lung and resected volume), the percentage of voxels attenuating at less than ‒950 HU (PVOX‒950 for the total lung and resected volume) and the ratio of iodine concentrations for the resected volume over that of the total lung. The correlation between predicted and real values will be compared to (and is expected to improve upon) that of previously published methods. Secondary analyses will include the prediction of transfer factor for carbon monoxide (TLCO) and complications in a similar fashion. The option to explore further variables as predictors of post-resection lung function or complications is kept open. Discussion Current methods for estimating post-resection lung function are imperfect and can add assessments (such as scintigraphy) to the pre-surgical workup. By using CT imaging data in a novel fashion, the results of the CLIPPCAIR study may not only improve such estimates, it may also simplify patient pathways. Trial registration Clinicaltrials.gov (NCT03885765).
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Affiliation(s)
- Carey Meredith Suehs
- Department of Respiratory Diseases, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Laurence Solovei
- Department of Thoracic Surgery, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Kheira Hireche
- Department of Thoracic Surgery, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Vachier
- Department of Respiratory Diseases, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Denis Mariano Goulart
- Department of Nuclear Medicine, The University of Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Lucie Gamon
- Department of Medical Information, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Jérémy Charriot
- Department of Respiratory Diseases, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Isabelle Serre
- Department of Pathology, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Nicolas Molinari
- IMAG, CNRS, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, The University of Montpellier, CHU Montpellier, Montpellier, France.,PhyMedExp, CNRS, INSERM, The University of Montpellier, CHU Montpellier, Montpellier, France
| | - Sébastien Bommart
- PhyMedExp, CNRS, INSERM, The University of Montpellier, CHU Montpellier, Montpellier, France.,Department of Radiology, The University of Montpellier, CHU Montpellier, Montpellier, France
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15
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Pulmonary Vascular Alterations on Computed Tomography Imaging and Outcomes in Heart Failure With Preserved Ejection Fraction: a Preliminary Data. J Card Fail 2021; 27:1031-1033. [PMID: 33965537 DOI: 10.1016/j.cardfail.2021.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Pulmonary vascular disease may play an important role in the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). However, no study has demonstrated noninvasive quantification of pulmonary vascular alterations in HFpEF. This study sought to determine the association between pulmonary vascular alterations quantified by chest computed tomography scan and clinical outcomes in HFpEF. METHODS AND RESULTS Pulmonary vascular alterations were quantified in 151 patients with HFpEF who underwent noncontrast chest computed tomography scan by measuring the percentage of total cross-sectional area (CSA) of pulmonary vessels less than 5 mm2 to the total lung area (%CSA<5). We divided the patients by the median value of %CSA<5 (=1.45%) and examined the association between %CSA<5 and a composite outcome of all-cause mortality or HF hospitalization. During a median follow-up of 17.3 months, there were 44 (29%) composite outcomes. Event rates were significantly higher in patients with higher %CSA<5 than those with lower %CSA<5 (log-rank P = .02). %CSA<5 was associated with an increased risk of the outcome (hazard ratio per 1.0% increment, 1.46; 95% confidence interval 1.06-1.98; P = .02) in an unadjusted Cox model, and was independently and incrementally associated with the outcome over age, the presence of atrial fibrillation, E/e' ratio, and estimated pulmonary artery systolic pressure (global χ2 17.3 vs 11.5, P = .02). CONCLUSIONS A higher %CSA<5 was associated with an increased risk of all-cause mortality or HF hospitalization in patients with HFpEF, with an incremental prognostic value over age, atrial fibrillation, E/e' ratio, and pulmonary artery systolic pressure.
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16
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Benlala I, Laurent F, Dournes G. Structural and functional changes in COPD: What we have learned from imaging. Respirology 2021; 26:731-741. [PMID: 33829593 DOI: 10.1111/resp.14047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of mortality worldwide. It is a heterogeneous disease involving different components of the lung to varying extents. Developments in medical imaging and image analysis techniques provide new insights in the assessment of the structural and functional changes of the disease. This article reviews the leading imaging techniques: CT and MRI of the lung in research settings and clinical routine. Both visual and quantitative methods are reviewed, emphasizing their relevance to patient phenotyping and outcome prediction.
