Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2016 Jul 6;11(7):e0158637.
doi: 10.1371/journal.pone.0158637. eCollection 2016.

CT Scan Does Not Differentiate Patients With Hepatopulmonary Syndrome From Other Patients With Liver Disease

Affiliations
Free PMC article
Multicenter Study

CT Scan Does Not Differentiate Patients With Hepatopulmonary Syndrome From Other Patients With Liver Disease

Yingming Amy Chen et al. PLoS One. .
Free PMC article

Abstract

Background: Hepatopulmonary syndrome (HPS) is defined by liver dysfunction, intrapulmonary vascular dilatations, and impaired oxygenation. The gold standard for detection of intrapulmonary vascular dilatations in HPS is contrast echocardiography. However, two small studies have suggested that patients with HPS have larger segmental pulmonary arterial diameters than both normal subjects and normoxemic subjects with cirrhosis, when measured by CT. We sought to compare CT imaging-based pulmonary vasodilatation in patients with HPS, patients with liver dysfunction without HPS, and matching controls on CT imaging.

Methods: We performed a retrospective cohort study at two quaternary care Canadian HPS centers. We analyzed CT thorax scans in 23 patients with HPS, 29 patients with liver dysfunction without HPS, and 52 gender- and age-matched controls. We measured the artery-bronchus ratios (ABRs) in upper and lower lung zones, calculated the "delta ABR" by subtracting the upper from the lower ABR, compared these measurements between groups, and correlated them with clinically relevant parameters (partial pressure of arterial oxygen, alveolar-arterial oxygen gradient, macroaggregated albumin shunt fraction, and diffusion capacity). We repeated measurements in patients with post-transplant CTs.

Results: Patients had significantly larger lower zone ABRs and delta ABRs than controls (1.20 +/- 0.19 versus 0.98 +/- 0.10, p<0.01; and 0.12 +/- 0.17 versus -0.06 +/- 0.10, p<0.01, respectively). However, there were no significant differences between liver disease patients with and without HPS, nor any significant correlations between CT measurements and clinically relevant parameters. There were no significant changes in ABRs after liver transplantation (14 patients).

Conclusions: Basilar segmental artery-bronchus ratios are larger in patients with liver disease than in normal controls, but this vasodilatation is no more severe in patients with HPS. CT does not distinguish patients with HPS from those with uncomplicated liver disease.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. CT scans from a control subject demonstrating bronchovascular measurements.
Axial images demonstrate measurements of the main pulmonary artery (A), the right pulmonary artery (B), and the left pulmonary artery (C). Coronal image from the same subject demonstrates location of the upper and lower zones for bronchovascular measurements (brackets) (D).
Fig 2
Fig 2. Axial CT images of the right upper zone in a patient with hepatopulmonary syndrome (A), subclinical hepatopulmonary syndrome (B), liver dysfunction only (C), and control subject (D) with representative artery and accompanying bronchus highlighted (brackets).
Fig 3
Fig 3. Axial CT images of the right lower zone in a patient with hepatopulmonary syndrome (A), subclinical hepatopulmonary syndrome (B), liver dysfunction only (C), and control subject (D) with representative artery and accompanying bronchus highlighted (brackets).

Similar articles

See all similar articles

Cited by 3 articles

References

    1. Fritz JS, Fallon MB, Kawut SM. Pulmonary Vascular Complications of Liver Disease. Am J Respir Crit Care Med. 2013;187: 133–143. 10.1164/rccm.201209-1583CI - DOI - PMC - PubMed
    1. Fallon MB, Krowka MJ, Brown RS, Trotter JF, Zacks S, Roberts KE, et al. Impact of hepatopulmonary syndrome on quality of life and survival in liver transplant candidates. Gastroenterology. 2008;135: 1168–1175. 10.1053/j.gastro.2008.06.038 - DOI - PMC - PubMed
    1. Rodríguez-Roisin R, Agustí AG, Roca J. The hepatopulmonary syndrome: new name, old complexities. Thorax. 1992;47: 897–902. - PMC - PubMed
    1. McAdams HP, Erasmus J, Crockett R, Mitchell J, Godwin JD, McDermott VG. The hepatopulmonary syndrome: radiologic findings in 10 patients. AJR Am J Roentgenol. 1996;166: 1379–1385. 10.2214/ajr.166.6.8633451 - DOI - PubMed
    1. Köksal D, Kaçar S, Köksal AS, Tüfekçioğlu O, Küçükay 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. - PubMed

Publication types

Grant support

Dr. Gupta is supported by the Department of Medicine of the University of Toronto, The Li Ka Shing Research Institute of St. Michael's Hospital, and the Michael Locke Chair in Rare Lung Disease and Knowledge Translation Research.
Feedback