Computer-aided diagnosis method for determining pulmonary hypertension severity

FIELD: medicine.

SUBSTANCE: method involves measuring main pulmonary artery diameter. Chest diameter is additionally measured at the level the examination is carried out. Vasculothoracic index VTI1 is calculated as ratio of transverse chest diameter at the level of the main pulmonary artery to main pulmonary artery diameter. VTI2 is also calculated as ratio of transverse chest diameter at the level of pulmonary artery bifurcation to main pulmonary artery diameter at given level. Mean VTI is calculated as (VTI1+ VTI2)/2. Mean VTI value being equal to 6.9-9.4, moderate pulmonary hypertension severity is considered to be the case. The value being less than 6.8, apparent pulmonary hypertension is considered to be the case.

EFFECT: high accuracy of diagnosis.

2 dwg

 

The invention relates to medicine, in particular to pulmonology and radiation diagnostics, can be used for early diagnosis of pulmonary hypertension.

Interstitial lung disease (IBL) is a heterogeneous group of disorders characterized by chronic diffuse lesions of the respiratory departments pulmonary interstice with inflammation (alveolitis) and fibrous disorganization of the walls of the alveoli and the development of respiratory failure. To the Ibla include more than 204 nosological forms.

Despite the polymorphism of clinical and morphological manifestations of the Ibla, universal morphological component in these diseases is fibrosing alveolitis, presents stereotypical changes in the alveolar walls and pulmonary interstice as alveolitis in the beginning of the disease and interstitial fibrosis with formation of cellular lung in the final.

Pulmonary arterial hypertension (LAS) at the Ibla is currently a problem, defining labor and life prognosis, as one third of patients IBL, according to the literature, registered the increase of pressure in the small circle of blood circulation. The average duration of life of patients after a diagnosis of signs of pulmonary hypertension is about five years.

Despite greater prognostic shall naimoli LAG when IBL, its early detection causes considerable difficulty due to the complexity of invasive and especifically separate instrumental diagnostic methods (direct methods of measuring blood pressure in the right departments of heart, repulsorcraft in terms of dosage increase intrabronchial pressure, kinetotherapy right ventricle), and insufficient information about the features of the pathogenesis and clinical picture LAG when IBL [Fascias, VA, V.F. Yakovlev, Kurds, M.K. and other Integrated assessment of circulation in patients with mitral stenosis complicated by moderate pulmonary hypertension // Cardiology. 1991.-T, No. 4. P.28-29]. Therefore, the recent trend towards the use of non-invasive and quite informative diagnostic techniques, primarily computed tomography and computerized angiography of the chest [Tyurin, I.E. Computed tomography of the chest cavity. // St. Petersburg, 2003. C52-57]can be considered justified.

Conventional radiological signs LAG can be attributed to the increase in the size of the right ventricle, enlargement of the pulmonary artery, the symptom of "amputation of roots" and "break the caliber of the vessels, surge roots [Vasilchuk I.V. Possible x-ray examinations in the detection of pulmonary vascular component drawing/Modern possibilities of x is ideological method in the diagnosis of diseases of the lungs L., 1983. C32-37], (detected mainly in x-rays). The radiological examination in the period of stable LAG is detected bulging conus pulmonalis, which is defined in the oblique position. There have been attempts to judge the severity of the LAG of the change in the lightness of the peripheral parts of the lungs [Vasilchuk I.V. Possible x-ray examinations in the detection of pulmonary vascular component /patterns/ Modern possibilities of x-ray method in the diagnosis of lung diseases. - L., 1983. C32-37], the diameter of the pulmonary artery with a deep breath and alone, taking into account the diameters of the arteries smaller caliber and veins 1 and 8 segments [Pogrebnyakov VY Possible objectification assessment of the pulmonary circulation by x-ray// Mechanisms of adaptation and prevention of prevalent diseases in the area of construction of BAM. - Chita, 1984. S-44].

However, all these methods are not widely used in practice due to the complexity and subjectivity of interpretation.

