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Accurate Pulmonary Artery and Vein Segmentation from Non-Contrast CT Scans Reveals Demographic Associations in Pulmonary Vasculature Anatomy


Core Concepts
Accurate and abundant segmentation of pulmonary arteries and veins can be achieved from non-contrast CT scans using the proposed HiPaS framework, enabling contrast-agent-free diagnosis and revealing novel associations between pulmonary vessel abundance and sex and age.
Abstract
The authors present HiPaS, a deep learning-based framework for accurate and abundant segmentation of pulmonary arteries and veins from both non-contrast CT and contrast-enhanced CT pulmonary angiography (CTPA) scans. Key highlights: HiPaS incorporates an Inter-and-Intra-slice Super Resolution (I2SR) module to address spatial anisotropy and a Saliency-Transmission Segmentation (STS) module to enhance perception of multiscale vascular features. The authors established a large multi-center dataset with meticulous manual annotations of pulmonary arteries and veins, enabling comprehensive model training and evaluation. Extensive experiments on external datasets demonstrated the superior performance of HiPaS, outperforming state-of-the-art methods by 7-13% in dice score and 15-20% in sensitivity. HiPaS achieved non-inferior segmentation performance on non-contrast CT compared to CTPA, the clinical gold standard. Employing HiPaS, the authors conducted a large-scale anatomical study on 10,613 participants, revealing novel associations between pulmonary vessel abundance and sex and age. The authors conclude that HiPaS enables accurate, contrast-agent-free pulmonary ar/v segmentation, facilitating clinical diagnosis and understanding of pulmonary physiology.
Stats
Pulmonary arteries have significantly longer skeleton length (13998±2895 cm for males, 10949±2540 cm for females) and more branch counts (1858±496 for males, 1554±509 for females) compared to females, when controlling for lung volume (p<0.0001). Pulmonary vessel abundance, as measured by skeleton length and branch counts, exhibits a slightly decreasing trend with age in both males and females (p<0.0001). Females show a larger linear regression coefficient of vessel skeleton length and branch counts with lung volume compared to males (p<0.0001).
Quotes
"Females exhibit more vessel branch counts and longer skeleton length of the pulmonary vessels compared to males when controlling for the lung volume." "Age presents a negative association with pulmonary vessel abundance."

Deeper Inquiries

How do the observed sex and age differences in pulmonary vessel anatomy relate to the incidence, diagnosis, and treatment of pulmonary and cardiovascular diseases?

The observed sex and age differences in pulmonary vessel anatomy can have significant implications for the incidence, diagnosis, and treatment of pulmonary and cardiovascular diseases. Incidence: Sex-specific differences in pulmonary vessel anatomy, such as vessel abundance and morphology, can influence the incidence of certain diseases. For example, the finding that females exhibit more vessel branch counts and longer vessel skeleton length compared to males can impact disease susceptibility. Certain conditions like pulmonary embolism or pulmonary hypertension may manifest differently based on these anatomical variations. Diagnosis: Understanding the sex and age-related differences in pulmonary vessel anatomy can aid in more accurate and personalized diagnosis of pulmonary and cardiovascular diseases. For instance, if females are found to have a higher vessel abundance, clinicians may need to consider this factor when interpreting imaging results or assessing disease severity. Additionally, variations in vessel morphology could affect the interpretation of imaging studies and diagnostic tests. Treatment: The anatomical differences in pulmonary vessels based on sex and age can also influence treatment strategies. For example, if females have a higher vessel abundance, this may impact the efficacy of certain treatments or interventions. Tailoring treatment plans to account for these anatomical variations can lead to more targeted and effective therapies for pulmonary and cardiovascular diseases.

What are the potential mechanisms underlying the sex and age-related differences in pulmonary vascular anatomy?

Hormonal Influence: Sex hormones, such as estrogen and testosterone, can play a role in shaping vascular structure and function. Estrogen, for example, has been associated with vasodilation and vascular remodeling, which could contribute to differences in vessel abundance between males and females. Genetic Factors: Genetic variations between sexes and across different age groups can influence vascular development and morphology. Certain genetic predispositions may lead to differences in vessel branching patterns or vessel density. Aging Effects: With aging, there may be changes in vascular structure and function, including vascular remodeling, endothelial dysfunction, and increased vascular stiffness. These age-related changes can impact vessel morphology and abundance. Environmental Factors: Lifestyle factors, such as diet, exercise, and exposure to environmental toxins, can also influence vascular health and anatomy. These factors may interact with genetic and hormonal influences to shape pulmonary vessel anatomy.

Can the HiPaS framework be extended to study vascular changes in specific pulmonary diseases, and how might that advance our understanding of disease pathophysiology?

Yes, the HiPaS framework can be extended to study vascular changes in specific pulmonary diseases, such as pulmonary embolism, pulmonary hypertension, or chronic obstructive pulmonary disease (COPD). By applying the HiPaS framework to analyze vascular changes in these diseases, we can: Quantify Disease Progression: HiPaS can provide detailed and accurate segmentation of pulmonary vessels, allowing for the quantification of changes in vessel morphology and abundance associated with specific pulmonary diseases. This can help track disease progression and response to treatment. Identify Biomarkers: The framework can help identify specific vascular patterns or biomarkers associated with different pulmonary diseases. These biomarkers can serve as diagnostic or prognostic indicators, aiding in early detection and personalized treatment strategies. Understand Disease Mechanisms: By studying vascular changes in specific pulmonary diseases, we can gain insights into the underlying pathophysiology of these conditions. Understanding how vascular anatomy is altered in disease states can provide valuable information on disease mechanisms and potential therapeutic targets. Optimize Treatment Strategies: The insights gained from studying vascular changes using HiPaS can help optimize treatment strategies for pulmonary diseases. By tailoring interventions based on specific vascular characteristics, clinicians can improve treatment outcomes and patient care.
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