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Cereser L, Zussino G, Cicciò C, Tullio A, Montanaro C, Driussi M, Di Poi E, Patruno V, Zuiani C, Girometti R. Impact of an expert-derived, quick hands-on tool on classifying pulmonary hypertension in chest computed tomography: a study on inexperienced readers using RAPID-CT-PH. LA RADIOLOGIA MEDICA 2024:10.1007/s11547-024-01852-5. [PMID: 39048761 DOI: 10.1007/s11547-024-01852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 07/04/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE To test the inter-reader agreement in classifying pulmonary hypertension (PH) on chest contrast-enhanced computed tomography (CECT) between a consensus of two cardio-pulmonary-devoted radiologists (CRc) and inexperienced readers (radiology residents, RRs) when using a CECT-based quick hands-on tool built upon PH imaging literature, i.e., the "Rapid Access and Practical Information Digest on Computed Tomography for PH-RAPID-CT-PH". MATERIAL AND METHODS The observational study retrospectively included 60 PH patients who underwent CECT between 2015 and 2022. Four RRs independently reviewed all CECTs and classified each case into one of the five PH groups per the 2022 ESC/ERS guidelines. While RR3 and RR4 (RAPID-CT-PH group) used RAPID-CT-PH, RR1 and RR2 (control group) did not. RAPID-CT-PH and control groups' reports were compared with CRc using unweighted Cohen's Kappa (k) statistics. RRs' report completeness and reporting time were also compared using the Wilcoxon-Mann-Whitney test. RESULTS The inter-reader agreement in classifying PH between the RAPID-CT-PH group and CRc was substantial (k = 0.75 for RR3 and k = 0.65 for RR4); while, it was only moderate for the control group (k = 0.57 for RR1 and k = 0.49 for RR2). Using RAPID-CT-PH resulted in significantly higher report completeness (all p < 0.0001) and significantly lower reporting time (p < 0.0001) compared to the control group. CONCLUSION RRs using RAPID-CT-PH showed a substantial agreement with CRc on CECT-based PH classification. RAPID-CT-PH improved report completeness and reduced reporting time. A quick hands-on tool for classifying PH on chest CECT may help inexperienced radiologists effectively contribute to the PH multidisciplinary team.
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Affiliation(s)
- Lorenzo Cereser
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy.
| | - Gaia Zussino
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Carmelo Cicciò
- Department of Diagnostic Imaging and Interventional Radiology, IRCCS Sacro Cuore Don Calabria Hospital, via don A. Sempreboni, 5, 37024, Negrar di Valpolicella, Verona, Italy
| | - Annarita Tullio
- Department of Medicine, Institute of Hygiene and Clinical Epidemiology, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Chiara Montanaro
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Mauro Driussi
- Cardiology, Cardiothoracic Department, University Hospital S. Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Emma Di Poi
- Department of Medicine, Rheumatology Clinic, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Vincenzo Patruno
- Pulmonology Department, University Hospital S. Maria della Misericordia, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Chiara Zuiani
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
| | - Rossano Girometti
- Department of Medicine, Institute of Radiology, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale (ASUFC), p.le S. Maria della Misericordia, 15, 33100, Udine, Italy
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Averjanovaitė V, Gumbienė L, Zeleckienė I, Šileikienė V. Unmasking a Silent Threat: Improving Pulmonary Hypertension Screening Methods for Interstitial Lung Disease Patients. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:58. [PMID: 38256318 PMCID: PMC10820938 DOI: 10.3390/medicina60010058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/23/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024]
Abstract
This article provides a comprehensive overview of the latest literature on the diagnostics and treatment of pulmonary hypertension (PH) associated with interstitial lung disease (ILD). Heightened suspicion for PH arises when the advancement of dyspnoea in ILD patients diverges from the expected pattern of decline in pulmonary function parameters. The complexity of PH associated with ILD (PH-ILD) diagnostics is emphasized by the limitations of transthoracic echocardiography in the ILD population, necessitating the exploration of alternative diagnostic approaches. Cardiac magnetic resonance imaging (MRI) emerges as a promising tool, offering insights into hemodynamic parameters and providing valuable prognostic information. The potential of biomarkers, alongside pulmonary function and cardiopulmonary exercise tests, is explored for enhanced diagnostic and prognostic precision. While specific treatments for PH-ILD remain limited, recent studies on inhaled treprostinil provide new hope for improved patient outcomes.