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Affiliation(s)
- Ilyes Benlala
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
| | - François Laurent
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
| | - Gael Dournes
- Centre de recherche Cardio-Thoracique de Bordeaux, University of Bordeaux, INSERM, Bordeaux, France
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Yang T, Chen C, Chen Z. The CT pulmonary vascular parameters and disease severity in COPD patients on acute exacerbation: a correlation analysis. BMC Pulm Med 2021; 21:34. [PMID: 33472612 PMCID: PMC7816324 DOI: 10.1186/s12890-020-01374-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 12/14/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND It is necessary to analyze the CT pulmonary vascular parameters and disease severity in chronic obstructive pulmonary disease (COPD) patients to provide evidence support for the management of COPD. METHODS COPD patients on acute exacerbation admitted to our hospital from COPD patients from January 2019 to March 2020 was selected. The characteristics and ratio of the cross-sectional area (CSA) of small pulmonary vessels to the total area of the lung field, and the ratio of pulmonary artery and aorta (PA/A) cross-sectional diameter in patients with COPD were analyzed. RESULTS A total of 128 COPD patients were included. There were significant differences in the duration of COPD, smoking history, the PaO2, PaCO2, pH, and FEV1, FVC and FEV1/FVC among COPD patients with different severity (all p < 0.05). The duration of COPD, smoking, PaO2, PaCO2, CSA and PA/A were correlated with the COPD severity (all p < 0.05). Both CSA, PA/A were correlated with post BD FEV1 (all p < 0.05). The cutoff value of CSA and PA/A for the diagnosis of severe COPD was 0.61 and 0.87 respectively, and the AUC of CSA and PA/A for the diagnosis of severe COPD was 0.724 and 0.782 respectively. CONCLUSIONS Patients with CSA ≤ 0.61 and PA/A ≥ 0.87 may have higher risks for severe COPD, and more studies are needed in the future to further elucidate the management of COPD.
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Affiliation(s)
- Tao Yang
- Imaging Department, Linyi Central Hospital, Linyi, 276400, Shandong, China
| | - Chihua Chen
- Radiology Department, Hubei Provincial Hospital of Integrated Chinese & Western Medicine, Wuhan, 430015, Hubei, China
| | - Zhongyuanlong Chen
- Department of Radiology, Chest Hospital of Xinjiang Uygur Autonomous Region of the PRC, No. 106, Yan'an road, Urumqi, 830049, Xinjiang, China.
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Pulmonary Vascular Morphology Associated With Gas Exchange in Systemic Sclerosis Without Lung Fibrosis. J Thorac Imaging 2020; 34:373-379. [PMID: 30817504 DOI: 10.1097/rti.0000000000000395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Gas exchange in systemic sclerosis (SSc) is known to be affected by fibrotic changes in the pulmonary parenchyma. However, SSc patients without detectable fibrosis can still have impaired gas transfer. We aim to investigate whether pulmonary vascular changes could partly explain a reduction in gas transfer of SSc patients without fibrosis. MATERIALS AND METHODS We selected 77 patients whose visual computed tomography (CT) scoring showed no fibrosis. Pulmonary vessels were detected automatically in CT images, and their local radii were calculated. The frequency of occurrence for each radius was calculated, and, from this radius histogram, 2 imaging biomarkers (α and β) were extracted, wherein α reflects the relative contribution of small vessels compared with large vessels, and β represents the vessel tree capacity. Correlations between imaging biomarkers and gas transfer [single-breath diffusion capacity for carbon monoxide corrected for hemoglobin concentration (DLCOc) %predicted] were evaluated with Spearman correlation. Multivariable stepwise linear regression was performed with DLCOc %predicted as the dependent variable and age, BMI, sPAP, FEV1 %predicted, TLC %predicted, FVC %predicted, α, β, voxel size, and CT-derived lung volume as independent variables. RESULTS Both α and β were significantly correlated with gas transfer (R=-0.29, P-value=0.011 and R=0.32, P-value=0.004, respectively). The multivariable stepwise linear regression analysis selected sPAP [coefficient=-0.78; 95% confidence interval (CI)=-1.07, -0.49; P-value<0.001], β (coefficient=8.6; 95% CI=4.07, 13.1; P-value<0.001), and FEV1% predicted (coefficient=0.3; 95% CI=0.12, 0.48; P-value=0.001) as significant independent predictors of DLCOc %predicted (R=0.71, P-value<0.001). CONCLUSIONS In SSc patients without detectable pulmonary fibrosis, impaired gas exchange is associated with alterations in pulmonary vascular morphology.
