A four-tier classification system of pulmonary artery metrics on computed tomography for the diagnosis and prognosis of pulmonary hypertension

Truong, Quynh A.; Bhatia, Harpreet; Szymonifka, Jackie; Zhou, Qing; Lavender, Zachary; Waxman, Aaron B.; Semigran, Marc J.; Malhotra, Rajeev

doi:10.1016/j.jcct.2017.12.001

Cited by 34 publications

(39 citation statements)

References 20 publications

(31 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the current study, patients who died of RHF tended to have a higher frequency of exclusively chronic peripheral PE and a greater mean dRV/dLV ratio on presenting CT scans compared with survivors. As opposed to the results reported by Truong et al [ 33 ], we found no significant associations of baseline dPA and dPA/dAA ratio with mortality. However, when comparing the current study with the study by Truong et al [ 33 ], one must consider the differences in study design and study population between the two investigations: The patient cohort evaluated by Truong et al [ 33 ] was heterogeneous, consisting of 92 non-PH patients and 136 PH patients; during a median follow-up of 6.4 years (5.0–8.2 years) there were 85 deaths, 65 in the PH group and 20 in the non-PH group.…”

Section: Discussioncontrasting

confidence: 99%

“…In a study including 145 patients with CTEPH, Leone et al [ 4 ] demonstrated significant correlation of mPAP with dPA (p < 0.001) as well as significant associations of mPAP and PVR with severity of mosaic perfusion subclassified into three grades based on a visual scoring system. More recently, Truong et al [ 33 ] reported significant correlation of dPA and dPA/dAA ratio with mPAP and right atrial pressure, using a four-tier severity grading system. Moderate (≥ 31–34 mm) and severe (> 34mm) enlargement of the dPA, and moderate (> 1.0–1.1) and severe (> 1.1) increase of the dPA/dAA ratio were associated with increased mortality as compared to the dPA and dPA/dAA metrics classified as normal [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

“…More recently, Truong et al [ 33 ] reported significant correlation of dPA and dPA/dAA ratio with mPAP and right atrial pressure, using a four-tier severity grading system. Moderate (≥ 31–34 mm) and severe (> 34mm) enlargement of the dPA, and moderate (> 1.0–1.1) and severe (> 1.1) increase of the dPA/dAA ratio were associated with increased mortality as compared to the dPA and dPA/dAA metrics classified as normal [ 33 ]. In the current study, patients who died of RHF tended to have a higher frequency of exclusively chronic peripheral PE and a greater mean dRV/dLV ratio on presenting CT scans compared with survivors.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Grosse

Lang

2018

PLoS ONE

View full text Add to dashboard Cite

PurposeThe aim of this study was to evaluate the vascular and parenchymal CT imaging findings, including vessel and cardiac chamber diameter measurements, in patients newly diagnosed with chronic thromboembolic pulmonary hypertension (CTEPH). The CT imaging findings were correlated with hemodynamic measurements and patient outcome.MethodsVascular and parenchymal CT findings were assessed on retrospectively ECG-gated MDCT angiography scans in 76 patients newly diagnosed with CTEPH. The diameters of the right and left ventricle (dRV, dLV), the right and left atrium (dRA, dLA), the ascending aorta (dAA), the right and left pulmonary arteries (drPA, dlPA), and the main pulmonary artery (dPA) were measured on axial CT scans. The CT imaging findings were correlated with demographic and hemodynamic data and adverse patient outcome due to right heart failure (RHF).ResultsThe majority of patients showed chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals in CT. Mean pulmonary artery pressure (mPAP) was not significantly different in patients with and those without chronic PE, mosaic perfusion, disparity in segmental vessel size, parenchymal densities, bronchial dilatation, and bronchial collaterals. Mean PAP showed significant correlations with the CT metrics of dRV/dLV ratio, dRA, dRV, dPA and dPA/dAA ratio, but no correlation with the central thrombi score. By backward linear regression, the dPA/dAA ratio independently correlated with mPAP. Patients who died of RHF tended to have a higher frequency of exclusively chronic peripheral PE and greater dRV/dLV ratios on presenting CT scans compared with survivors.ConclusionThe majority of patients newly diagnosed with CTEPH show vascular signs of chronic PE, mosaic perfusion, parenchymal densities, disparity in segmental vessel size, bronchial dilatation, and bronchial collaterals on presenting CT scans. Particularly CTEPH patients with exclusively chronic peripheral PE and increased dRV/dLV ratios seem to be at risk of adverse outcome due to RHF.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Grosse

