CT血管造影肺动脉容积测量诊断肺动脉高压的价值分析

Value of pulmonary artery volume measurement on CT pulmonary angiography in the diagnosis of pulmonary artery hypertension

目的探讨利用CT肺动脉成像(CTPA)对肺动脉(PA)3D容积测量在诊断肺动脉高压中的价值。方法回顾性分析70例接受右心导管造影(RHC)和CTPA的疑似肺动脉高压患者,根据RHC测量结果将患者分为肺动脉高压组(41例)及对照组(29例)。手动测量PA直径,包括主肺动脉(MPA)、左肺动脉(LPA)、右肺动脉(RPA)、升主动脉(AA),计算主肺动脉直径与升主动脉直径比值(rPA)。使用3D分割软件测量PA、MPA、LPA和RPA的体积。使用双侧t检验评价两组之间肺动脉参数的差异;使用ROC曲线确定CTPA诊断肺动脉高压最佳诊断界值、敏感度和特异度,计算和比较ROC曲线下面积(AUC);根据体表面积(BSA)调整后比较计算结果;使用Pearson等级相关系数评价平均肺动脉压(mPAP)与肺动脉测量参数之间的相关性。结果肺动脉高压组和对照组之间差异具有统计学意义指标为MPA直径(MPAD)、LPA直径(LPAD)、RPA直径(RPAD)、rPA、PA体积(PAV)、MPA体积(MPAV)、LPA体积(LPAV)和RPA体积(RPAV)(均P<0.001)。MPAD、RPAD、rPA、PAV、MPAV、LPAV和RPAV的AUC值均高于0.8(P<0.001)。根据BSA调整后PAV最佳诊断界值为28.63 ml/m^(2),敏感度92.5%,特异度80%,AUC为0.923均优于肺动脉直径的测量。mPAP与MPAD(r=0.210)、rPA(r=0.642)、PAV(r=0.788)、MPAV(r=0.734)、LPAV(r=0.591)和RPAV(r=0.462)之间的相关性均具有统计学意义,其中PAV与mPAP相关系数最高(r=0.788,P<0.01)。结论使用CTPA对肺动脉进行三维容积分析较肺动脉直径测量更有助于诊断肺动脉高压。

Objective To assess the diagnostic value of three-dimensional(3-D)CT pulmonary angiogram(CTPA)in pulmonary artery hypertension(PAH).Methods CTPA of 70 patients undergoing right heart catheterization(RHC)for suspected PAH was reviewed.According to the RHC measurements,the patients were divided into PAH(41)and control(29)groups.The diameters of main pulmonary artery(MPA),left pulmonary artery(LPA),right pulmonary artery(RPA),and ascending aorta(AA)were measured and the ratio of MPA to AA diameters(rPA)were calculated.The volumes of MPA,LPA and RPA were measured using 3-D segmentation.The vascular parameters between the two groups were compared by two-sided t test.The sensitivity and specificity of CTPA in the diagnosis of PAH were determined by the receiver operating characteristic(ROC)curve and the area under the ROC curve(AUC)was calculated.Pearson rank correlation coefficient was used to evaluate the correlation between mean pulmonary artery pressure(mPAP)and cardiovascular measurements.Results The MPA diameter(MPAD),LPA diameter(LPAD),RPA diameter(RPAD),rPA,PA volume(PAV),MPA volume(MPAV),LPA volume(LPAV)and RPA volume(RPAV)were all significantly different between the 2 groups(P<0.001).The AUC values of MPAD,RPAD,rPA,PAV,MPAV,LPAV and RPAV were higher than 0.8(P<0.001).The best diagnostic limit of PAV adjusted according to body surface area(BSA)was 28.63 ml/m^(2) with sensitivity of 92.5%,specificity of 80%,and the AUC of 0.923,which were better than the measurement of PAD.The correlations between mPAP and MPAD(r=0.210),rPA(r=0.642),PAV(r=0.788),MPAV(r=0.734),LPAV(r=0.591),RPAV(r=0.462)were statistically significant,and the correlation coefficient between PAV and mPAP was the highest(r=0.788,P<0.01).Conclusion 3-D PA volume analysis on CTPA is more useful than PAD for diagnosing PAH.