Abstract
Purpose: To evaluate the itnaging features on high-resolutiort computed tomograpby (HRCT) of tbe chest and the clinical paratneters that arc associated with pulmonary hypertension in systemic sclerosis. We specifically investigated whether main pulmonary artery (MPA) diatneter atid burden of lung fibrosis are predictors of pulmonary hypertension in these patients. Methods: We retrospectively retrieved tbe database information of patients witb systemic sclerosis seen at our hospital betweeti Jatiuary 2007 and Decetnber 2008. A total of 75 patients bad HRCT of tbe chest, pulmonary function testing (PFT), and ecbocardiograpby witbin 6 months of eacb other. Tbe ecbocardiograpby images were reviewed by a level-3 ecbocardiograpber, and 29 cases were excluded because of suboptimal evaluation of pulmonary artery (PA) pressure. Peak PA pressures and PFT of the remaining 46 cases (43 women and 3 tnen) were charted. The PFT included total lutig capacity (TLC), diffusion capacity of lung for carbon monooxide (DLCO) and the ratio of forced expiratory volume in one second and forced vital capacity (raVl/FVC). Tbe HRCT of tbe chest of each patient was read by a chest radiologist. Tbe extent of ground glass, reticulation, and honeycombing was objectively scored. Tbe maxinuitn diameter of the tnain pulmonary artery (MPAD) and ascending aorta were measured. The ratio of main pulmonary artery diameter and ascetiding aortic diameter (MPAD/AD) and ratio of tTiain pulmonary artery diameter and body surface area (MPAD/BSA) were also calculated. Results: Statistical analysis done by using a multivariate model showed that tbe calculated fibrotic score strongly correlated witb peak PA pressures {P < .001 ). MPAD {P = .0175), and the ratio MPAD/AD (P = .0102) also showed a statistically significant correlation with peak PA pressures. By using stepwise regression analysis, tbe fibrotic score was found to be tbe most reliable independent predictor of pulmonary hypertension. Conclusion: HRCT-determined severity and extent of pulmonary fibrosis may be helpful in screetiing for pulmonary hypertension in patients witb sy.stemic sclerosis.