Correspondence Acta Radiologica 2015, Vol. 56(1) NP6–NP7 ! The Foundation Acta Radiologica 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0284185113511604 acr.sagepub.com

Is there a correlation between bronchial artery hypertrophy and coronary artery disease? We read the recent article titled ‘‘Bronchial artery hypertrophy is correlated with coronary artery disease’’ by Tresoldi et al. (1) with great interest. The authors evaluated a possible association between bronchial artery hypertrophy and coronary artery disease in patients without known pulmonary diseases undergoing coronary computed tomography angiography. They concluded that there is an association between coronary artery disease and bronchial artery hypertrophy, and bronchial artery hypertrophy could be caused by undiagnosed underlying coronary artery disease. When we read the article, some questions were raised in our minds. We need clarification from the authors on a few topics. In addition, we would like to make a contribution regarding normal anatomical features of bronchial arteries. First, the authors stated that the scanning volume was from the carina to the diaphragm in 75% (75/100) of the patients without coronary artery bypass graft (1). This information leads to two important questions: 1. How did the authors evaluate the entire lungs on these images as the authors could not see both upper lung lobes in 75% of the patients. We think that various important lung diseases affecting bronchial artery diameters may be located only in the upper lung lobes. 2. Ectopic bronchial arteries may originate from the proximal descending aorta, the aortic arch, and its branches (2–5). It is likely that the authors probably could not see the origin and/or entire course of the many ectopic bronchial arteries in 75 patients without coronary artery bypass graft. We think that these two important issues might have affected the results of the study. Second, the authors report that bronchial artery diameter was measured using electronic calipers placed at the aortic origin and bronchial arteries were

coded as hypertrophic when the diameter was >1.5 mm (1). However, it is not clear how the authors measured the different types of bronchial arteries (e.g. single bronchial artery originating from the aorta separately, common trunk of both bronchial arteries [CTB], and intercostal-bronchial trunk [IBT]), as their normal diameters may be different from each other. Moreover, Tresoldi et al. (1) stated that 100 (50%) bronchial arteries were orthotopic, and 99 (50%) were ectopic. How did the authors measure the diameter of ectopic bronchial arteries as the aortic or extra-aortic origin might be located out of the scan volume in most of the patients? In a recent study performed by Battal et al. (2), the mean diameters of bronchial arteries, right bronchial arteries, left bronchial arteries, and CTB were reported as 1.56, 1.64, 1.48, and 2.05 mm, respectively. In another study performed by Morita et al. (3), the mean diameters of bronchial arteries, right bronchial arteries, left bronchial arteries, and CTB were reported as 1.98, 2.05, 1.69, and 2.38 mm, respectively. We believe that normal diameters of CTB and IBTs may be >1.5 mm. In addition, some normal right and left bronchial arteries may have larger diameter than the cut-off value used by the authors (2–5). Tresoldi et al. (1) reported that some group 1 patients without significant coronary artery disease had bronchial arteries >1.5 mm, similar to previous reports (2–5). According to the authors’ hypothesis, we believe that bronchial artery numbers could also be important in addition to the bronchial artery diameter. Larger diameter of the bronchial artery means more blood volume. Correspondingly, an increased number of bronchial arteries, even if within normal diameters, may indicate a higher blood volume. Third, Battal et al. (2) reported that men had a significantly higher number of bronchial arteries than women. Moreover, right bronchial arteries had a significantly higher diameter than left bronchial arteries (2). These differences may be related to gender, different lung volumes, or the volume of the structures supplied by the bronchial arteries (2,4). Therefore, when we evaluate the correlation between bronchial artery diameter and other conditions such as pulmonary parenchymal or vascular diseases or coronary artery disease, we

Battal et al have to know what the normal diameter of the bronchial artery is for each patient. Each patient has a specific bronchial artery diameter according to body weight, body architecture, lung volumes, and volume of other structures supplied by bronchial arteries. The description of the hypertrophy and determination of an acceptable cut-off value for bronchial arteries may be difficult due to individual differences. We suggest that the author’s hypothesis must be confirmed by comprehensive studies, which takes into consideration other objective parameters such as bronchial artery number, side, lung volume, body architecture, and body weight, along with bronchial artery diameters.

References 1. Tresoldi S, Di Leo G, Villa F, et al. Bronchial artery hypertrophy is correlated with coronary artery disease. Acta Radiol 2013;doi: 10.1177/0284185113496678. 2. Battal B, Akgun V, Karaman B, et al. Normal anatomical features and variations of bronchial arteries: an analysis with 64-detector-row computed tomographic angiography. J Comput Assist Tomogr 2011;35:253–259.

NP7 3. Morita Y, Takase K, Ichikawa H, et al. Bronchial artery anatomy: preoperative 3D simulation with multidetector CT. Radiology 2010;255:934–943. 4. Akgun V, Battal B, Sari S. Bronchial arteries: normal anatomy, variation and radiologic evaluation. Surg Radiol Anat 2013;doi: 10.1007/s00276-013-1141-1. 5. Battal B, Saglam M, Ors F, et al. Aberrant right bronchial artery originating from right coronary artery – MDCT angiography findings. Br J Radiol 2010;83:e101–e104.

Bilal Battal1, Veysel Akgun1, Yalcin Bozkurt2 and Salih Hamcan3 1 Department of Radiology, Gulhane Military Medical School, Ankara, Turkey 2 Department of Radiology, Golcuk Military Hospital, Kocaeli, Turkey 3 Department of Radiology, Agri Military Hospital, Agri, Turkey Corresponding author: Bilal Battal, Gulhane Military Medical School Department of Radiology, 06018, Etlik, Ankara, Turkey Email: [email protected]

Is there a correlation between bronchial artery hypertrophy and coronary artery disease?

Is there a correlation between bronchial artery hypertrophy and coronary artery disease? - PDF Download Free
50KB Sizes 0 Downloads 7 Views