Lang

2018

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Lee et al, [6] reported the diameter of AA as significantly higher in males than in females but our study showed no significant difference. [6,14,23] The results of our study revealed that diameters of RMB and LMB were higher than in previous studies. [11,24] These diameters were found higher in male, in both our study and in earlier studies.…”

Section: Min-max (Cm)contrasting

confidence: 62%

Pulmonary trunk to ascending aorta ratio and reference values for diameters of pulmonary arteries and main bronchi in healthy adults

Pirinç

Fazlıoğulları

Koplay

et al. 2020

Anatomy

View full text Add to dashboard Cite

Objectives: The ratio of the diameter of pulmonary trunk (PT) to the diameter of the ascending aorta (AA) is used to evaluate cardiopulmonary diseases. Different values have been reported for the normal value of PT:AA ratio (to be less than 0.9, 1 or 1.4). In this study, we aimed to investigate the diameters of the PT, right (RPA) and left pulmonary artery (LPA), AA, right (RMB) and left main bronchus LMB) using multidetector computed tomography (MDCT) and to determine reference values for PT:AA according to age and sex in normal healthy adults. Methods: Thoracic CT images of 200 individuals, (103 males, 97 females; age 18-89 years), without cardiopulmonary pathology and surgery, were retrospectively evaluated using MDCT. Diameters of PT, RPA, LPA, AA were measured at the level of the pulmonary artery bifurcationand PT:AA ratio was calculated.

show abstract

“…A wide range of cut-off values for identifying RHC-confirmed pulmonary hypertension have been proposed for MPAD (from 25 to 38 mm) and PA:Ao (from 0.84 to 1.4) [4,6,7,9,10,[15][16][17][18][19][20][21][22][23][24][25][26][27][28]. We elected to use the cut-offs proposed in the European Society of Cardiology/European Respiratory Society pulmonary hypertension guideline for our main analyses [13,14], but also ran analyses using a range of values, and found that alternative cut-off values performed better.…”

Section: Discussionmentioning

confidence: 99%

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

Ratanawatkul

Richards

et al. 2020

ERJ Open Res

View full text Add to dashboard Cite

BackgroundOn high-resolution computed tomography (HRCT), pulmonary artery (PA) dimensions may hint at the presence of pulmonary hypertension. We aimed to determine how accurately various measures of the PA, as viewed on HRCT, predict right heart catheterisation (RHC)-confirmed pulmonary hypertension.MethodsWe retrospectively reviewed patients who had HRCT and RHC between 2010 and 2018. Analyses considered respiratory cycle, pulmonary hypertension diagnostic criteria, time between HRCT and RHC, and subgroup analysis in interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD).ResultsOf 620 patients, 375 had pulmonary hypertension. For pulmonary hypertension (defined as mean PA pressure (mPAP) ≥25 mmHg) and from HRCT performed within 60 days of RHC, main PA diameter (MPAD) ≥29 mm had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 88%, 42%, 0.70 and 0.70, respectively, while ratio of the diameter of the PA to the diameter of the ascending aorta (PA:Ao) ≥1.0 showed 53%, 85%, 0.84 and 0.54, respectively. In general, results were similar when the interval between HRCT and RHC varied from 7 to 60 days and when measured on expiratory images. In ILD, the sensitivity of MPAD was higher; in COPD, the specificity of PA:Ao was higher. There was moderately positive correlation between mPAP and inspiratory MPAD, PA:Ao, right PA diameter (RPAD), left PA diameter (LPAD) and (RPAD+LPAD)/2 (r=0.48, 0.51, 0.34, 0.34 and 0.36, respectively), whereas there was weak negative correlation between mPAP and PA angle (r= −0.24).ConclusionsFindings on HRCT may assist in the diagnosis of RHC-confirmed pulmonary hypertension. MPAD ≥29 mm had high sensitivity and PA:Ao ≥1.0 had high specificity. Compared with the entire cohort, MPAD had greater sensitivity in ILD and PA:Ao had higher specificity in COPD.

show abstract

A four-tier classification system of pulmonary artery metrics on computed tomography for the diagnosis and prognosis of pulmonary hypertension

Cited by 34 publications

References 20 publications

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Evaluation of the CT imaging findings in patients newly diagnosed with chronic thromboembolic pulmonary hypertension

Pulmonary trunk to ascending aorta ratio and reference values for diameters of pulmonary arteries and main bronchi in healthy adults

Performance of pulmonary artery dimensions measured on high-resolution computed tomography scan for identifying pulmonary hypertension

Contact Info

Product

Resources

About