Shall We Report Cardiomegaly at Routine Computed Tomography of the Chest?

Gollub, Marc J.; Panu, Neety; Delaney, Holly; Sohn, Michael; Zheng, Junting; Moskowitz, Chaya S.; Rademaker, Jürgen; Liu, Jennifer

doi:10.1097/rct.0b013e318241e585

Cited by 28 publications

(26 citation statements)

References 11 publications

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“…In both cases, linear measurements were taken in an adapted way according to the method of Ungerleider and Gubner [6] as described in several previous CT studies [10][11][12]. All measurements were performed on axial slices using the workstation caliper tool.…”

Section: Discussionmentioning

confidence: 99%

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Cardiothoracic ratio in postmortem computed tomography: reliability and threshold for the diagnosis of cardiomegaly

Winklhofer

Berger

Ruder

et al. 2013

Forensic Sci Med Pathol

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The aim of this study was to evaluate the reliability of the cardiothoracic ratio (CTR) in postmortem computed tomography (PMCT) and to assess a CTR threshold for the diagnosis of cardiomegaly based on the weight of the heart at autopsy. PMCT data of 170 deceased human adults were retrospectively evaluated by two blinded radiologists. The CTR was measured on axial computed tomography images and the actual cardiac weight was weighed at autopsy. Inter-rater reliability, sensitivity, and specificity were calculated. Receiver operating characteristic curves were calculated to assess enlarged heart weight by CTR. The autopsy definition of cardiomegaly was based on normal values of the Zeek method (within a range of both, one or two SD) and the Smith method (within the given range). Intra-class correlation coefficients demonstrated excellent agreements (0.983) regarding CTR measurements. In 105/170 (62 %) cases the CTR in PMCT was >0.5, indicating enlarged heart weight, according to clinical references. The mean heart weight measured in autopsy was 405 ± 105 g. As a result, 114/170 (67 %) cases were interpreted as having enlarged heart weights according to the normal values of Zeek within one SD, while 97/170 (57 %) were within two SD. 100/170 (59 %) were assessed as enlarged according to Smith's normal values. The sensitivity/specificity of the 0.5 cut-off of the CTR for the diagnosis of enlarged heart weight was 78/71 % (Zeek one SD), 74/55 % (Zeek two SD), and 76/59 % (Smith), respectively. The discriminative power between normal heart weight and cardiomegaly was 79, 73, and 74 % for the Zeek (1SD/2SD) and Smith methods respectively. Changing the CTR threshold to 0.57 resulted in a minimum specificity of 95 % for all three definitions of cardiomegaly. With a CTR threshold of 0.57, cardiomegaly can be identified with a very high specificity. This may be useful if PMCT is used by forensic pathologists as a screening tool for medico-legal autopsies.

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Section: Discussionmentioning

confidence: 99%

“…Several studies have assessed and adapted the CTR approach to computed tomography (CT) and these measures have been shown to correlate highly with those from CXR [10][11][12]. Despite this, there continue to be differing opinions regarding the clinical reliability and usefulness of the CTR in cross sectional imaging [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Cardiothoracic ratio in postmortem computed tomography: reliability and threshold for the diagnosis of cardiomegaly

Winklhofer

Berger

Ruder

et al. 2013

Forensic Sci Med Pathol

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“…Additionally, Goddard classification was also used to evaluate severity of pulmonary emphysema 45 . CT-based cardiothoracic ratio (CT-CTR) was measured as previously described 46 because CT-CTR was highly concordant to CTR on chest X-ray.…”

Section: Methodsmentioning

confidence: 99%

Mediastinal pulmonary artery is associated with greater artery diameter and lingular division volume

Dejima

Takahashi

Hato

et al. 2017

Sci Rep

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Pulmonary vessels have numerous variation and aberrant branching patterns. Mediastinal lingular artery (MLA), the most common aberrant branch, might contribute to greater blood flow to lingular division. Hence, we investigated a correlation between lingular division volume and MLA using three-dimensional CT volumetry. We included 199 consecutive patients who underwent surveillance chest CT to detect possible malignancies in April 2015. We measured lingular division volume and cross-sectional area of lingular arteries using three-dimensional CT volumetry. MLA was identified in 58 cases (29.1%). The MLA group had significantly greater lingular division volume (median ± quartile deviation: 378.3 ± 75.5 mL vs. 330.0 ± 87.5 mL; p = 0.021) and percentage lingular division to left lung volume (19.0 ± 2.62% vs. 16.6 ± 2.39%; p < 0.001) than the non-MLA group. Total cross-sectional area of lingular arteries of the MLA group was significantly larger than that of the non-MLA group (46.1 ± 9.46 vs. 40.2 ± 5.76 mm2; p = 0.003). The total cross-sectional area of the lingular arteries strongly correlated to the percentage of lingular division to left lung volume (r = 0.689, p < 0.001). This is the first report demonstrating a positive correlation between branching pattern of pulmonary artery and lung volume.

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“…A number of studies have also shown that CTR can be applied to computed tomography (CT) and therefore post-mortem CT (PMCT) [1,2]. However, this has not been done with ventilated postmortem computed tomography (VPMCT) [8], which can be used to replicate the inspiratory breath-hold chest radiograph that is normally used for CTR.…”

Section: Introductionmentioning

confidence: 99%

“…Cardiothoracic ratio (CTR) is used clinically to assess heart size, as an increased heart size has been associated with risk of cardiovascular disease [1,2]. The use of the CTR was first described using plain-film x-ray in 1919 by Danzer [3].…”

Section: Introductionmentioning

confidence: 99%

Cardiothoracic ratio (CTR) measured on post-mortem computed tomography (PMCT) – Pre- and post-ventilation

James

Morgan

Rutty

et al. 2016

Journal of Forensic Radiology and Imaging

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Shall We Report Cardiomegaly at Routine Computed Tomography of the Chest?

Abstract: In patients with cancer undergoing routine ECHO, the cardiothoracic ratio at routine CT scans was highly correlated with that at CXR. Preliminary estimates in this small study indicate a low likelihood of LVH when the CTR is less than 0.49.

Cited by 28 publications

References 11 publications

Cardiothoracic ratio in postmortem computed tomography: reliability and threshold for the diagnosis of cardiomegaly

Cardiothoracic ratio in postmortem computed tomography: reliability and threshold for the diagnosis of cardiomegaly

Mediastinal pulmonary artery is associated with greater artery diameter and lingular division volume

Cardiothoracic ratio (CTR) measured on post-mortem computed tomography (PMCT) – Pre- and post-ventilation

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