John Andrew Pura, Abstract Co-Author: Nothing to Disclose

Roberto F. Machado MD, Abstract Co-Author: Nothing to Disclose

Ronald M. Summers MD, PhD, Abstract Co-Author: Royalties, iCAD, Inc, Nashua, NH Grant, iCAD, Inc, Nashua, NH Stockholder, Johnson & Johnson

Gregory J. Kato MD, Abstract Co-Author: Nothing to Disclose

Bradford Johns Wood MD, Abstract Co-Author: Support, Koninklijke Philips Electronics NV Support, Celsion Corporation Advisory Board, Koninklijke Philips Electronics NV Support, Biocompatibles International plc, UK Intellectual Property, Koninklijke Philips Electronics NV Intellectual Property, Traxtal, Inc

Marius George Linguraru DPhil, MS, Presenter: Nothing to Disclose

Mark Gladwin MD, Abstract Co-Author: Nothing to Disclose

Caterina P. Minniti MD, Abstract Co-Author: Nothing to Disclose

00030490-DMT et al, Abstract Co-Author: Nothing to Disclose

To evaluate the role of pulmonary artery (PA) size from CT noninvasive image analysis to assess pulmonary hypertension (PHT) and PA hemodynamics in sickle cell disease (SCD).

CT-pulmonary angiography (CTA) data were analyzed for 32 cases: 16 patients with SCD and secondary PHT (mean PA pressure (PAP) ≥25 mmHg from right-heart catheterization, (RHC) and 16 controls without SCD or PHT. Transthoracic echocardiography (TE) and brain-natriuretic peptide (BNP) data were collected for patients. Controls and patients were matched by age and gender. A clinical tool based on level sets was used to semi-automatically segment the PA from CTA. Maximum diameters of the pulmonary trunk (PT) and main branches (PB) were measured via a centerline algorithm. PA sizes were correlated with BNP, tricuspid regurgitant velocity (TRV) from TE, and cardiopulmonary hemodynamics from RHC.

PT and PB diameters of controls showed significant correlations with body surface area, BSA (PT: R=-.68, p=.004; PB: r=.67, p=.004) and body mass index, BMI (PT: R=.63, p=.008; PB: r=.62, p=.01). BSA-adjusted diameters predicted PHT better than unadjusted with area under the ROC curve, AUC=.97 and .91 (.96 and .91), respectively, for PT (PB). Adjusted mean diameters (in mm•m-2) varied significantly (PT: p<.001; PB: p<.001) between patients (PT: 19.3±.6; PB: 14.6±.5) and controls (PT: 14.1±.4; PB: 10.8±.3). PHT is assessed with 100% sensitivity at 81.2% (93.7%) specificity on PT (PB). Within SCD patients, BMI-adjusted diameters correlated best with pulmonary hemodynamics. Significant correlations were found between BMI-adjusted artery sizes and TRV(PT: R=0.59,p=.014), systolic PAP(PT: R=0.63,p=.009; PB: R=.55,p=.02), mean PAP(PT: R=.56,p=.02), cardiac output(PT: R=-.62, p=.01; PB: R=-.61, p=.01), pulmonary vascular resistance(PT: R=.78, p <.001; PB: R=.69, p =.003), and systemic vascular resistance(PT: R=.8, p<.001; PB: R=.75, p =.001). No significant correlations were found between PA size and BNP.

The semi-automated quantification of PA sizes shows great potential to diagnose PHT secondary to SCD. There were significant correlations between PA sizes and hemodynamic markers of PHT.

Image analysis using CTA may serve as a noninvasive surrogate for assessing severity of PHT and facilitate prognosis and acute management in SCD patients.

Pura, J, Machado, R, Summers, R, Kato, G, Wood, B, Linguraru, M, Gladwin, M, Minniti, C, et al, 0, Noninvasive Measurements of Pulmonary Artery Size in CT-Angiography and Their Relation to Pulmonary Hemodynamics and Diagnosis of Secondary Pulmonary Hypertension in Sickle-Cell Disease.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8002630.html