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Hepatopulmonary syndrome has low prevalence of pulmonary vascular abnormalities on chest computed tomography


Autoři: Luciano Folador aff001;  Felipe S. Torres aff003;  Juliana F. Zampieri aff002;  Betina C. Machado aff001;  Marli M. Knorst aff001;  Marcelo B. Gazzana aff001
Působiště autorů: Programa de Pós-Graduação em Ciências Pneumológicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil aff001;  Serviço de Radiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil aff002;  Department of Medical Imaging, University of Toronto, Toronto, ON, Canada aff003;  Serviço de Pneumologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223805

Souhrn

Purpose

Hepatopulmonary syndrome (HPS) is defined as an arterial oxygenation defect induced by intrapulmonary vascular dilatations associated with hepatic disease. This study aimed to assess the prevalence of type 1 and 2 pulmonary vascular abnormalities on chest computed tomography (CT) in patients with cirrhosis and HPS and to characterize intra- and interobserver reliability.

Materials and methods

Two thoracic radiologists retrospectively evaluated chest CT scans from 38 cirrhosis patients with HPS. They classified the pulmonary vascular abnormalities as type 1 (multiple dilated distal pulmonary arteries), type 2(nodular dilatation or individual pulmonary arterial malformation), or absence of abnormality. Furthermore, they measured the diameters of the central pulmonary arteries and subsegmental pulmonary arteries and bronchi. We analyzed the prevalence, intraobserver reliability, and interobserver reliability of abnormal CT findings related to HPS, and the correlation of these findings with partial arterial oxygen pressure (PaO2).

Results

The overall prevalence of pulmonary vascular abnormalities was 28.9% (95% confidence intervals: 15.4%, 45.9%). Moreover, 26.3% of patients had type 1 abnormality (13.4%, 43.1%) and 2.6% of patients had type 2 abnormality (0.0%, 13.8%). The intraobserver reliability kappa value was 0.666 (0.40, 0.91) and the interobserver kappa value was 0.443 (0.12, 0.77). There was no correlation between pulmonary vascular abnormalities on CT and PaO2 values.

Conclusions

The prevalence of pulmonary vascular abnormalities on chest CT of patients with cirrhosis and HPS is low and not correlated with PaO2. These findings question the usefulness of chest CT for the evaluation of patients with cirrhosis and HPS.

Klíčová slova:

Arteries – Blood – Cirrhosis – Computed axial tomography – Oxygen – Pulmonary arteries – Hantavirus pulmonary syndrome – Bronchi


Zdroje

1. Rodriguez-Roisin R, Krowka MJ, Hervé P, Fallon MB. Pulmonary–Hepatic vascular Disorders (PHD). Eur Respir J 2004;24:861–880. doi: 10.1183/09031936.04.00010904 15516683

2. Grilo-Bensusan I, Pascasio-Acevedo JM. Hepatopulmonary syndrome: What we know and what we would like to know. World J Gastroenterol 2016;22:5728–5741. doi: 10.3748/wjg.v22.i25.5728 27433086

3. Schenk P, Fuhrmann V, Madl C, Schenk, Fuhrmann P, Madl V, et al. Hepatopulmonary syndrome: prevalence and predictive value of various cut offs for arterial oxygenation and their clinical consequences. Gut 2002;51:853–859. doi: 10.1136/gut.51.6.853 12427789

4. Lima BL, França AV, Pazin-Filho A, França AVC, Maciel A, Araújo WM, Martinez JAB, et al. Frequency, clinical characteristics, and respiratory parameters of hepatopulmonary syndrome. Mayo Clin Proc 2004;79:42–48. doi: 10.4065/79.1.42 14708947

5. Soulaidopoulos S, Cholongitas E, Giannakoulas G, Vlachoun M, Goulis I. Review article: Update on current and emergent data on hepatopulmonary syndrome. World J Gastroenterol 2018;24:1285–1298. doi: 10.3748/wjg.v24.i12.1285 29599604

6. Schenk P, Schöniger-Hekele M, Fuhrmann V, Madl C, Silberhumer G, Müller C. Prognostic significance of the hepatopulmonary syndrome in patients with cirrhosis. Gastroenterology 2003;125:1042–1052. doi: 10.1016/s0016-5085(03)01207-1 14517788

7. Mcadams HP, Erasmus J, Crockett R, Mcdermott G. The hepatopulmonary syndrome: Radiologic findings in 10 patients. AJR Am J Roentgenol 1996;166:1379–1385. doi: 10.2214/ajr.166.6.8633451 8633451

8. Köksal D, Kaçar S, Köksal AS, Tufekçiglu O, Kuçuakay F, Okten S, et al. Evaluation of intrapulmonary vascular dilatations with high-resolution computed thorax tomography in patients with hepatopulmonary syndrome. J Clin Gastroenterol 2006;40:77–83. doi: 10.1097/01.mcg.0000190775.57903.86 16340638

9. Lee K, Lee HJ, Shin WW, Webb WR. Hypoxemia and liver cirrhosis (hepatopulmonary syndrome) in eight patients: Comparison of the central and peripheral pulmonary vasculature. Radiology 1999;211:549–553. doi: 10.1148/radiology.211.2.r99ma46549 10228541

10. Chen YA, Prabhudesai V, Castel H, Gupta S. CT scan does not differentiate patients with hepatopulmonary syndrome from other patients with liver disease. PLoS One 2016;11:1–10.

11. Aluja Jaramillo F, Gutierrez FR, Diaz Telli FG, Aravena SY, Javidan-Nejad C, Bhalla S. Approach to pulmonary hypertension: From CT to clinical diagnosis. Radiographics 2018;38:357–373. doi: 10.1148/rg.2018170046 29432063

12. Kim YK, Kim Y, Shim SS. Thoracic complications of liver cirrhosis. Radiographics 2009;29:825–837. doi: 10.1148/rg.293085093 19448118

13. Krowka MJ, Dickson ER, Cortese DA. Hepatopulmonary syndrome. Clinical observations and lack of therapeutic response to somatostatin analogue. Chest 1993;104:515–521. doi: 10.1378/chest.104.2.515 8101797

14. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159–174. 843571

15. Schraufnagel DE, Kay JM. Structural and pathologic changes in the lung vasculature in chronic liver disease. Clin Chest Med 1996;17:1–15. 8665783

16. Murata K, Itoh H, Todo G, Kanaoka M, Noma S, Itoh T, et al. Centrilobular lesions of the lung: Demonstration by high-resolution CT and pathologic correlation. Radiology 1986;161:641–645. doi: 10.1148/radiology.161.3.3786710 3786710

17. Kim SJ, Im JG, Kim IO, Cho ST, Cha SH, Park KS, et al. Normal bronchial and pulmonary arterial diameters measured by thin section CT. J Comput Assist Tomogr 1995;19:365–369. doi: 10.1097/00004728-199505000-00005 7790543

18. McErlean A, Panicek DM, Zabor EC, Moskowitz CS, Bitar R, Motzer RJ, et al. Intra and interobserver variability in CT measurements in oncology. Radiology 2013;269:451–459. doi: 10.1148/radiol.13122665 23824993

19. Beigelman-Aubry C, Brillet PY, Grenier PA. MDC T of the airways: Technique and normal results. Radiol Clin North Am 2009;47:185–201. doi: 10.1016/j.rcl.2009.01.001 19249451

20. Perez-Rovira A, Kuo W, Petersen J, Tiddens HAWM, Bruijne M. Automatic airway–artery analysis on lung CT to quantify airway wall thickening and bronchiectasis. Med Phys 2016;43:5736–5744. doi: 10.1118/1.4963214 27782697


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