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Kovacs G, Agusti A, Barberà JA, Celli B, Criner G, Humbert M, Sin DD, Voelkel N, Olschewski H. Pulmonary Vascular Involvement in Chronic Obstructive Pulmonary Disease. Is There a Pulmonary Vascular Phenotype? Am J Respir Crit Care Med 2019; 198:1000-1011. [PMID: 29746142 DOI: 10.1164/rccm.201801-0095pp] [Citation(s) in RCA: 109] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- Gabor Kovacs
- 1 Medical University of Graz, Graz, Austria.,2 Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Alvar Agusti
- 3 Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.,4 Centro Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Joan Albert Barberà
- 3 Respiratory Institute, Hospital Clinic, August Pi i Sunyer Biomedical Research Institute, University of Barcelona, Barcelona, Spain.,4 Centro Investigacion Biomedica en Red de Enfermedades Respiratorias, Madrid, Spain
| | | | - Gerard Criner
- 6 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Marc Humbert
- 7 Université Paris-Sud, Université Paris-Saclay; Inserm U999; Hôpital Bicêtre, Assistance Publique - Hôpitaux de Paris, Le Kremlin Bicêtre, France
| | - Don D Sin
- 8 Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.,9 Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Canada; and
| | - Norbert Voelkel
- 10 Department of Pulmonary Medicine, Frije University, Medical Center, Amsterdam, the Netherlands
| | - Horst Olschewski
- 1 Medical University of Graz, Graz, Austria.,2 Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
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Coste F, Benlala I, Dournes G, Girodet PO, Laurent F, Berger P. Assessing pulmonary hypertension in COPD. Is there a role for computed tomography? Int J Chron Obstruct Pulmon Dis 2019; 14:2065-2079. [PMID: 31564854 PMCID: PMC6732516 DOI: 10.2147/copd.s207363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/10/2019] [Indexed: 12/22/2022] Open
Abstract
Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD) and is associated with increased morbidity and mortality. Reference standard method to diagnose PH is right heart catheterization. Several non-invasive imaging techniques have been employed in the detection of PH. Among them, computed tomography (CT) is the most commonly used for phenotyping and detecting complications of COPD. Several CT findings have also been described in patients with severe PH. Nevertheless, CT analysis is currently based on visual findings which can lead to reproducibility failure. Therefore, there is a need for quantification in order to assess objective criteria. In this review, progresses in automated analyses of CT parameters and their values in predicting PH and COPD outcomes are presented.
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Affiliation(s)
- Florence Coste
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France
| | - Ilyes Benlala
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Gaël Dournes
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Pierre-Olivier Girodet
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - François Laurent
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
| | - Patrick Berger
- University Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, F-33000 France.,Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, CIC1401, Bordeaux, F-33000 France.,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, Pessac, F-33600 France
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21
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Zhai Z, Staring M, Hernández Girón I, Veldkamp WJH, Kroft LJ, Ninaber MK, Stoel BC. Automatic quantitative analysis of pulmonary vascular morphology in CT images. Med Phys 2019; 46:3985-3997. [PMID: 31206181 PMCID: PMC6852650 DOI: 10.1002/mp.13659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/07/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Vascular remodeling is a significant pathological feature of various pulmonary diseases, which may be assessed by quantitative computed tomography (CT) imaging. The purpose of this study was therefore to develop and validate an automatic method for quantifying pulmonary vascular morphology in CT images. METHODS The proposed method consists of pulmonary vessel extraction and quantification. For extracting pulmonary vessels, a graph-cuts-based method is proposed which considers appearance (CT intensity) and shape (vesselness from a Hessian-based filter) features, and incorporates distance to the airways into the cost function to prevent false detection of airway walls. For quantifying the extracted pulmonary vessels, a radius histogram is generated by counting the occurrence of vessel radii, calculated from a distance transform-based method. Subsequently, two biomarkers, slope α and intercept β, are calculated by linear regression on the radius histogram. A public data set from the VESSEL12 challenge was used to independently evaluate the vessel extraction. The quantitative analysis method was validated using images of a three-dimensional (3D) printed vessel phantom, scanned by a clinical CT scanner and a micro-CT scanner (to obtain a gold standard). To confirm the association between imaging biomarkers and pulmonary function, 77 scleroderma patients were investigated with the proposed method. RESULTS In the independent evaluation with the public data set, our vessel segmentation method obtained an area under the receiver operating characteristic (ROC) curve of 0.976. The median radius difference between clinical and micro-CT scans of a 3D printed vessel phantom was 0.062 ± 0.020 mm, with interquartile range of 0.199 ± 0.050 mm. In the studied patient group, a significant correlation between diffusion capacity for carbon monoxide and the biomarkers, α (R = -0.27, P = 0.018) and β (R = 0.321, P = 0.004), was obtained. CONCLUSION In conclusion, the proposed method was validated independently using a public data set resulting in an area under the ROC curve of 0.976 and using a 3D printed vessel phantom data set, showing a vessel sizing error of 0.062 mm (0.16 in-plane pixel units). The correlation between imaging biomarkers and diffusion capacity in a clinical data set confirmed an association between lung structure and function. This quantification of pulmonary vascular morphology may be helpful in understanding the pathophysiology of pulmonary vascular diseases.
