Chest
Volume 132, Issue 3, September 2007, Pages 773-779
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ORIGINAL RESEARCH
PULMONARY HYPERTENSION
High-Resolution Chest CT Findings Do Not Predict the Presence of Pulmonary Hypertension in Advanced Idiopathic Pulmonary Fibrosis

https://doi.org/10.1378/chest.07-0116Get rights and content

Background

Reliable, noninvasive approaches to the diagnosis of pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF) are needed. We tested the hypothesis that chest CT-determined extent of pulmonary fibrosis and/or main pulmonary artery diameter (MPAD) can be used to identify the presence of PH in patients with advanced IPF.

Methods

Cross-sectional study of 65 patients with advanced IPF and available right-heart catheterization and high-resolution chest CT. An expert radiologist scored ground-glass opacity, lung fibrosis, and honeycombing in the CT images on a scale of 0 to 4. These scores were also summed into a total profusion score. The main pulmonary artery was measured at its widest dimension on the supine full-chest sequence. At this same level, the widest aorta diameter was measured.

Results

Chest CT-determined fibrosis score, ground-glass opacity score, honeycombing score, total profusion score, diameter of the main pulmonary artery, and the ratio of the pulmonary artery to aorta diameter did not differ between those with and without PH. There was no significant correlation between mean pulmonary artery pressure and any of the chest CT-determined measures.

Conclusions

High-resolution chest CT-determined extent of pulmonary fibrosis and/or MPAD cannot be used to screen for PH in advanced IPF patients.

Section snippets

Study Sample

We retrospectively reviewed the medical records of all patients with IPF who were seen at our institution between July 1999 and June 2006. During the initial visit, all patients prospectively provided written informed consent (approved by the University of California, Los Angeles institutional review board) to use their clinical and demographic information for research purposes. All patients met accepted diagnostic criteria for IPF, and the majority (74%) had histopathologic evidence of usual

Results

The study sample (n = 65) had more advanced pulmonary disease (with lower FVC, diffusing capacity of the lung for carbon monoxide [Dlco], and room air Spo2) than the rest of the cohort (n = 257) but was representative of the cohort with respect to age, gender, and race (Table 1). MPAP in the study sample was similar to the MPAP in the 56 patients with RHC data who were excluded from the study because their RHC was > 1 month distant from their HRCT.

Discussion

PH is common in patients with advanced IPF, and its presence has a significant adverse impact on survival.23 Noninvasive approaches to the diagnosis of PH in patients with IPF are needed. In this study, we found that the CT-determined extent and severity of pulmonary fibrosis and MPAD do not help in identifying PH in advanced IPF patients.

Intuitively, the severity of lung fibrosis should correlate with the prevalence and degree of PH. It seems logical that as IPF progresses and the lungs become

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    All work was performed at the David Geffen School of Medicine.

    Dr. Zisman received research grants from Actelion Pharmaceuticals and Cotherix Pharmaceuticals to do multicenter studies. Dr. Zisman is funded by the National Institutes of Health IPF Clinical Research Network, which includes participation in a pulmonary hypertension study with sildenafil.

    This work was supported, in part, by grants from the National Institutes of Health: 5U10HL080411 and 5P50HL67665 to Dr. Zisman, HL080206 and HL086491 to Dr. Belperio, and AR055075 to Dr. Keane.

    The authors have no other conflicts of interest to disclose.

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