CT measurement of central pulmonary arteries to diagnose pulmonary hypertension (PHTN): more reliable than valid?

Terpenning, Silanath; Deng, Matthew; Hong-Zohlman, Susie; Lin, Cheng Ting; Kligerman, Seth; Jeudy, Jean; Ketai, Loren H.

doi:10.1016/j.clinimag.2016.02.024

Cited by 16 publications

(13 citation statements)

References 13 publications

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“…Transthoracic Doppler echocardiography-the most widely used noninvasive screening tool in PH-will not be reviewed in this position paper because it has been covered in recent international guidelines and proceedings of the World Symposium on PH (7,9). diameter-to-aorta ratio (hereafter, PA ratio), respectively (10)(11)(12)(13)(19)(20)(21)(22). This variability likely reflects heterogeneity arising from differences in diagnostic criteria and reference standards used to establish the presence of PH, lack of standardization in vascular measurement techniques and applied cutoff values, and nonuniform patient selection practices resulting in study populations that differed in chronicity and severity of PH.…”

Section: Overview Of Modalities For Imaging Phmentioning

confidence: 99%

Imaging of Pulmonary Hypertension in Adults: A Position Paper from the Fleischner Society

Rémy‐Jardin¹,

Ryerson²,

Schiebler³

et al. 2021

Radiology

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Section: Overview Of Modalities For Imaging Phmentioning

confidence: 99%

Imaging of Pulmonary Hypertension in Adults: A Position Paper from the Fleischner Society

Rémy‐Jardin¹,

Ryerson²,

Schiebler³

et al. 2021

Radiology

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“…[ 3 – 18 ] However, sometimes it was difficult to determine the bifurcation site due to the morphologically complex shape and axis of the MPA and its branches. The MPA diameter was measured at the bifurcation site in a few studies, which focused on the tubular or bifurcation site of the right PA. [ 3 , 10 , 12 , 34 ] Truong et al [ 35 ] measured the MPA diameter at the bifurcation site of the right PA, although the images appeared to indicate the tubular site. Therefore, several studies reported conflicting conclusions regarding the diagnostic value of the MPA diameter or PA:AA ratio in pulmonary hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, several studies reported conflicting conclusions regarding the diagnostic value of the MPA diameter or PA:AA ratio in pulmonary hypertension. [ 20 , 34 , 36 – 38 ] The potential advantage of the tubular segment of the MPA relates to its relatively constant diameter. Thus, we believe that measuring the MPA diameter at the tubular site is simpler and less subjective, potentially decreasing discordant measurements.…”

Section: Discussionmentioning

confidence: 99%

CT measurements of central pulmonary vasculature as predictors of severe exacerbation in COPD

et al. 2018

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To identify a predictive value for the exacerbation status of chronic obstructive pulmonary disease (COPD) subjects, we evaluated the relationship between pulmonary vascular measurements on chest CT and severe COPD exacerbation.Six hundred three subjects enrolled in the COPDGene population were included and divided into nonexacerbator (n = 313) and severe exacerbator (n = 290) groups, based on whether they had an emergency room visit and/or hospitalization for COPD exacerbation. We measured the diameter of the main pulmonary artery (MPA) and ascending aorta (AA) at 2 different sites of the MPA (the tubular midportion and bifurcation) on both axial images and multiplanar reconstructions. Using multiple logistic regression analyses, we evaluated the relationship between each CT-measured pulmonary vasculature and exacerbation status.Axial and multiplanar MPA to AA diameter ratios (PA:AA ratios) at the tubular midportion and the axial PA:AA ratios at the bifurcation indicated significant association with severe exacerbation. The strongest association was found with the axial PA:mean AA ratio at the bifurcation (adjusted odds ratio [OR] = 12.53, 95% confidence interval [CI] = 2.35–66.74, P = .003) and the axial PA:major AA ratio at the tubular midportion (adjusted OR = 10.72, 95% CI = 1.99–57.86, P = .006). No differences were observed in the MPA diameter. Receiver operating characteristic analysis of these variables indicates that they may serve as a good predictive value for severe exacerbation (area under the curve, 0.77–0.78). The range of cut-off value for PA:AA ratio was 0.8 to 0.87.CT-measured PA:AA ratios at either the bifurcation or the tubular site, measured either on axial or multiplanar images, are useful for identification of the risk of severe exacerbation, and consequently can be helpful in guiding the management of COPD. Although CT measurement was used at the level of pulmonary bifurcation in previous studies, we suggest that future studies should monitor the tubular site of the MPA for maximum diagnostic value of CT in pulmonary hypertension or severe COPD exacerbation, as the tubular site of the MPA remains relatively constant on CT images.

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“…Numerous CT [10][11][12][13][14] and MRI studies [15][16][17][18] have shown that absolute or relative size of the pulmonary artery (PA) can be directly correlated with PAP as measured with right heart catheterisation. However, the diagnostic performance of static PA dimensions on routine chest CT studies to identify PH has yielded inconsistent results, with areas under the receiver operating characteristic curve, or AUCs, ranging from 0.55 to 0.93 for PA diameter and 0.73-0.95 for PA diameter-to-aorta ratio (hereafter, PA ratio), respectively [10][11][12][13][19][20][21][22].…”

Section: Question 1: Is Noninvasive Imaging Capable Of Identifying Ph?mentioning

confidence: 99%

Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society

et al. 2021

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Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mmHg and classified into five different groups sharing similar pathophysiologic mechanisms, haemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH: a) Is noninvasive imaging capable of identifying PH? b) What is the role of imaging in establishing the cause of PH? c) How does imaging determine the severity and complications of PH? d) How should imaging be used to assess chronic thromboembolic PH before treatment? e) Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH.

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CT measurement of central pulmonary arteries to diagnose pulmonary hypertension (PHTN): more reliable than valid?

Cited by 16 publications

References 13 publications

Imaging of Pulmonary Hypertension in Adults: A Position Paper from the Fleischner Society

Imaging of Pulmonary Hypertension in Adults: A Position Paper from the Fleischner Society

CT measurements of central pulmonary vasculature as predictors of severe exacerbation in COPD

Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society

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