title: Potential Role of CT Metrics in Chronic Obstructive Pulmonary Disease with Pulmonary Hypertension.
abstract: OBJECTIVE
  Recent imaging studies demonstrated the usefulness of quantitative computed tomographic (CT) analysis assessing pulmonary hypertension (PH) in patients with chronic obstructive lung disease (COPD-PH). The aim of this study was to investigate whether it would be also valuable for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH.
  
  
  METHODS
  We analyzed a correlation between the extent of cystic destruction (LAA%) and total cross-sectional areas of small pulmonary vessels less than 5 mm(2) (%CSA <5) in many CT slices from each of four COPD-PH patients before and after the initiation of pulmonary vasodilator. To evaluate those generalized data from patients with COPD, we evaluated multiple slices from 42 patients whose PH was not clinically suspicious. We also selected five PH patients with idiopathic interstitial pneumonia (IIP-PH) and analyzed serial changes of pulmonary artery enlargement (PA:A ratio).
  
  
  RESULTS
  In 42 COPD patients without PH, LAA% had a statistically significant negative correlation with %CSA <5. However, three of four COPD-PH patients manifested no such correlation. In two patients, clinical findings were dramatically improved after the initiation of pulmonary vasodilator. Notably, LAA% and %CSA <5 in those patients correlated significantly after its treatment. In COPD-PH, the PA:A ratio was significantly decreased after the initiation of pulmonary vasodilator therapy (1.25 ± 0.13 vs. 1.13 ± 0.11, p = 0.019), but not in IIP-PH.
  
  
  CONCLUSIONS
  Our study demonstrates that the use of quantitative CT analysis is a plausible and beneficial tool for predicting and evaluating the effect of pulmonary vasodilators in patients with COPD-PH.
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan. kando@juntendo.ac.jp.
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Ando
authors.affiliation: Department of Pulmonology, Nagano Red Cross Hospital, 5-22-1 Wakasato, Nagano, Nagano, 380-8582, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kuraishi
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
authors.forename: Tetsutaro
authors.initials: T
authors.lastname: Nagaoka
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
authors.forename: Takeo
authors.initials: T
authors.lastname: Tsutsumi
authors.affiliation: Department of Pulmonology, Koshigaya Municipal Hospital, 10-47 Higashi-koshigaya, Koshigaya, Saitama, 343-8577, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Hoshika
authors.affiliation: Department of Cardiovascular Medicine, Koshigaya Municipal Hospital, 10-47 Higashi-koshigaya, Koshigaya, Saitama, 343-8577, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Kimura
authors.affiliation: Department of Pulmonology, Koshigaya Municipal Hospital, 10-47 Higashi-koshigaya, Koshigaya, Saitama, 343-8577, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ienaga
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Morio
authors.affiliation: Division of Respiratory Medicine, Department of Internal Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D000077300:Bosentan; D065128:Endothelin Receptor Antagonists / Q000627:therapeutic use; D005080:Exercise Test; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011653:Pulmonary Diffusing Capacity; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011658:Pulmonary Fibrosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000068677:Sildenafil Citrate / Q000627:therapeutic use; D013449:Sulfonamides / Q000627:therapeutic use; D000068581:Tadalafil / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014665:Vasodilator Agents / Q000627:therapeutic use; D014797:Vital Capacity
chemical_list: D065128:Endothelin Receptor Antagonists; D013449:Sulfonamides; D014665:Vasodilator Agents; D000068581:Tadalafil; D000068677:Sildenafil Citrate; D000077300:Bosentan
keywords: Chronic obstructive pulmonary disease; Computed tomography; Pulmonary hypertension; Pulmonary vasodilator