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Affiliation(s)
- Zhiwei Zhai
- Division of Image ProcessingDepartment of RadiologyLeiden University Medical CenterPO Box 96002300 RCLeidenThe Netherlands
| | - Marius Staring
- Division of Image ProcessingDepartment of RadiologyLeiden University Medical CenterPO Box 96002300 RCLeidenThe Netherlands
| | - Irene Hernández Girón
- Medical Physics, Department of RadiologyLeiden University Medical CenterPO Box 96002300 RCLeidenThe Netherlands
| | - Wouter J. H. Veldkamp
- Medical Physics, Department of RadiologyLeiden University Medical CenterPO Box 96002300 RCLeidenThe Netherlands
| | - Lucia J. Kroft
- Department of RadiologyLeiden University Medical CenterPO Box 96002300 RCLeidenThe Netherlands
| | - Maarten K. Ninaber
- Department of PulmonologyLeiden University Medical CenterPO Box 96002300 RCLeidenThe Netherlands
| | - Berend C. Stoel
- Division of Image ProcessingDepartment of RadiologyLeiden University Medical CenterPO Box 96002300 RCLeidenThe Netherlands
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Capron T, Bourdin A, Perez T, Chanez P. COPD beyond proximal bronchial obstruction: phenotyping and related tools at the bedside. Eur Respir Rev 2019; 28:28/152/190010. [PMID: 31285287 DOI: 10.1183/16000617.0010-2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 05/04/2019] [Indexed: 11/05/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is characterised by nonreversible proximal bronchial obstruction leading to major respiratory disability. However, patient phenotypes better capture the heterogeneously reported complaints and symptoms of COPD. Recent studies provided evidence that classical bronchial obstruction does not properly reflect respiratory disability, and symptoms now form the new paradigm for assessment of disease severity and guidance of therapeutic strategies. The aim of this review was to explore pathways addressing COPD pathogenesis beyond proximal bronchial obstruction and to highlight innovative and promising tools for phenotyping and bedside assessment. Distal small airways imaging allows quantitative characterisation of emphysema and functional air trapping. Micro-computed tomography and parametric response mapping suggest small airways disease precedes emphysema destruction. Small airways can be assessed functionally using nitrogen washout, probing ventilation at conductive or acinar levels, and forced oscillation technique. These tests may better correlate with respiratory symptoms and may well capture bronchodilation effects beyond proximal obstruction.Knowledge of inflammation-based processes has not provided well-identified targets so far, and eosinophils probably play a minor role. Adaptative immunity or specific small airways secretory protein may provide new therapeutic targets. Pulmonary vasculature is involved in emphysema through capillary loss, microvascular lesions or hypoxia-induced remodelling, thereby impacting respiratory disability.
