Differential Diagnosis of Pulmonary Hypertension With Automated Image Analysis

Study Overview
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Brief Summary
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The aim of the study is to determine relevant morphologic parameters of the lung vasculature for the differentiation between different groups of patients with pulmonary hypertension (PH) by thoracic computer tomography (CT). In this pilot study patients undergoing right heart catheterization will be investigated by thoracic CT and special software to determine morphologic readouts. The investigators expect that using this non-invasive method, parameters relevant for the differentiation of the patients with PH can be determined.

Detailed Description
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Pulmonary hypertension (PH) is defined as an elevated mean pressure in the pulmonary artery above 20mmHg determined at right-heart catheterization. Depending on the presentation and pathogenesis, patients are classified according to five main groups. A correct classification is crucial, since it is essential for the available therapy options. A promising non-invasive method to provide important hemodynamic and clinical Information is the fully-automatic analysis of thoracic computed tomography images. This method can yield a number of quantitative morphologic readouts of the lung vasculature and the parenchyma. This study aims to identify quantitative markers from the fully-automatic image analysis, which allow a discrimination between the various PH patient groups.

Official Title
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Differential Diagnosis of Pulmonary Hypertension With Automated Image Analysis - a Pilot Study

Conditions
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Pulmonary Hypertension

Intervention / Treatment
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* Radiation: Thoracic computed tomography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with right-heart catheterization Clinical indication for thoracic CT Exclusion Criteria: Pregnancy Decreased kidney function Intolerance to contrast material Other standard CT contraindications

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 99 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Pulmonary arterial hypertension (PAH)<br>The patients with PAH received an invasive right-heart catheterization and a thoracic CT scan as part of their routine work up. | Radiation: Thoracic computed tomography<br>* Patients undergo contrast-enhanced thoracic computed tomography as part of their routine clinical work up.<br>|
| PH due to left-heart disease (PH-LHD)<br>The patients with PH-LHD received an invasive right-heart catheterization and a thoracic CT scan as part of their routine work up. | Radiation: Thoracic computed tomography<br>* Patients undergo contrast-enhanced thoracic computed tomography as part of their routine clinical work up.<br>|
| Chronic thromboembolic pulmonary hypertension (CTEPH)<br>The patients with CTEPH received an invasive right-heart catheterization and a thoracic CT scan as part of their routine work up. | Radiation: Thoracic computed tomography<br>* Patients undergo contrast-enhanced thoracic computed tomography as part of their routine clinical work up.<br>|
| PH due to emphysema (PH-LD-Emphys)<br>The patients with PH-LD-Emphys received an invasive right-heart catheterization and a thoracic CT scan as part of their routine work up. | Radiation: Thoracic computed tomography<br>* Patients undergo contrast-enhanced thoracic computed tomography as part of their routine clinical work up.<br>|
| PH due to lung fibrosis (PH-LD-Fibr)<br>The patients with PH-LD-Fibr received an invasive right-heart catheterization and a thoracic CT scan as part of their routine work up. | Radiation: Thoracic computed tomography<br>* Patients undergo contrast-enhanced thoracic computed tomography as part of their routine clinical work up.<br>|
| PH due to combined emphysema and fibrosis (PH-LD-CPFE)<br>The patients with PH-LD-CPFE received an invasive right-heart catheterization and a thoracic CT scan as part of their routine work up. | Radiation: Thoracic computed tomography<br>* Patients undergo contrast-enhanced thoracic computed tomography as part of their routine clinical work up.<br>|
| No PH<br>The patients without PH received an invasive right-heart catheterization and a thoracic CT scan as part of their routine work up. | Radiation: Thoracic computed tomography<br>* Patients undergo contrast-enhanced thoracic computed tomography as part of their routine clinical work up.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lung vessel morphology | Quantitative measures of lung vessel morphology based on automated CT image analysis based on artery-vein separation and vessel segmentation, which allow differentiation between the different groups of PH | 1 day |