CT肺动脉造影的多参数测量联合心动超声对肺动脉高压程度的预测价值  

The predictive value of CT pulmonary angiography combined with echocardiography for the degree of pulmonary hypertension

作　　者：董宁利 杨宏刚 黑欢欢 郭佑民[1] 段小艺[1] 沈聪 DONG Ningli;YANG Honggang;HEI Huanhuan;GUO Youmin;DUAN Xiaoyi;SHEN Cong(Department of PET/CT,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061;Department of Medical Imaging,Baoji No.2 Hospital of Traditional Chinese Medicine,Baoji 721300;Department of Imaging,The Second Affiliated Hospital of Xi’an Medical College,Xi’an 710038,China)

机构地区：[1]西安交通大学第一附属医院PET/CT室,陕西西安710061 [2]宝鸡市第二中医医院影像科,陕西宝鸡721300 [3]西安医学院第二附属医院影像科,陕西西安710038

出　　处：《西安交通大学学报（医学版）》2023年第2期275-282,共8页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：国家自然科学基金资助项目(No.62073260)。

摘　　要：目的比较CT肺动脉造影(computer tomography pulmonary angiography,CTPA)联合心动超声对肺动脉高压(pulmonary hypertension,PH)程度的预测价值。方法回顾性收集我院2013年11月至2021年4月因可疑或确诊PH行右心导管、CTPA和心动超声检查的患者54例。右心导管测量得到肺动脉收缩压(PASP)和肺动脉平均压(PAMP),根据PAMP分为无PH组和轻度、中度、重度PH组。计算机辅助下分割获得肺动脉的三维模型,测量肺动脉的最佳拟合圆直径(Dfit)、最小内切圆直径(Dmin)、最大外切圆直径(Dmax)、水力直径(Dh)、截面积(Area)、周长(Scf),测量右心室最大面积、最大短径。心动超声估测PASP。比较不同PH分组间以上参数的差异,分析以上参数与PASP、PAMP的相关性,纳入具有统计学意义的指标,建立PAMP的3个预测模型(模型1:CTPA肺动脉;模型2:CTPA肺动脉+CTPA右心室;模型3:CTPA肺动脉+CTPA右心室+心动超声),采用受试者操作特性(ROC)曲线比较3个模型的诊断效能。结果主肺动脉(Dfit、Dmin、Dmax、Dh、Area、Scf)、右肺动脉(Dmax、Dh、Area、Scf)、左肺动脉(Dfit)的部分参数及右心室短径随着PAMP的增高而增大(P<0.05)。肺动脉主干、右肺动脉、左肺动脉的Dfit、Dmin、Dh、Area与PASP、PAMP呈正相关(P<0.05)。右室短径、右室最大面积与PASP呈正相关(P<0.05),右室短径与PAMP呈正相关(P<0.05)。心动超声中肺动脉收缩压估测值与PASP、PAMP呈正相关(P<0.05)。模型1、模型2和模型3均可以用来鉴别轻度PH和中度PH,模型3在鉴别无PH和轻度PH、中度PH和重度PH的效能最高。结论CTPA和心动超声有助于评估PH程度,二者联合在鉴别无PH和轻度PH、中度和重度PH具有更好的准确度。Objective To compare the value of CT pulmonary angiography(CTPA)and echocardiography in predicting the degree pulmonary hypertension(PH).Methods Fifty-four patients in our hospital who underwent right heart catheterization,CTPA and echocardiography for suspected or confirmed PH from November 2013 to April 2021 were retrospectively recruited.Pulmonary artery systolic pressure(PASP)and mean pulmonary artery pressure(PAMP)were measured by right heart catheterization.According to PAMP,the patients were divided into non-PH group and mild,moderate,and severe PH groups.The three-dimensional model of the pulmonary artery was obtained by computer-aided segmentation,and the best fitting circle diameter(Dfit),inscribed circle diameter(Dmin),circumscribed circle diameter(Dmax),hydraulic diameter(Dh),cross-sectional area(Area),circumference(Scf),and the largest area and largest short diameter of the right ventricle were measured.Echocardiography was used to estimate PASP.The differences in the above parameters between different PH groups were compared,the correlations of the above parameters with PASP and PAMP were analyzed,and statistically significant indicators were included to establish three predictive models of PAMP(Model 1:CTPA pulmonary artery;Model 2:CTPA pulmonary artery+CTPA right ventricle;Model 3:CTPA pulmonary artery+CTPA right ventricle+echocardiography),and receiver operating characteristic(ROC)curves were used to compare the diagnostic performance of the three models.Results Some parameters of main pulmonary artery(Dfit,Dmin,Dmax,Dh,Area,Scf),right pulmonary artery(Dmax,Dh,Area,Scf),left pulmonary artery(Dfit),and right ventricular short diameter increased with the increase of PAMP(P<0.05).Dfit,Dmin,Dh,and area of main pulmonary artery,right pulmonary artery and left pulmonary artery were positively correlated with PASP and PAMP(P<0.05).Right ventricular short diameter and right ventricular maximum area were positively correlated with PASP(P<0.05),and right ventricular short diameter was positively correlated

关 键 词：肺动脉高压 右心导管检查 CT肺动脉造影 心动超声 预测模型 

分 类 号：R445.3[医药卫生—影像医学与核医学]