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Affiliation(s)
- Thibaut Capron
- Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France
| | - Arnaud Bourdin
- Université de Montpellier, PhyMedExp, INSERM, CNRS, CHU de Montpellier, Dept of Respiratory Diseases, Montpellier, France
| | - Thierry Perez
- Dept of Respiratory Diseases, CHU Lille, Center for Infection and Immunity of Lille, INSERM U1019 - CNRS UMR 8204, Université Lille Nord de France, Lille, France
| | - Pascal Chanez
- Clinique des Bronches, Allergies et Sommeil, Hôpital Nord, Assistance Publique des Hôpitaux de Marseille, Aix Marseille Université, Marseille, France .,Aix Marseille Université, INSERM, INRA, CV2N, Marseille, France
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23
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Dupin I, Thumerel M, Maurat E, Coste F, Eyraud E, Begueret H, Trian T, Montaudon M, Marthan R, Girodet PO, Berger P. Fibrocyte accumulation in the airway walls of COPD patients. Eur Respir J 2019; 54:13993003.02173-2018. [DOI: 10.1183/13993003.02173-2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/28/2019] [Indexed: 12/16/2022]
Abstract
The remodelling mechanism and cellular players causing persistent airflow limitation in COPD remain largely elusive. We have recently demonstrated that circulating fibrocytes, a rare population of fibroblast-like cells produced by the bone marrow stroma, are increased in COPD patients during an exacerbation. We aimed to quantify fibrocyte density in situ in bronchial specimens from both control subjects and COPD patients, to define associations with relevant clinical, functional and computed tomography (CT) parameters, and to investigate the effect of the epithelial microenvironment on fibrocyte survival in vitro (“Fibrochir” study).A total of 17 COPD patients and 25 control subjects, all requiring thoracic surgery, were recruited. Using co-immunostaining and image analysis, we identified CD45+ FSP1+ cells as tissue fibrocytes, and quantified their density in distal and proximal bronchial specimens. Fibrocytes, cultured from the blood samples of six COPD patients, were exposed to primary bronchial epithelial cell secretions from control subjects or COPD patients.We demonstrate that fibrocytes are increased in both distal and proximal tissue specimens of COPD patients. The density of fibrocytes is negatively correlated with lung function parameters and positively correlated with bronchial wall thickness as assessed by CT scan. A high density of distal bronchial fibrocytes predicts the presence of COPD with a sensitivity of 83% and a specificity of 70%. Exposure of fibrocytes to COPD epithelial cell supernatant favours cell survival.Our results thus demonstrate an increased density of fibrocytes within the bronchi of COPD patients, which may be promoted by epithelial-derived survival-mediating factors.
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24
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Barnes J, Krick S. How to Detect Tobacco-related Vasculopathy: Are We There Yet? Ann Am Thorac Soc 2019; 16:674-675. [PMID: 31149853 PMCID: PMC6850744 DOI: 10.1513/annalsats.201901-095ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Jarrod Barnes
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
| | - Stefanie Krick
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama
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Coste F, Benlala I, Dournes G, Dromer C, Blanchard E, Girodet PO, Montaudon M, Baldacci F, Picard F, Marthan R, Laurent F, Berger P. Quantitative CT assessment of bronchial and vascular alterations in severe precapillary pulmonary hypertension. Int J Chron Obstruct Pulmon Dis 2019; 14:381-389. [PMID: 30809092 PMCID: PMC6377046 DOI: 10.2147/copd.s177638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background Little is known about in vivo alterations at bronchial and vascular levels in severe pulmonary hypertension (PH) of different etiologies. We aimed to compare quantitative computed tomography (CT) data from the following three groups of severe precapillary PH patients: COPD, idiopathic pulmonary arterial hypertension (iPAH), and chronic thromboembolic PH (CTEPH). Patients and methods This study was approved by the institutional review board. Severe PH patients (mean pulmonary arterial pressure [mPAP] ≥35 mmHg) with COPD, iPAH, or CTEPH (n=24, 16, or 16, respectively) were included retrospectively between January 2008 and January 2017. Univariate analysis of mPAP was performed in each severe PH group. Bronchial wall thickness (WT) and percentage of cross sectional area of pulmonary vessels less than 5 mm2 normalized by lung area (%CSA<5) were measured and compared using CT, and then combined to arterial partial pressure of oxygen (PaO2) to generate a “paw score” compared within the three groups using Kruskal–Wallis and its sensitivity using Fisher’s exact test. Results WT was higher and %CSA<5 was lower in the COPD group compared to iPAH and CTEPH groups. Mosaic pattern was higher in CTEPH group than in others. In severe PH patients secondary to COPD, mPAP was positively correlated to %CSA<5. By contrast, in severe iPAH, this correlation was negative, or not correlated in severe CTEPH groups. In the COPD group, “paw score” showed higher sensitivity than in the other two groups. Conclusion Unlike in severe iPAH and CTEPH, severe PH with COPD can be predicted by “paw score” reflecting bronchial and vascular morphological differential alterations.
