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Keywords:
Cardiovascular system, Pulmonary vessels, CT, CT-Angiography, CT-High Resolution, Computer Applications-3D, Computer Applications-Detection, diagnosis, Outcomes, Hypertension
Authors:
S. Terpenning1, L. Ketai1, C. T. Lin2, S. J. Kiglerman2, J. Jeudy2; 1Albuquerque, NM/US, 2Baltimore, MD/US
DOI:
10.1594/ecr2015/C-0732
Conclusion
MPAD in our study has normal distribution similar to Shirin and Sinem et al (3,4).
We did not find any correlation between patient’s demographic data or patient factors and the size of MPA while prior works have shown mixed results.
Previously published data had shown that pulmonary artery pressure,
patient’s age,
height,
weight and BSA were correlated with the size of main pulmonary artery while the patient’s gender was not.
(4-8).
There is no statistical significance among 3 radiologists with different years of experience in cardiothoracic imaging in measuring MPA,
RPA and LPA size and the distance of measured MPA to the pulmonary artery bifurcation.
From this we infer measurement accuracy does not depend upon experience.
When using 3.15 cm as a cut-off value to diagnose PHTN,
per case inter-rater agreement was good,
kappa value > 0.65.
Our results were similar to Mohammedi et al and PD Edwards et al (7,9).
The higher cut-off values had more increase in sensitivity and more decrease in specificity.
Incorporating RPA and/or LPA measurement to diagnose PHTN improved the sensitivity but markedly degraded the specificity.
We found this to be disadvantageous in the diagnosis of PHTN.
To establish the cut-off value to diagnose PHTN,
the trade-off of misdiagnosis of PHTN and sensitivity/specificity calculated from different cut off values must be weighed.
The size of central pulmonary arteries,
specifically dilated MPA may imply presence of PHTN but is not diagnostic.
PHTN patients can have normal sized MPA (Fig. 7) and conversely,
normal PAP patients can have dilated MPA ( Fig. 8 ).
The latter,
the false positive diagnosis of PHTN did not appear to be related to patient size (BSA) in our data.
In conclusion,
measurements of MPA on CT examinations of the chest are reproducible.
Cut-off values that are widely used are moderately sensitive relatively nonspecific.
Incorporation or RPA and LPA measurement can improve sensitivity but severely degrade specificity. Diagnosis of PHTN based solely on CT examinations of the chest may not be sufficiently accurate for clinical use.