Treatment Effect of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension Quantified by Automatic Comparative Imaging in Computed Tomography Pulmonary Angiography
Treatment Effect of Balloon Pulmonary Angioplasty in Chronic Thromboembolic Pulmonary Hypertension Quantified by Automatic Comparative Imaging in Computed Tomography Pulmonary Angiography
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DOI：
10.1097/rli.0000000000000441
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发表时间：
2018-05-01
影响因子：
6.7
通讯作者：
Stoel, Berend C.
中科院分区：
文献类型：
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作者：
Zhai, Zhiwei;Ota, Hideki;Stoel, Berend C.
目的：球囊肺血管成形术（BPA）治疗不可手术的慢性血栓栓塞性肺动脉高压（CTEPH）患者可能具有不同的结局。为了更深入地了解这种变化，我们设计了一种方法，通过自动比较BPA治疗前后的计算机断层扫描（CT）肺血管造影来可视化和量化肺灌注的变化。我们验证了这些定量的血流动力学变化测量与右侧heartcatheter.Materials和方法：我们研究了14个连续CTEPH患者（12名妇女，年龄，70.5 +/- 24），谁接受了CT肺动脉造影和右侧心导管检查，BPA前后。将治疗后图像与治疗前CT扫描（使用Elastix工具箱）配准，以获得相应的位置。分别采用图割法和距离变换法检测肺血管树及其中心线。血管远端区域定义为肺实质。随后，计算血管中心线和实质区域内的密度变化，并针对吸气水平差异进行校正。为了可视化，以颜色编码的叠加图显示密度变化。对于定量，计算血管和实质区域密度变化的中位数和四分位数范围（Δ VD和Δ PD）。记录的血流动力学参数变化，包括收缩压、舒张压和平均肺动脉压（分别为Δ sPAP、Δ dPAP和Δ mPAP）和血管阻力（Δ PVR）的变化，用作治疗效果的参考评估。斯皮尔曼相关系数被用来研究灌注变化和血流动力学变化之间的相关性。在肺血管内，Δ VD的四分位距与Δ sPAP（R =-0.58，P = 0.03）、Δ dPAP（R =-0.71，P = 0.005）、Δ mPAP（R =-0.71，P = 0.005）和Δ PVR（R =-0.77，P = 0.001）显著相关。在脑实质中，Delta PD的中位数与Delta dPAP（R =-0.58，P = 0.030）和Delta mPAP（R =-0.59，P = 0.025）显著相关。结论：通过对CTEPH患者进行影像学比较分析，可以了解BPA治疗效果的差异。灌注变化的定量提供了反映血流动力学变化的无创测量。
Objectives: Balloon pulmonary angioplasty (BPA) in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) can have variable outcomes. To gain more insight into this variation, we designed a method for visualizing and quantifying changes in pulmonary perfusion by automatically comparing computed tomography (CT) pulmonary angiography before and after BPA treatment. We validated these quantifications of perfusion changes against hemodynamic changes measured with right-sided heart catheterization.Materials and Methods: We studied 14 consecutive CTEPH patients (12 women; age, 70.5 +/- 24), who underwent CT pulmonary angiography and right-sided heart catheterization, before and after BPA. Posttreatment images were registered to pretreatment CT scans (using the Elastix toolbox) to obtain corresponding locations. Pulmonary vascular trees and their centerlines were detected using a graph cuts method and a distance transform method, respectively. Areas distal from vessels were defined as pulmonary parenchyma. Subsequently, the density changes within the vascular centerlines and parenchymal areas were calculated and corrected for inspiration level differences. For visualization, the densitometric changes were displayed in color-coded overlays. For quantification, the median and interquartile range of the density changes in the vascular and parenchymal areas (Delta VD and Delta PD) were calculated. The recorded changes in hemodynamic parameters, including changes in systolic, diastolic, and mean pulmonary artery pressure (Delta sPAP, Delta dPAP, and Delta mPAP, respectively) and vascular resistance (Delta PVR), were used as reference assessments of the treatment effect. Spearman correlation coefficients were employed to investigate the correlations between changes in perfusion and hemodynamic changes.Results: Comparative imaging maps showed distinct patterns in perfusion changes among patients. Within pulmonary vessels, the interquartile range of Delta VD correlated significantly with Delta sPAP (R = -0.58, P = 0.03), Delta dPAP (R = -0.71, P = 0.005), Delta mPAP (R = -0.71, P = 0.005), and Delta PVR (R = -0.77, P = 0.001). In the parenchyma, the median of Delta PD had significant correlations with Delta dPAP (R = -0.58, P = 0.030) and Delta mPAP (R = -0.59, P = 0.025).Conclusions: Comparative imaging analysis in CTEPH patients offers insight into differences in BPA treatment effect. Quantification of perfusion changes provides noninvasive measures that reflect hemodynamic changes.