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Affiliation(s)
- Florence Coste
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France,
| | - Ilyes Benlala
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France,
| | - Gaël Dournes
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Claire Dromer
- CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Elodie Blanchard
- CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Pierre-Olivier Girodet
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Michel Montaudon
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Fabien Baldacci
- Université de Bordeaux, LaBRI, F-33405 Talence Cedex, France
| | - François Picard
- CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Roger Marthan
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - François Laurent
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
| | - Patrick Berger
- Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France, .,Centre de Recherche Cardio-Thoracique de Bordeaux, INSERM, U1045, Université de Bordeaux, CIC1401, F-33000 Bordeaux, France, .,CHU de Bordeaux, Service d'Imagerie Thoracique et Cardiovasculaire, Service des Maladies Respiratoires, Service de Cardiologie, CIC1401, Service d'Explorations Fonctionnelles Respiratoires, F-33600 Pessac, France
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Yu N, Yuan H, Duan HF, Ma JC, Ma GM, Guo YM, Wu F. Determination of vascular alteration in smokers by quantitative computed tomography measurements. Medicine (Baltimore) 2019; 98:e14438. [PMID: 30762753 PMCID: PMC6408080 DOI: 10.1097/md.0000000000014438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A new method of quantitative computed tomography (CT) measurements of pulmonary vessels are applicable to morphological studies and may be helpful in defining the progression of emphysema in smokers. However, limited data are available on the relationship between the smoking status and pulmonary vessels alteration established in longitudinal observations. Therefore, we investigated the change of pulmonary vessels on CTs in a longitudinal cohort of smokers.Chest CTs were available for 287 current smokers, 439 non-smokers, and 80 former smokers who quit smoking at least 2 years after the baseline CT. CT images obtained at the baseline and 1 year later were assessed by a new quantitative CT measurement method, computing the total number of pulmonary vessels (TNV), mean lung density (MLD), and the percentage of low-attenuation areas at a threshold of -950 (density attenuation area [LAA]%950). Analysis of variance (ANOVA) and the independent sample t test were used to estimate the influence of the baseline parameters. The t paired test was employed to evaluate the change between the baseline and follow-up results.The current smokers related to have higher whole-lung MLD, as well as less and lower TNV values than the non-smokers (P <.05). But no significant differences in LAA%950 were found between smokers and non-smokers. After one year, the increase in LAA%950 was more rapid in the current (additional 0.3% per year, P <. 05-.01) than in the former smokers (additional 0.2% per year, P = .3). Additionally, the decline in TNV was faster in the current (additional -1.3 per year, P <.05-.01) than that in the former smokers (additional -0.2 per year, P = .6). Current smoke, pack-years, weight, and lung volume independently predicted TNV at baseline (P <.001) in multivariate analysis.The findings of this study reveal that the decline in the pulmonary vessels in smokers can be measured and related to their smoking status.
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Affiliation(s)
- Nan Yu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Da Lian
- Department of Radiology, The Shaanxi university of Chinese medicine
| | - Hui Yuan
- Department of Radiology, The Shaanxi university of Chinese medicine
| | - Hai-feng Duan
- Department of Radiology, The Shaanxi university of Chinese medicine
| | - Jun-chao Ma
- Department of Radiology, The Shaanxi university of Chinese medicine
| | - Guang-ming Ma
- Department of Radiology, The Shaanxi university of Chinese medicine
| | - You-min Guo
- Department of Radiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Fei Wu
- Department of Radiology, Affiliated Zhongshan Hospital of Dalian University, Da Lian
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Guo X, Fan Y, Cui J, Hao B, Zhu L, Sun X, He J, Yang J, Dong J, Wang Y, Liu X, Chen J. NOX4 expression and distal arteriolar remodeling correlate with pulmonary hypertension in COPD. BMC Pulm Med 2018; 18:111. [PMID: 29986678 PMCID: PMC6038356 DOI: 10.1186/s12890-018-0680-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 06/25/2018] [Indexed: 12/26/2022] Open
Abstract
Background Pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) is suggested as the consequence of emphysematous destruction of vascular bed and hypoxia of pulmonary microenvironment, mechanisms underpinning its pathogenesis however remain elusive. The dysregulated expression of nicotinamide adenine dinucleotide phosphate (NADPH)-oxidases and superoxide generation by pulmonary vasculatures have significant implications in the hypoxia-induced PH. Methods In this study, the involvement of NADPH oxidase subunit 4 (NOX4) in pulmonary arteriolar remodeling of PH in COPD was investigated by ascertaining the morphological alteration of pulmonary arteries and pulmonary blood flow using cardiac magnetic resonance imaging (cMRI), and the expression and correlation of NOX4 with pulmonary vascular remodeling and pulmonary functions in COPD lungs. Results Results demonstrated that an augmented expression of NOX4 was correlated with the increased volume of pulmonary vascular wall in COPD lung. While the volume of distal pulmonary arteries was inversely correlated with pulmonary functions, despite it was positively associated with the main pulmonary artery distensibility, right ventricular myocardial mass end-systolic and right ventricular myocardial mass end-diastolic in COPD. In addition, an increased malondialdehyde and a decreased superoxide dismutase were observed in sera of COPD patients. Mechanistically, the abundance of NOX4 and production of reactive oxygen species (ROS) in pulmonary artery smooth muscle cells could be dynamically induced by transforming growth factor-beta (TGF-β), which in turn led pulmonary arteriolar remodeling in COPD lungs. Conclusion These results suggest that the NOX4-derived ROS production may play a key role in the development of PH in COPD by promoting distal pulmonary vascular remodeling.
