[Value of spiral computed tomography in pulmonary hypertension]

Pulmonary hypertension (PH) represents an important diagnostic problem, because of its non-specific clinical presentation.

Estimation of sensitivity and specificity of spiral computed tomography (SCT) in diagnosis of PH. Estimation of the influence of the cause and character of PH on morphology of pulmonary arteries and right ventricle-pulmonary artery coupling.

102 patients with clinical suspicion of acute pulmonary embolism (APE) or chronic PH (54F, av. age 51.3 +/- 17.3). Diameters of pulmonary arteries obtained in SCT, systolic pulmonary pressure calculated from the tricuspid gradient pressure, and indices of the right ventricle-pulmonary artery dynamical coupling (AcT) obtained from the echo-Doppler method were compared.

Increased diameter (> 18 mm) of interlobar arteries was the most specific sign of PH (specificity 92%, sensitivity 45%). Diameter of proximal pulmonary arteries and pulmonary pressure was correlated in patients with APE (r = 0.487, p < 0.003), but not in those with chronic PH (r = 0.223). In a group of patients with pulmonary arterial hypertension (PAH), enlargement of proximal pulmonary arteries seemed to result in less disturbed right ventricle-pulmonary artery dynamic coupling.

1. SCT measurements of diameters of pulmonary arteries have relatively low sensitivity for PH, precluding its reliable exclusion. 2. The relationship between the pulmonary pressure and the diameters of pulmonary arteries was found in acute but not in chronic PH, in which right ventricle-pulmonary artery dynamical coupling seemed less disturbed when pulmonary arteries were markedly dilated.