CT Scan Does Not Differentiate Patients with Hepatopulmonary Syndrome from Other Patients with Liver Disease

• Published in: PloS one Vol. 11; no. 7; p. e0158637
• Main Authors: Chen, Yingming Amy, Prabhudesai, Vikramaditya, Castel, Helene, Gupta, Samir
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 06.07.2016; Public Library of Science (PLoS)
• Subjects: Adult; Aged; Alveoli; Asthma; Biology and Life Sciences; Blood pressure; Bronchi - diagnostic imaging; Bronchi - physiopathology; Bronchus; Canada; Care and treatment; CAT scans; Chronic obstructive pulmonary disease; Cirrhosis; Computed tomography; Correlation analysis; Diagnosis; Diagnosis, Differential; Disease control; Echocardiography; Hepatopulmonary Syndrome - diagnosis; Hepatopulmonary Syndrome - diagnostic imaging; Hospitals; Humans; Hypertension; Liver; Liver cancer; Liver cirrhosis; Liver diseases; Liver Diseases - diagnosis; Liver Diseases - diagnostic imaging; Liver Transplantation; Liver transplants; Lung - diagnostic imaging; Lung - physiopathology; Lung diseases; Lungs; Medical imaging; Medicine and Health Sciences; Middle Aged; Nitric oxide; Oxygen; Oxygenation; Parameters; Partial pressure; Patients; Pulmonary arteries; Quaternary; Reproducibility of Results; Research and Analysis Methods; Retrospective Studies; Sensitivity and Specificity; Thorax; Tomography, X-Ray Computed - methods; Transplantation; Transplants & implants; Vasodilation; Veins & arteries; Canada; Montreal Quebec Canada
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0158637

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. 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. 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). 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.