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Affiliation(s)
- Xiaotong Guo
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Yuchun Fan
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Jieda Cui
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China.,Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Binwei Hao
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China
| | - Li Zhu
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Xiao Sun
- Department of Radiology, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Jinxi He
- Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Jiali Yang
- Institute of Human Stem Cell Research, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Jianda Dong
- Department of Pathology, Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Yanyang Wang
- Department of Radiotherapy, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China
| | - Xiaoming Liu
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China. .,Institute of Human Stem Cell Research, General Hospital of Ningxia Medical University, Yinchuan, 750004, Ningxia, China.
| | - Juan Chen
- Department of Pulmonary and Critical Care Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, Ningxia, 750004, People's Republic of China.
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Matsuoka S, Kotoku A, Yamashiro T, Matsushita S, Fujikawa A, Yagihashi K, Nakajima Y. Quantitative CT Evaluation of Small Pulmonary Vessels in Patients with Acute Pulmonary Embolism. Acad Radiol 2018; 25:653-658. [PMID: 29331359 DOI: 10.1016/j.acra.2017.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 11/13/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to investigate the correlation between the computed tomography (CT) cross-sectional area (CSA) of small pulmonary vessels and the CT obstruction index in patients with acute pulmonary embolism (PE) and the correlation between the changes in these measurements after anticoagulant therapy. MATERIALS AND METHODS Fifty-two patients with acute PE were selected for this study. We measured the CSA less than 5 mm2 on coronal reconstructed images to obtain the percentage of the CSA (%CSA < 5). CT angiographic index was obtained based on the Qanadli method for the evaluation of the degree of pulmonary arterial obstruction. Spearman rank correlation analysis was used to evaluate the relationship between the initial and the follow-up values and changes in the %CSA < 5 and the CT obstruction index. RESULTS There was no significant correlation between the %CSA < 5 and CT obstruction index on both initial (ρ = -0.03, P = 0.84) and follow-up (ρ = -0.03, P = 0.82) assessments. In contrast, there was a significant negative correlation between the changes in %CSA < 5 and the CT obstruction index (ρ = -0.59, P < 0.0001). CONCLUSIONS Although the absolute %CSA < 5 and CT obstruction index were not significantly correlated, the changes in the values of the two parameters had a significant correlation. Changes in %CSA < 5, which can be obtained easily, can be used as biomarker of therapeutic response in patients with acute PE.
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Affiliation(s)
- Shin Matsuoka
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan.
