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Synn AJ, Margerie-Mellon C, Jeong SY, et al. Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography. Pulm Circ. 2021;11(4):20458940211061284doi: 10.1177/20458940211061284.
Synn, A. J., Margerie-Mellon, C., Jeong, S. Y., Rahaghi, F. N., Jhun, I., Washko, G. R., Estépar, R. S. J., Bankier, A. A., Mittleman, M. A., VanderLaan, P. A., & Rice, M. B. (2021). Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography. Pulmonary circulation, 11(4), 20458940211061284. https://doi.org/10.1177/20458940211061284
Synn, Andrew J, et al. "Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography." Pulmonary circulation vol. 11,4 (2021): 20458940211061284. doi: https://doi.org/10.1177/20458940211061284
Synn AJ, Margerie-Mellon C, Jeong SY, Rahaghi FN, Jhun I, Washko GR, Estépar RSJ, Bankier AA, Mittleman MA, VanderLaan PA, Rice MB. Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography. Pulm Circ. 2021 Nov 29;11(4):20458940211061284. doi: 10.1177/20458940211061284. eCollection 2021. PMID: 34881020; PMCID: PMC8647266.
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Pulm Circ. 2021 Nov 29;11(4):20458940211061284. doi: 10.1177/20458940211061284. eCollection 2021.

Vascular remodeling of the small pulmonary arteries and measures of vascular pruning on computed tomography.

Pulmonary circulation

Andrew J Synn, Constance De Margerie-Mellon, Sun Young Jeong, Farbod N Rahaghi, Iny Jhun, George R Washko, Raúl San José Estépar, Alexander A Bankier, Murray A Mittleman, Paul A VanderLaan, Mary B Rice

Affiliations

  1. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
  2. Radiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Louis, Paris, France.
  3. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
  4. Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  5. Department of Pathology, Stanford University, Stanford, CA, USA.
  6. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
  7. Department of Radiology, University of Massachusetts Medical School, Worchester, MA, USA.
  8. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
  9. Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

PMID: 34881020 PMCID: PMC8647266 DOI: 10.1177/20458940211061284

Abstract

Pulmonary hypertension is characterized histologically by intimal and medial thickening in the small pulmonary arteries, eventually resulting in vascular "pruning." Computed tomography (CT)-based quantification of pruning is associated with clinical measures of pulmonary hypertension, but it is not established whether CT-based pruning correlates with histologic arterial remodeling. Our sample consisted of 138 patients who underwent resection for early-stage lung adenocarcinoma. From histologic sections, we identified small pulmonary arteries and measured the relative area comprising the intima and media (VWA%), with higher VWA% representing greater histologic remodeling. From pre-operative CTs, we used image analysis algorithms to calculate the small vessel volume fraction (BV5/TBV) as a CT-based indicator of pruning (lower BV5/TBV represents greater pruning). We investigated relationships of CT pruning and histologic remodeling using Pearson correlation, simple linear regression, and multivariable regression with adjustment for age, sex, height, weight, smoking status, and total pack-years. We also tested for effect modification by sex and smoking status. In primary models, more severe CT pruning was associated with greater histologic remodeling. The Pearson correlation coefficient between BV5/TBV and VWA% was -0.41, and in linear regression models, VWA% was 3.13% higher (95% CI: 1.95-4.31%, p < 0.0001) per standard deviation lower BV5/TBV. This association persisted after multivariable adjustment. We found no evidence that these relationships differed by sex or smoking status. Among individuals who underwent resection for lung adenocarcinoma, more severe CT-based vascular pruning was associated with greater histologic arterial remodeling. These findings suggest CT imaging may be a non-invasive indicator of pulmonary vascular pathology.

© The Author(s) 2021.

Keywords: histology; image analysis; vasculopathy

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