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Affiliation(s)
| | - Lina Gumbienė
- Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
| | | | - Virginija Šileikienė
- Clinic of Chest Diseases, Immunology and Allergology, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania;
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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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Ruaro B, Salton F, Baratella E, Confalonieri P, Geri P, Pozzan R, Torregiani C, Bulla R, Confalonieri M, Matucci-Cerinic M, Hughes M. An Overview of Different Techniques for Improving the Treatment of Pulmonary Hypertension Secondary in Systemic Sclerosis Patients. Diagnostics (Basel) 2022; 12:diagnostics12030616. [PMID: 35328169 PMCID: PMC8947575 DOI: 10.3390/diagnostics12030616] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/17/2022] [Accepted: 02/28/2022] [Indexed: 12/24/2022] Open
Abstract
In systemic sclerosis (SSc) mortality is mainly linked to lung involvement which is characterized by interstitial lung disease (ILD) and pulmonary hypertension (PH). In SSc, PH may be due to different etiologies, including ILD, chronic thromboembolic disease, pulmonary veno-occlusive disease, and pulmonary arterial hypertension (PAH). The main tool to screen PAH is transthoracic echocardiography (TTE), which has a sensitivity of 90%, even if definitive diagnosis should be confirmed by right heart catheterization (RHC). The radiological evaluation (i.e., HRTC) plays an important role in defining the possible causes and in monitoring the evolution of lung damage. For PAH, identifying individuals who have borderline elevation of pulmonary arterial pressure needs to be appropriately managed and followed. In the past few years, the strategy for the management of PAH has significantly evolved and new trials are underway to test other therapies. This review provides an overview of the tools to evaluate PAH in SSc patients and on treatment options for these patients.
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Affiliation(s)
- Barbara Ruaro
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
- Correspondence: ; Tel.: +39-3470502394
| | - Francesco Salton
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy;
| | - Paola Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Pietro Geri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Riccardo Pozzan
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Chiara Torregiani
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Roberta Bulla
- Department of Life Sciences, University of Trieste, 34149 Trieste, Italy;
| | - Marco Confalonieri
- Department of Pulmonology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy; (F.S.); (P.C.); (P.G.); (R.P.); (C.T.); (M.C.)
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, University of Firenze, 50139 Florence, Italy;
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Michael Hughes
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton-Under-Lyne OL6 9RW, UK;
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester M1 1AA, UK
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Predictive value of chest HRCT for survival in idiopathic pulmonary arterial hypertension. Respir Res 2021; 22:293. [PMID: 34789251 PMCID: PMC8597242 DOI: 10.1186/s12931-021-01893-8] [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: 06/20/2021] [Accepted: 11/09/2021] [Indexed: 11/15/2022] Open
Abstract
Background Little attention has been paid to chest high resolution computed tomography (HRCT) findings in idiopathic pulmonary arterial hypertension (IPAH) patients so far, while a couple of small studies suggested that presence of centrilobular ground-glass opacifications (GGO) on lung scans could have a significant negative prognostic value. Therefore, the aims of the present study were: to assess frequency and clinical significance of GGO in IPAH, and to verify if it carries an add-on prognostic value in reference to multidimensional risk assessment tool recommended by the 2015 European pulmonary hypertension guidelines. Methods Chest HRCT scans of 110 IPAH patients were retrospectively analysed. Patients were divided into three groups: with panlobular (p)GGO, centrilobular (c)GGO, and normal lung pattern. Association of different GGO patterns with demographic, functional, haemodynamic, and biochemical parameters was tested. Survival analysis was also performed. Results GGO were found in 46% of the IPAH patients: pGGO in 24% and cGGO in 22%. Independent predictors of pGGO were: positive history of haemoptysis, higher number of low-risk factors, and lower cardiac output. Independent predictors of cGGO were: positive history of haemoptysis, younger age, higher right atrial pressure, and higher mixed venous blood oxygen saturation. CGGO had a negative prognostic value for outcome in a 2-year perspective. This effect was not seen in the longer term, probably due to short survival of cGGO patients. Conclusions Lung HRCT carries a significant independent prognostic information in IPAH, and in patients with cGGO present on the scans an early referral to lung transplantation centres should be considered.
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Imaging the pulmonary extracellular matrix. CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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