Important information about the condition of pulmonary blood flow in patients IBL was obtained by carrying out angiography: the expansion of the Central branches of the pulmonary artery and narrowing them on the periphery, the contours of their fuzzy, delayed arterial phase of blood flow. There are lots of fast arteriovenous the aqueous shunting with boosted contrast venous flow [Ilkovich MM Diseases of the respiratory system. // St. Petersburg, 1998. Volume # 2. S]. As a result of these changes increases the speed of blood flow in functioning capillaries of the lungs, especially in load conditions (when the increase in cardiac output). This reduces the area and contact time of erythrocytes with alveolar air.

The method of radial diagnostics of pulmonary hypertension has the following disadvantages:

1) invasiveness (catheterization of the subclavian artery);

2) high radiation load on the patient and surrounding personnel;

3) loss of diagnostic information in the result of summation of the overlay image soft tissue, bone structures,

4) the possibility of severe complications for the patient's life.

The most informative radiation method for diagnosing pulmonary hypertension lung disease is a CT scan.

Ng CS, Wells, Padley SP [A CT sing of chronic pulmonary arterial hypertesion the ratio of main pulmonary frtery to aortic diameter // J Thorac Imaging 1999 Oct. 14(4):270-8] when catheterization of the pulmonary artery was measured pressure in the main pulmonary artery. When computed tomography (CT) of the thorax measured the diameter of the main pulmonary artery. When the study was conducted correlation of pressure in the pulmonary artery with age-related changes: patients older than 50 years, the pressure in the pulmonary artery at what was iniciales along with the expansion of its diameter (specificity 70%, p<0.0005).

But not always increase the diameter of the pulmonary artery corresponds to a pressure increase in the pulmonary artery. In persons with hypertensionin physique, athletes, age peculiarities of the increase in the diameter of the pulmonary artery may be at a normal pressure. In addition, catheterization is associated with a risk of complications: cardiac arrhythmias, thrombosis of peripheral veins, development of infective endocarditis. And you must have a special operating room, equipped with x-ray apparatus, surgical instruments, specially trained qualified personnel.

Therefore, the objective of the invention is to develop a more accurate and simple method of assessing the degree of pulmonary hypertension, while computed tomography (CT) of the chest, do not pose a threat to the life of the patient.

To assess the degree of pulmonary hypertension was used echocardiographic classification of degrees LAG, based on the average pressure in a pulmonary artery, a specific method Kitabatake, 1983 [Mitkov CENTURIES Clinical guidelines for ultrasonic diagnosis, T5. S] [Ultrasound diagnosis in cardiology. Methodical manual. International centre for copyright medical technologies. Moscow. 1992].

Emit trace the matter of degree on the average pressure in the pulmonary artery (RLA):

Norma9-18 mm Hg
Easy (moderate)19-40 mm Hg
Pronouncedmore than 40 mm Hg

In the process of developing this study was performed chest CT scan and CT angiography computed tomography "Hi Speed Siti/I" spiral mathematics of the company "General electric"H "Aquilion" Toshiba. During a spiral scan received 10 slices per breath.

Were observed following physical-technical conditions.

For spiral scanning:

- voltage 140 kV,

- exposition - 300 mAs,

speed -10 mm/s

Further images of the lungs were reconstructed using enhancing filter and detailed algorithm retrospective reconstruction without changing its parameters.

Contrast enhancement of the vascular bed received intravenous molluscom introduction omnipack 370 100 ml.

The proposed vascular-thoracic index is an indicator of the true expansion of the pulmonary artery that does not depend on the Constitution of the patient and correlated with age.

Vascular-thoracic index (STI), respectively, equal to the ratio of the lateral dimension of the thoracic cavity between the costal players (D1 or D2) at the level of issledovanij the diameter of the main pulmonary artery (DLA) and at the level of its bifurcation (DLA) (1, 2)

STI=D1/DLA STI=D2/DLA

The task was carried out by measurement:

1) the diameter of the main pulmonary artery (DLA);

2) the diameter at the point of dividing it into right and left branches (DLA),

3) the transverse diameter of the thorax at the level of research between the inner surfaces of the costal of players (D1 and D2).

