Imaging Features in <i>BMPR2</i> Mutation-associated Pulmonary Arterial Hypertension.

Abstract

Background Germline mutation in the <i>BMPR2</i> gene is common in patients with pulmonary arterial hypertension (PAH). However, its association with imaging findings in these patients is, to the knowledge of the authors, unknown. Purpose To characterize distinctive pulmonary vascular abnormalities at CT and pulmonary artery angiography in patients with and without <i>BMPR2</i> mutation. Materials and Methods In this retrospective study, chest CT scans, pulmonary artery angiograms, and genetic test data were acquired for patients diagnosed with idiopathic PAH (IPAH) or heritable PAH (HPAH) between January 2010 and December 2021. Perivascular halo, neovascularity, centrilobular ground-glass opacity (GGO), and panlobular GGO were evaluated at CT and graded on a four-point severity scale by four independent readers. Clinical characteristics and imaging features between patients with <i>BMPR2</i> mutation and noncarriers were analyzed using the Kendall rank-order coefficient and the Kruskal-Wallis test. Results This study included 82 patients with <i>BMPR2</i> mutation (mean age, 38 years ± 15 [SD]; 34 men; 72 patients with IPAH and 10 patients with HPAH) and 193 patients without the mutation, all with IPAH (mean age, 41 years ± 15; 53 men). A total of 115 patients (42%; 115 of 275) had neovascularity, and 56 patients (20%; 56 of 275) had perivascular halo at CT, and so-called frost crystals were observed on pulmonary artery angiograms in 14 of 53 (26%) patients. Compared with patients without <i>BMPR2</i> mutation, patients with <i>BMPR2</i> mutation more frequently showed two distinctive radiographic manifestations, perivascular halo and neovascularity (38% [31 of 82] vs 13% [25 of 193] in perivascular halo [<i>P</i> < .001] and 60% [49 of 82] vs 34% [66 of 193] in neovascularity [<i>P</i> < .001], respectively). "Frost crystals" were more frequent in patients with <i>BMPR2</i> mutation compared with noncarriers (53% [10 of 19] vs 12% [four of 34]; <i>P</i> < .01). Severe perivascular halo frequently coexisted with severe neovascularity in patients with <i>BMPR2</i> mutation. Conclusion Patients with PAH with <i>BMPR2</i> mutation showed distinctive features at CT, specifically perivascular halo and neovascularity. This suggested a link between the genetic, pulmonary, and systemic manifestations that underly the pathogenesis of PAH. © RSNA, 2023 <i>Supplemental material is available for this article.</i>