| | - Akiyuki Kotoku
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan; Department of Radiology, Graduate School of Medical Science, University of the Ryukyu, Okinawa, Japan
| | - Shoichiro Matsushita
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan
| | - Atsuko Fujikawa
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan
| | - Kunihiro Yagihashi
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan
| | - Yasuo Nakajima
- Department of Radiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki City, Kanagawa 216-8511, Japan
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Shimizu K, Konno S, Makita H, Kimura H, Kimura H, Suzuki M, Nishimura M. Transfer coefficients better reflect emphysematous changes than carbon monoxide diffusing capacity in obstructive lung diseases. J Appl Physiol (1985) 2018; 125:183-189. [PMID: 29648520 DOI: 10.1152/japplphysiol.01062.2017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The overlap between asthma and chronic obstructive pulmonary disease (COPD) has attracted the interest of pulmonary physicians; thus, measurement of carbon monoxide diffusion capacity (DLco) and/or transfer coefficients (Kco, DLco/VA) may become valuable in clinical settings. How these parameters behave in chronic obstructive lung diseases is poorly understood. We predicted that Kco might more accurately reflect emphysematous changes in the lungs than DLco. We examined DLco and Kco in nonsmokers and smokers with asthma and investigated their relationships with forced expiratory volume in 1 s (%FEV1) by group. We then selected nonsmokers (As-NS) and smokers with asthma (As-Sm) in both groups and those with COPD while controlling for the degree of airflow limitation across groups. Emphysema volumes [%lung attenuation volume (%LAV)] and percentage of cross-sectional area of small pulmonary vessels <5 mm2 (%CSA<5) were measured by computed tomography. In As-NS, %Kco was significantly higher when FEV1% was reduced, but such a correlation was not seen in As-Sm. %Kco successfully differentiated among the three groups when airflow limitation levels were matched. However, %DLc, was significantly reduced only in patients with COPD. Both %LAV and %CSA<5 were better correlated with %Kco than with %DLco. There was discordance between %DLCO and %Kco in As-Sm, which was not seen in As-NS. Overall, %Kco better reflects emphysematous changes in obstructive lung diseases than %DLco. NEW & NOTEWORTHY Despite differing behaviors of %Kco and %DLco in several diseases, the characteristics of these parameters have not been fully examined in smokers with asthma. Here, we demonstrated that %Kco is a more sensitive parameter of pathophysiology, better reflecting emphysematous changes in chronic obstructive lung diseases overall, compared with %DLco. Thus, more precise interpretations of %DLco and %Kco may provide clues for understanding the pathophysiology of obstructive lung diseases.
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Affiliation(s)
- Kaoruko Shimizu
- Department of Respiratory Medicine, Hokkaido University , Sapporo , Japan
| | - Satoshi Konno
- Department of Respiratory Medicine, Hokkaido University , Sapporo , Japan
| | - Hironi Makita
- Department of Respiratory Medicine, Hokkaido University , Sapporo , Japan
| | - Hirokazu Kimura
- Department of Respiratory Medicine, Hokkaido University , Sapporo , Japan
| | - Hiroki Kimura
- Department of Respiratory Medicine, Hokkaido University , Sapporo , Japan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Hokkaido University , Sapporo , Japan
| | - Masaharu Nishimura
- Department of Respiratory Medicine, Hokkaido University , Sapporo , Japan
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Shimizu K, Tsujino I, Sato T, Sugimoto A, Nakaya T, Watanabe T, Ohira H, Ito YM, Nishimura M. Performance of computed tomography-derived pulmonary vasculature metrics in the diagnosis and haemodynamic assessment of pulmonary arterial hypertension. Eur J Radiol 2017; 96:31-38. [DOI: 10.1016/j.ejrad.2017.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 09/08/2017] [Accepted: 09/17/2017] [Indexed: 12/20/2022]
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A diffuse lung emphysema, severe pulmonary hypertension and lack of airflow limitation. Respir Med Case Rep 2017; 21:74-77. [PMID: 28413774 PMCID: PMC5384413 DOI: 10.1016/j.rmcr.2017.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 04/02/2017] [Accepted: 04/03/2017] [Indexed: 12/01/2022] Open
Abstract
Pulmonary veno-occlusive disease is characterized by remodeling of pulmonary arteries, capillaries and venules. We report a case of diffuse lung emphysema and pulmonary veno-occlusive disease with the characteristic of having no airflow limitation. A very low diffusing capacity for carbon monoxide and results of high-resolution computed tomography of the chest suggested pulmonary veno-occlusive disease. The diagnosis was confirmed on histological analysis after lung transplantation. The combination of results of the computed tomography of the chest and the histological analysis suggested a relationship between diffuse lung emphysema and remodeling of pulmonary vessels. A distinctive pattern of mild-to-moderate airflow limitation in patients with chronic obstructive pulmonary disease and severe pulmonary hypertension has been described. This observation of the combination of diffuse emphysema, pulmonary veno-occlusive disease and no airflow limitation supports further pathophysiological studies on severe pulmonary hypertension in chronic obstructive pulmonary disease.
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Pulmonary Hypertension and the Quantification of Lung Density on Chest CT: "I Know It When I See It.". Acad Radiol 2016; 23:933-4. [PMID: 27298057 DOI: 10.1016/j.acra.2016.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 05/19/2016] [Indexed: 11/21/2022]
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