Abstract
Hepatopulmonary syndrome (HPS) is defined as an arterial oxygenation defect induced by intrapulmonary vascular dilatations associated with hepatic disease. This study aimed to assess the prevalence of type 1 and 2 pulmonary vascular abnormalities on chest computed tomography (CT) in patients with cirrhosis and HPS and to characterize intra- and interobserver reliability. Two thoracic radiologists retrospectively evaluated chest CT scans from 38 cirrhosis patients with HPS. They classified the pulmonary vascular abnormalities as type 1 (multiple dilated distal pulmonary arteries), type 2(nodular dilatation or individual pulmonary arterial malformation), or absence of abnormality. Furthermore, they measured the diameters of the central pulmonary arteries and subsegmental pulmonary arteries and bronchi. We analyzed the prevalence, intraobserver reliability, and interobserver reliability of abnormal CT findings related to HPS, and the correlation of these findings with partial arterial oxygen pressure (PaO2). The overall prevalence of pulmonary vascular abnormalities was 28.9% (95% confidence intervals: 15.4%, 45.9%). Moreover, 26.3% of patients had type 1 abnormality (13.4%, 43.1%) and 2.6% of patients had type 2 abnormality (0.0%, 13.8%). The intraobserver reliability kappa value was 0.666 (0.40, 0.91) and the interobserver kappa value was 0.443 (0.12, 0.77). There was no correlation between pulmonary vascular abnormalities on CT and PaO2 values. The prevalence of pulmonary vascular abnormalities on chest CT of patients with cirrhosis and HPS is low and not correlated with PaO2. These findings question the usefulness of chest CT for the evaluation of patients with cirrhosis and HPS.
Highlights
Hepatopulmonary syndrome (HPS) affects 3–47% of patients with terminal liver disease depending on the diagnostic criteria [1,2,3,4,5], and it is an independent risk factor for a worse prognosis among cirrhosis patients [5,6].There is little, and contradictory, information regarding the use of thoracic computed tomography (CT) scans for the diagnosis of HPS [1]
There was no correlation between pulmonary vascular abnormalities on CT and partial pressure of oxygen (PaO2) values
The prevalence of pulmonary vascular abnormalities on chest CT of patients with cirrhosis and HPS is low and not correlated with PaO2. These findings question the usefulness of chest CT for the evaluation of patients with cirrhosis and HPS
Summary
HPS affects 3–47% of patients with terminal liver disease depending on the diagnostic criteria [1,2,3,4,5], and it is an independent risk factor for a worse prognosis among cirrhosis patients [5,6].There is little, and contradictory, information regarding the use of thoracic computed tomography (CT) scans for the diagnosis of HPS [1]. Initial data from a small study with only 10 patients reported that multiple dilated vessels with increased numbers of visible terminal branches that extend to the pleura indicate a diagnosis of HPS [7]. Two subsequent studies in individuals with cirrhosis and HPS reported an increased CT diameter of the peripheral pulmonary vasculature compared with both healthy controls and patients with normoxemic cirrhosis [8,9]. Another study reported evidence of peripheral pulmonary artery dilatation on CT in patients with liver disease compared with healthy controls, but no differences between patients with liver disease with or without HPS [10]. No previous studies have addressed the prevalence of these two patterns of pulmonary vascular abnormalities in a larger sample of patients with HPS or evaluated the reproducibility of CT pulmonary vasculature and bronchial-to-artery ratio measurements in such patients
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