When computer angiography corresponding measurements were carried out in 43 patients with interstitial lung disease and spiral CT of the chest in 237 patients. The difference between the diameter of the main pulmonary artery on computer angiography and spiral CT of the chest is 0.7±0.15 mm, This allows you to judge fairly high precision measurements of parameters at spiral CT of the thorax.

The difference between STI and STI was equal to 1.3±1.05. Therefore, we proposed the calculation of the average STI, which equals the sum of STI/2+STI/2.

STI=STI/2+STI/2

In our studies, 57 patients with interstitial lung disease was defined by a mean pulmonary artery pressure (RLA) when ECHOCARDIOGRAPHY is the study on the apparatus Ultramark-9 (ATL USA) and Acuson/Sequoia" (USA) using sector electronic sensor with frequency ultrasound 3-3,5 MHz and trancedevotee sensor.

But not all patients can measure the pulmonary artery pressure using ECHOCARDIOGRAPHY, using the receiving trancedevotee sensor. Debilitated patients, patients with systemic connective tissue diseases, varicose expanded veins of an esophagus, with increased gag reflex and other diseases introduction trancedevotee sensor is not possible, involve great difficulties, dangers of rupture of the esophagus and massive bleeding, and other complications. Therefore, the use of computed tomography of the chest to assess the degree of pulmonary hypertension is the only diagnostic method.

When the correlation of the average vascular-thoracic index (STI) and the average pressure in the pulmonary artery (RLA) found a direct correlation between increased average pressure in a pulmonary artery and a decrease in the average vascular-thoracic index.

Produced average STI (11.41) in patients not suffering from pulmonary diseases. In the age-related changes is the deviation of 1.9±2.2.

So, we established that in patients with moderate (mild) degree of pulmonary hypertension STI=6,9-9,4 in severe degree of pulmonary hypertension TIS less 6,8.

Clinical example 1.

Patient W., 43 years. For twelve years increased shortness of breath during physical activity, unproductive cough, occasionally appearing horacka. Treatment with antibacterial drugs - without effect. The patient's condition at admission satisfactory. On examination, the skin and mucous membranes pale, pastos face, redness of the nail ridges, striated nails, the formation of the "hour glass". In the lungs in the lower divisions to listen to moist rales, crepitation on both sides. When conducting open transthoracic lung biopsy revealed ELISA, desquamative option.

Review radiographs (WG) of the chest in light amid increased pulmonary pattern was revealed reduction of pneumatization lung tissue due to the focal-like infiltrative shadows medium intensity, sometimes merging with each other with the formation of larger conglomerates, located mostly in the middle and lower sections of subpleural. On the background of the infiltration of the lung tissue in the lower aperture and the roots of the lungs are poorly differentiated.

In computer tomography, high-resolution (CTVR) chest: increased pulmonary pattern, mainly due to interstitial component, reducing pneumatization due to alveolar edema (a symptom of "frosted glass"). In all departments the signs vnutridolkovom emphysema. The lymph nodes are not enlarged.

The morphological examination of biopsy material with open thoracic biopsy to define what is significant lymphoid infiltration millionary partitions and alveoli.

When conducting measurements with computed tomography diameter of the main pulmonary artery (DLA) was equal to 26.8 mm, the diameter of the thoracic cavity at the study level (D1) is equal to 231.2 mm When calculating vascular-thoracic index (CTI) was received value: 8.6.

When measuring pulmonary artery at the level of bifurcation (DLA) was equal to 27.5 mm, the diameter of the thoracic cavity at the study level (D2) is equal to 243.2 mm When calculating vascular-thoracic index (CTI) were obtained value: 8.8.

The average STI=(STY+STI):2=(8.8+8.6):2=8.7.

When measuring the average pressure in the pulmonary artery when ECHOCARDIOGRAPHY RLA=28 mm Hg, which corresponds to moderate pulmonary hypertension.

