动态通气 CT 上的右主肺动脉扩张性及其与呼吸功能的关系

IF 3.7 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Radiology Experimental Pub Date : 2024-04-04 DOI:10.1186/s41747-024-00441-5

Tatsuya Oki, Yukihiro Nagatani, Shota Ishida, Masayuki Hashimoto, Yasuhiko Oshio, Jun Hanaoka, Ryo Uemura, Yoshiyuki Watanabe

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引用次数: 0

摘要

背景在慢性阻塞性肺疾病（COPD）患者和非慢性阻塞性肺疾病患者的呼吸动态过程中，可以使用动态通气计算机断层扫描（DVCT）测量右主肺动脉（MPA）基于心跳的横截面积（CSA）变化，该变化反映了与肺动脉高压相关的右主肺动脉扩张性。我们研究了 MPA 舒张率（MPAD）与呼吸功能之间的关系，以及基于心跳的 CSA 与肺活量、平均肺密度（MLD）和患者特征之间的关系。方法我们回顾性分析了 37 名肺癌患者（20 名女性和 17 名男性）术前进行的 DVCT，他们的年龄为 70.6 ± 7.9 岁（平均 ± 标准差），其中 18 人患有慢性阻塞性肺病，19 人没有慢性阻塞性肺病。通过离散傅立叶变换将 MPA-CSA 分离为呼吸波和心跳波。对于心搏波，分别计算吸气和呼气时的 CSA 变化（CSAC）和 CSA 变化比（CSACR）。结果在无慢性阻塞性肺病组和所有病例中，呼气时的 CSACR 与残肺容积百分比（%RV）和 RV/总肺活量成反比（r = -0.68，p = 0.003；r = -0.58，p = 0.014）。相反，在慢性阻塞性肺病组中，CSAC 吸入与 MLDmax 和 MLD 变化率（MLDmax/MLDmin）（r = 0.54，p = 0.020 和 r = 0.64，p = 0.004）以及 CSAC 呼气和 CSACR 呼气相关。在呼气不足的慢性阻塞性肺疾病患者中，吸气和呼气时的右侧 MPAD 均降低，这意味着呼气功能障碍是慢性阻塞性肺疾病并发肺动脉高压的一个诱因。相关声明在 DVCT 上评估不同呼吸阶段的 MPAD 有可能被用作肺部疾病和/或缺氧导致的肺动脉高压的无创评估，并阐明其发病机制。动态通气计算机断层扫描上的 MPAD 分析有助于了解呼气障碍患者因肺部疾病和/或缺氧导致肺动脉高压的发病机制。

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Right main pulmonary artery distensibility on dynamic ventilation CT and its association with respiratory function

Background

Heartbeat-based cross-sectional area (CSA) changes in the right main pulmonary artery (MPA), which reflects its distensibility associated with pulmonary hypertension, can be measured using dynamic ventilation computed tomography (DVCT) in patients with and without chronic obstructive pulmonary disease (COPD) during respiratory dynamics. We investigated the relationship between MPA distensibility (MPAD) and respiratory function and how heartbeat-based CSA is related to spirometry, mean lung density (MLD), and patient characteristics.

Methods

We retrospectively analyzed DVCT performed preoperatively in 37 patients (20 female and 17 males) with lung cancer aged 70.6 ± 7.9 years (mean ± standard deviation), 18 with COPD and 19 without. MPA-CSA was separated into respiratory and heartbeat waves by discrete Fourier transformation. For the cardiac pulse-derived waves, CSA change (CSAC) and CSA change ratio (CSACR) were calculated separately during inhalation and exhalation. Spearman rank correlation was computed.

Result

In the group without COPD as well as all cases, CSACR exhalation was inversely correlated with percent residual lung volume (%RV) and RV/total lung capacity (r = -0.68, p = 0.003 and r = -0.58, p = 0.014). In contrast, in the group with COPD, CSAC inhalation was correlated with MLDmax and MLD change rate (MLDmax/MLDmin) (r = 0.54, p = 0.020 and r = 0.64, p = 0.004) as well as CSAC exhalation and CSACR exhalation.

Conclusion

In patients with insufficient exhalation, right MPAD during exhalation was decreased. Also, in COPD patients with insufficient exhalation, right MPAD was reduced during inhalation as well as exhalation, which implied that exhalation impairment is a contributing factor to pulmonary hypertension complicated with COPD.

Relevance statement

Assessment of MPAD in different respiratory phases on DVCT has the potential to be utilized as a non-invasive assessment for pulmonary hypertension due to lung disease and/or hypoxia and elucidation of its pathogenesis.

Key points

• There are no previous studies analyzing all respiratory phases of right main pulmonary artery distensibility (MPAD).

• Patients with exhalation impairment decreased their right MPAD.

• Analysis of MPAD on dynamic ventilation computed tomography contributes to understanding the pathogenesis of pulmonary hypertension due to lung disease and/or hypoxia in patients with expiratory impairment.