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<p>Box plot analysis of serum concentrations of sRAGE (A), esRAGE (B), S100A9 (C) and HMGB1 (D) in patients with CTEPH (n = 26) and controls (n = 33). Independent Student’s t-test was used to compare groups. <i>RAGE</i> receptor for advanced glycation endproducts, <i>sRAGE</i> soluble RAGE, <i>esRAGE</i> endogenous secretory RAGE, <i>S100A9</i> member of S100 family of Ca+ binding proteins, <i>HMGB1</i> high mobility group box1, <i>CTEPH</i> chronic thromboembolic pulmonary hypertension.</p

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

<div><p>Purpose</p><p>The aim of this study was to evaluate the vascular and parenchymal CT imaging findings, including vessel and cardiac chamber diameter measurements, in patients newly diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). The CT imaging findings were correlated with hemodynamic measurements and patient outcome.</p><p>Methods</p><p>Vascular and parenchymal CT findings were assessed on retrospectively ECG-gated MDCT angiography scans in 76 patients newly diagnosed with CTEPH. The diameters of the right and left ventricle (dRV, dLV), the right and left atrium (dRA, dLA), the ascending aorta (dAA), the right and left pulmonary arteries (drPA, dlPA), and the main pulmonary artery (dPA) were measured on axial CT scans. The CT imaging findings were correlated with demographic and hemodynamic data and adverse patient outcome due to right heart failure (RHF).</p><p>Results</p><p>The majority of patients showed chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals in CT. Mean pulmonary artery pressure (mPAP) was not significantly different in patients with and those without chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals. Mean PAP showed significant correlations with the CT metrics of dRV/dLV ratio, dRA, dRV, dPA and dPA/dAA ratio, but no correlation with the central thrombi score. By backward linear regression, the dPA/dAA ratio independently correlated with mPAP. Patients who died of RHF tended to have a higher frequency of exclusively chronic peripheral PE and greater dRV/dLV ratios on presenting CT scans compared with survivors.</p><p>Conclusion</p><p>The majority of patients newly diagnosed with CTEPH show vascular signs of chronic PE, mosaic perfusion, parenchymal densities, disparity in segmental vessel size, bronchial dilatation, and bronchial collaterals on presenting CT scans. Particularly CTEPH patients with exclusively chronic peripheral PE and increased dRV/dLV ratios seem to be at risk of adverse outcome due to RHF.</p></div

Cardiac thrombi in patients with CTEPH.

<p>Axial MDCTA image shows wall-adherent thrombus (arrow) in the right atrium.</p

CT imaging findings in patients newly diagnosed with CTEPH.

<p>CT imaging findings in patients newly diagnosed with CTEPH.</p

Vascular measurements on MDCTA scans.

<p>Main pulmonary artery diameter (dPA), ascending aorta diameter (dAA) and right and left pulmonary artery diameter (drPA, dlPA) were assessed on transverse image.</p

Comparison of the CT imaging findings with vessel and cardiac chamber diameter measurements.

<p>Comparison of the CT imaging findings with vessel and cardiac chamber diameter measurements.</p

Patients’ demographic and hemodynamic characteristics.

<p>Patients’ demographic and hemodynamic characteristics.</p

Comparison between ROC curves for RHF-related death prediction according to each significant characteristic with full model.

<p>Comparison between ROC curves for RHF-related death prediction according to each significant characteristic with full model.</p

Bronchial collateral arteries in patients with CTEPH.

<p>Axial MDCTA image shows bronchial collateral arteries (arrow) in a patient with wall-adherent intraluminal thrombi in the right pulmonary artery and left lower lobe artery.</p

Vessel and cardiac chamber diameter measurements in patients newly diagnosed with CTEPH.

<p>Vessel and cardiac chamber diameter measurements in patients newly diagnosed with CTEPH.</p