基于胸部CT平扫影像测量肺血管体积鉴别毛细血管前和毛细血管后肺动脉高压的应用价值  

Application value of pulmonary vascular-volume measurement based on chest CT scan in differentiating pulmonary arterial hypertension of precapillary and postcapillary origin

作　　者：赵莞莞 谷闯 董宁利 黑欢欢 张华文 沈聪 Zhao Wanwan;Gu Chuang;Dong Ningli;Hei Huanhuan;Zhang Huawen;Shen Cong(Department of PET/CT,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Medical Imaging,No.215 Hospital of Shaanxi Nuclear Industry,Xianyang 712000,China;Department of Radiology,the 964th Hospital of the PLA Joint Logistic Support Force,Changchun 130000,China;Department of Medical Imaging,the Second Hospital of Traditional Chinese Medicine,Baoji 721300,China;Department of Imaging,the Second 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,西安71006 [2]陕西省核工业二一五医院影像科,咸阳712000 [3]解放军联勤保障部队第九六四医院放射诊断科,长春130000 [4]宝鸡市第二中医医院影像科,宝鸡721300 [5]西安医学院第二附属医院影像科,西安710038

出　　处：《中华解剖与临床杂志》2025年第2期94-101,共8页Chinese Journal of Anatomy and Clinics

基　　金：陕西省自然科学基础研究计划(2022JQ-763)。

摘　　要：目的探讨基于胸部CT影像测量的肺血管体积在毛细血管前和毛细血管后肺动脉高压(PH)鉴别诊断中的应用价值。方法横断面研究。纳入西安交通大学第一附属医院2020年4月—2023年1月疑似PH患者180例,其中男56例、女124例,年龄18~76(45.8±13.8)岁。患者均行右心导管检查(RHC)和胸部CT平扫,并按RHC结果分组:排除PH的患者90例为对照组,确诊PH的患者90例为PH组;后者又进一步分为毛细血管前PH组(pre-PH组,68例)和毛细血管后PH组(post-PH组,22例)。观察指标获取与分析:(1)通过住院电子病例系统收集患者的临床病理特征,包括年龄、性别、收缩压、舒张压、呼吸和脉搏频次、心衰临床表现、心功能分级、肺动脉直径(PAd)和升主动脉直径(AAd),以及肺动脉收缩压(PASP)、肺动脉舒张压(PADP)、肺动脉平均压(MPAP)和肺动脉楔压(PAWP)等RHC检测指标,并进行组间比较。(2)基于CT平扫的DICOM图像,使用“数字肺”工具分割肺内血管,计算肺血管体积,包括全肺血管总体积(TBV)、动脉血管TBV(aTBV)和静脉血管TBV(vTBV);根据分割得到的肺血管及其分支横截面积的大小(<5 mm^(2),5~10 mm^(2),>10 mm^(2)),将其划分为不同口径(小、中、大口径)的肺血管,计算不同口径肺血管体积,包括其血管总体积(BV5、BV5-10、BV10)以及动、静脉血管体积(aBV5、aBV5-10、aBV10,vBV5、vBV5-10、vBV10),同时计算不同口径肺血管体积占比;比较各肺血管定量参数的组间差异。(3)纳入以上组间比较差异有统计学意义的指标进行多因素logistic回归分析,鉴别毛细血管前、后PH的独立影响因子;采用受试者操作特征曲线(ROC曲线)评估模型预测值在鉴别pre-PH、post-PH中的诊断效能。结果(1)post-PH组患者年龄大于pre-PH组及对照组、心功能较pre-PH组差,pre-PH组收缩压和AAd低于对照组、胸痛和心悸症状患者占比低于对照组和post-PH组,post-PH组和pre-PH组胸闷气短症状患�Objective This study aimed to explore the application value of pulmonary vascular-volume measurement based on chest CT scan in differentiating precapillary and postcapillary pulmonary hypertension(PH).Methods This work was a cross-sectional study.We included 180 suspected PH patients from the First Affiliated Hospital of Xi'an Jiaotong University from April 2020 to January 2023.Among them,56 were males and 124 were females,with ages ranging from 18-76(45.8±13.8)years.All patients underwent right heart catheterization and chest CT scan.They were divided into three groups according to the results of right heart catheterization:90 patients excluded from PH were included in the control group,and 90 patients with confirmed PH were included in the observation group.The latter were further divided into precapillary(68 patients)and postcapillary(22 patients)PH groups.Observation indicators were obtained and analyzed.(1)The clinicopathological characteristics of patients,including age,gender,systolic pressure,diastolic pressure,respiratory and pulse frequency,clinical manifestations,cardiac function grade,and past medical history were collected from the inpatient electronic medical-record system.Pulmonary artery systolic blood pressure(PASP),pulmonary artery diastolic blood pressure,mean pulmonary artery pressure(MPAP),pulmonary artery wedge pressure(PAWP),diameter of pulmonary artery(PAd),and diameter of ascending aorta(AAd)RHC indicators were compared between groups.(2)Based on the DICOM images of the CT scan,the"Digital Lung"tool was used to segment the pulmonary vasculature and calculate the pulmonary vascular volume,including the total pulmonary vascular volume(TBV),arterial TBV(aTBV),and venous TBV(vTBV).The segmented pulmonary vasculature and its branches were divided into different calibers(small,medium,and large)pulmonary vessels based on the cross-sectional area(<5,5-10,and>10 mm^(2)).The volumes of different caliber pulmonary vessels were calculated,including their vascular total volume(BV5,BV5-10,BV10)and art

关 键 词：高血压 肺性 毛细血管前肺动脉高压 毛细血管后肺动脉高压 体层摄影术 X线计算机 肺血管体积 

分 类 号：R544.1[医药卫生—心血管疾病] R816.4[医药卫生—内科学]