The value of multi-parameter chest CT in assessing prognosis in CTD-PAH

ZHANG Chunfang; LIU Wangyan; XU Yi; SUN Xiaoxuan; WANG Qiang; ZHU Yinsu

doi:10.20258/j.cnki.1006-9011.2025.01.013

Abstract：Objective To investigate the value of the prognostic value of CT pulmonary vascular parameters,interstitial lung disease,and pericardial effusion in predicting the prognosis of connective tissue disease-associated pulmonary arterial hyperten-sion(CTD-PAH).Methods The clinical and computed tomography(CT)data of 158 CTD-PAH patients were analyzed retro-spectively.All CT parameters,including main pulmonary artery diameter(MPAd),ascending aorta diameter(AAOd),descend-ing aorta diameter(DAOd),right pulmonary artery diameter(RPAd),left pulmonary artery diameter(LPAd),MPAd/AAOd and MPAd/DAOd ratios,interstitial lung disease(ILD)scores,pericardial effusion,were calculated.All-cause death events were followed up.COX risk prediction model was used to search for predictors of poor prognosis.Results MPA diameter,inter-stitial lung disease score and pericardial effusion were independent predictors of all-cause mortality in CTD-PAH patients.The 5-year survival rate of patients with MPAd>37.70mm(P<0.001)was lower than that of MPAd≤37.70mm,and the 5-year survival rate of patients with interstitial lung disease score≥2(P<0.001)was lower than that of patients with interstitial lung disease score≤1points.The mortality risk of patients with pericardial effusion was nearly 3 times higher than that of patients without pericardial effusion.Patients with MPAd>37.70mm combined with interstitial lung disease score≥2 had worse prognosis(P<0.0001).Conclusions Multi-slice spiral CT parameters,MPAd,ILD scores and pericardial effusion,are high risk factors for evaluating poor prognosis in patients with connective tissue disease-associated pulmonary arterial hypertension and the combination of main pulmonary artery diameter(MPAd)and interstitial lung disease score predicts higher risk of death.