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Published ahead of print on October 29, 2009
Am. J. Respir. Crit. Care Med. 2009, doi:10.1164/rccm.200908-1189OC
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Submitted on August 4, 2009
Accepted on October 28, 2009

Pulmonary Hypertension and CT Measurement of Small Pulmonary Vessels in Severe Emphysema

Shin Matsuoka1*, George R Washko2, Tsuneo Yamashiro1, Raul San Jose Estepar3, Alejandro Diaz2, Edwin K Silverman4, Eric Hoffman5, Henry E Fessler6, Gerard J Criner7, Nathaniel Marchetti7, Steven M Scharf8, Fernando J Martinez9, John J Reilly2, and Hiroto Hatabu1

1 Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States, 2 Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States, 3 Surgical Planning Laboratory, Laboratory of Mathematics in Imaging, Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States, 4 Pulmonary and Critical Care Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States; Channing Laboratory, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States, 5 Department of Radiology, University of Iowa, Iowa City, Iowa, United States, 6 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States, 7 Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, United States, 8 Division of Pulmonary and Critical Care Medicine, University of Maryland, Baltimore, Maryland, United States, 9 Division of Pulmonary and Critical Care Medicine, University of Michigan Health System, Ann Arbor, Michigan, United States

* To whom correspondence should be addressed. E-mail: shin4114{at}mac.com.

Rationale: Vascular alteration of small pulmonary vessels is one of the characteristic features of pulmonary hypertension in chronic obstructive pulmonary disease. The in vivo relationship between pulmonary hypertension and morphological alteration of the small pulmonary vessels has not been assessed in patients with severe emphysema. Objectives: We evaluated the correlation of total cross-sectional area of small pulmonary vessels (CSA) assessed on computed tomography (CT) scans with the degree of pulmonary hypertension estimated by right heart catheterization (RHC). Methods: In 79 severe emphysema patients enrolled in the National Emphysema Treatment Trial (NETT), we measured CSA less than 5mm2 (CSA<5) and 5-10 mm2 (CSA5-10), and calculated the percentage of total CSA for the lung area (%CSA<5, and %CSA5-10, respectively). The correlations of %CSA<5 and %CSA5-10 with pulmonary arterial mean pressure (Ppa) obtained by RHC were evaluated. Multiple linear regression analysis using Ppa as the dependent outcome was also performed. Measurements and Main Results: The %CSA<5 had a significant negative correlation with Ppa (r = -0.512, p < 0.0001), whereas the correlation between %CSA5-10 and Ppa did not reach statistical significance (r = -0.196, p = 0.083). Multiple linear regression analysis showed that %CSA<5 and diffusing capacity of carbon monoxide (DLCO) % predicted were independent predictors of Ppa (r2 = 0.541): %CSA<5 (p < 0.0001), and DLCO % predicted (p = 0.022). Conclusions: The %CSA<5 measured on CT images is significantly correlated to Ppa in severe emphysema, and can estimate the degree of pulmonary hypertension.


Key words: Chronic Obstructive Pulmonary Disease • emphysema • pulmonary hypertension • Computed tomography






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