CT Findings of Pulmonary Hypertension

Abstract

Primary pulmonary hypertension (PPH) has an extremely poor prognosis with a mean survival time of 2‐3 years from time of diagnosis. Hemodynamically, PPH is defined with a mPAP of ≥ 25 mm Hg. Currently, RHC is the gold standard for measuring the arterial pressures and diagnosing PPH; however, it is an incredibly invasive procedure. Our study will show whether CT angiography can be considered as a non‐invasive alternative for diagnosing PPH. Studies in the past have shown CT measurements of the MPAD and MPAD/AAD ratio having strong correlations with PPH. In addition to those measurements, we want to show if other CT parameters also have a correlation with PPH. Some of these novel measurements include the interventricular septal deviation and the Elizabeth Taylor sign. The interventricular septum is normally bowing to the right in a non‐pathological state. If it is straight or bowing to the left, this will indicate increased right ventricular pressures which would be indicative of PPH. Straight will indicate increased RV pressures, and bowing to the left will be considered markedly increased RV pressures. The Elizabeth Taylor sign is the ratio of the diameter of the segmental bronchi and its corresponding artery. We will hypothesize that the artery will be much larger than the bronchi in patients with PPH. Other measurements will include the left and right pulmonary arteries. This study is a retrospective review of subjects who underwent an otherwise unremarkable CT pulmonary artery angiogram. Subjects with pulmonary embolism or other acute pulmonary diseases are excluded. For each subject, the following CT findings are obtained: main pulmonary artery diameter (mPAD), ratio of mPAD to ascending aorta, right and left pulmonary artery diameters, ratio of segmental pulmonary artery to corresponding bronchus, and interventricular septal displacement. Straightening of the interventricular septum qualifies as increased right ventricular septal pressure and right‐to‐left bowing of the septum qualifies as a marked increase. Mean pulmonary artery pressure measured on any prior/subsequent RHC or echocardiogram within 3 months of the CT is recorded. Any past medical history of connective tissue disease is noted. Descriptive data are calculated and correlations are done to assess for presence and strength of associations among variables. Data from 484 subjects are collected. Incidence rate of pulmonary hypertension isv13% (n=63). 52% (n=33) of the subjects with pulmonary hypertension are female with an average age of 55 years. mPA diameter (p<0.001), mPA:AA ratio (p<0.001), right (p<0.001) and left pulmonary artery (p=0.004) diameters are predictors of pulmonary hypertension. sPA:B ratio (p=0.08) and interventricular septal displacement (p=0.96) are not predictive of pulmonary hypertension. This study supports an association of mPA diameter, mPA:AA ratio, right and left pulmonary artery diameters with pulmonary hypertension diagnosed by RHC or echocardiogram. Prospective research is warranted to confirm and establish threshold values for each variable. Currently, an invasive RHC remains the most accurate method of diagnosis. Correlating CT findings with pulmonary hypertension would allow clinicians to use CT as a noninvasive screening tool.