Thus, on the basis of the calculation of the STI was given conclusion about moderate degree of pulmonary hypertension.

Further pathogenetic therapy has confirmed this conclusion.

Clinical example 2.

Patient T., aged 35. The patient considers himself within 2 years, when I first became concerned about the numbness, the whitening of the fingers of the hands. Later joined myalgia, morning stiffness, dry cough, fever. In the blood: L 13800, ESR-32 mm/h Suspected chlamydia, which subsequently rejected. Further appeared periods of fever up to subfebrile figures, cough, dyspnea on exertion, asphyxiation in nocny the watch. X-ray picture of lung deformation pattern due to interstitial component was the indication for performing a thoracoscopic lung biopsy. Morphological picture of idiopathic fibrosing alveolitis.

When analyzing the WG chest saw an increase in pulmonary pattern and mesh deformation his distinctly traced, and on the periphery of the lung, discoid atelectasis. Roots mesostructure, pulmonary artery in the roots extended. Expressed signs subpleural reactions and different type bulkhead line curly. The volume of the lower lobes reduced. The transparency of the lung tissue in the upper sections is increased. Aperture is located on both sides at the level of the anterior segment of the 6th rib. Waist heart smoothed through the left atrial appendage.

On CTVR chest marked irregular thickening millionary and bilobular partitions (picture of the "catchatori"), changing the relative location of the vessels and bronchi in relation to the surrounding lung parenchyma, mainly in subpleural areas and basal regions of the lung, peribronchiolar and peribronchiolar infiltration, areas of interstitial fibrosis, discoid atelectasis, line curly.

The morphological examination of lung biopsy, obtained by open biopsy of the right lung, detecting the received interstitial fibrosis with phenomena expressed obstructive bronchiolitis (option ELISA).

When conducting measurements with computed tomography diameter of the main pulmonary artery (DLA) was equal 30,4 mm, the diameter of the thoracic cavity at the study level (D1) is equal to 200,7 mm When calculating vascular-thoracic index (CTI) it was obtained a value of 6.6.

When measuring pulmonary artery at the level of bifurcation (DLA) was equal to 31.8 mm, the diameter of the thoracic cavity at the study level (D2) is equal 216.6 mm When calculating vascular-thoracic index (CTI) was received value: 6,6.

The average STI=(ST1+STI):2=(6.9+6.7):2=6.8.

When measuring the average pressure in the pulmonary artery when ECHOCARDIOGRAPHY RLA=41 mm Hg, which corresponds to severe degree of pulmonary hypertension.

So, on the basis of the calculation of the STI was given conclusion about severe degree of pulmonary hypertension.

Thus, the present invention allows for more accurate and easy to identify early indicators of the degree of pulmonary hyperdensity in a small circle of blood circulation during the computed tomography of the chest. Indicators of change in vascular-thoracic index by measuring the diameters of the thorax and of the diameter of the main pulmonary artery (trunk or bifurcation) allows to speak about patients of the early signs of pulmonary hypertension. This facilitates timely policy making and holding l the treatment of pulmonary hypertension. The invention is of great diagnostic value, is non-invasive diagnostic method for avoiding threatening complications for the patients with invasive methods, conducts early diagnosis of pulmonary hypertension.

The method of computer diagnostics of the degree of pulmonary hypertension, including the measurement of the diameter of the main pulmonary artery, characterized in that it further measure the diameter of the thorax at the level of research, calculate vascular-thoracic index (CTI) is equal to the ratio of the transverse diameter of the thorax at the level of the main pulmonary artery to the diameter of the main pulmonary artery and STI, equal to the ratio of the transverse diameter of the thorax at the level of bifurcation of the pulmonary artery to the diameter of the pulmonary artery at this level, and then calculate the average STI, which equals the sum of STI/2+STI/2, and when the average STI 6,9-9,4 diagnose moderate the degree of pulmonary hypertension, and when the value is less 6,8 - pronounced degree of pulmonary hypertension.



 

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