# Pulmonary Artery and Vein Morphology as an Imaging Biomarker for the Diagnosis of Pulmonary Hypertension

## TL;DR

This study explores how the shape and density of pulmonary arteries and veins in CT scans can help diagnose pulmonary hypertension.

## Contribution

The study introduces a new imaging biomarker based on peripheral pulmonary artery and vein morphology for diagnosing pulmonary hypertension.

## Key findings

- Pulmonary artery vessel density was higher in PH patients for vessels 6–10 mm in diameter.
- The artery-to-vein ratio was significantly higher in PH patients for vessels 6–10 mm in diameter.
- Combining artery-to-vein ratio with DMPA slightly improved diagnostic accuracy but not significantly.

## Abstract

Background/Objectives: To evaluate whether peripheral pulmonary artery and vein morphology improves image-based diagnosis of pulmonary hypertension (PH), in accordance with the recently updated hemodynamic definition. Methods: 229 patients underwent CT pulmonary angiography (CTPA) within 30 days of RHC. Pulmonary vessels ranging between 2 and 10 mm in diameter were extracted and labeled as either arteries or veins by an independently validated fully automated algorithm. Segmentation labels were validated by a radiologist. Results: The segmentation algorithm reached a median accuracy of 90%, aligning with the radiologist’s assessments. Vessel density of pulmonary arteries with diameters between 6 and 10 mm was higher in patients with versus those without PH (median [inter-quartile range]: 8.9 [6.1–10.8] 1/L vs. 6.2 [3.1–7.0] 1/L; p = 0.007). Artery-to-vein ratio was higher in PH (1.32 [0.93–2.06] vs. 0.88 [0.48–1.17], p = 0.004). The artery-to-vein ratio for vessels with diameters between 6 and 10 mm identified PH with an AUC of 0.73 (95% CI: 0.60–0.87). Combining this readout with the DMPA resulted in a numerically higher AUC (sole DMPA AUC: 0.79 (95% CI: 0.68–0.90)) vs. DMPA + artery-to-vein ratio for vessels with diameters of 6–10 mm: 0.81 (95% CI: 0.71–0.92); however, this improvement was not statistically significant (p = 0.4). Conclusions: PH is associated with an increased ratio of peripheral pulmonary arteries to veins within the 6–10 mm diameter range. Pulmonary vascular morphology may complement the established morphological criterion of MPA diameter and improve the diagnostic accuracy of PH on CT.