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Pulmonary Arterial Hypertension: Thin-Section CT Predictors of Epoprostenol Therapy Failure¹

¹ From the Departments of Radiology (A.R., S.M., D.M.), Pneumology and Respiratory Intensive Care (M.H., O.S., G.S.) and Pathologic Anatomy (F.C.), Hôpital Antoine Béclère, 157 rue de la Porte de Trivaux, 92140 Clamart, France. From the 2000 RSNA scientific assembly. Received March 26, 2001; revision requested April 30; revision received July 19; accepted October 22. Address correspondence to A.R. (e-mail: arnaud.resten@abc.ap-hop-paris.fr).

PURPOSE: To correlate pretherapeutic thin-section computed tomographic (CT) findings in patients with pulmonary hypertension with the risk of fatality with treatment with epoprostenol.

MATERIALS AND METHODS: Seventy-three consecutive patients with severe pulmonary hypertension treated with epoprostenol were retrospectively separated into two groups. The first group included 12 patients who had a fatal outcome with epoprostenol therapy. The second group (n = 61) was a reference group of patients with epoprostenol-induced clinical improvement. Pretherapeutic thin-section CT scans of each patient were reviewed.

RESULTS: Poorly defined nodular opacities (P = .003), septal lines (P = .04), pleural effusion (P = .01), and adenopathy (P = .009) strongly correlated with a risk of clinical worsening with treatment. In six patients in group 1, postmortem examination of the lung revealed either pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis.

CONCLUSION: On pretherapeutic thin-section CT scans, poorly defined nodular opacities, septal lines, pleural effusion, and adenopathy should raise suspicion for pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis and provoke possible further evaluation before epoprostenol therapy.

© RSNA, 2002

Index terms: Hypertension, pulmonary, 56.78 • Lung, CT, 68.12118 • Lung, vascular disease, 56.788

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