Diagnostic accuracy of CT pulmonary angiography in suspected pulmonary hypertension

Objectives Computed tomography (CT) pulmonary angiography is widely used in patients with suspected pulmonary hypertension (PH). However, the diagnostic and prognostic significance remains unclear. The aim of this study was to (a) build a diagnostic CT model and (b) test its prognostic significance....

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Published in:	European radiology Vol. 30; no. 9; pp. 4918 - 4929
Main Authors:	Swift, Andrew J., Dwivedi, Krit, Johns, Chris, Garg, Pankaj, Chin, Matthew, Currie, Ben J, Rothman, Alex MK, Capener, Dave, Shahin, Yousef, Elliot, Charlie A, Charalampopolous, Thanos, Sabroe, Ian, Rajaram, Smitha, Hill, Catherine, Wild, Jim M., Condliffe, Robin, Kiely, David G.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-09-2020 Springer Nature B.V
Subjects:	Aged Angiography Cardiac Catheterization - methods Chest Computed tomography Computed Tomography Angiography - methods Derivation Diagnostic Radiology Diagnostic systems Diameters Female Heart Humans Hypertension Hypertension, Pulmonary - diagnosis Hypertension, Pulmonary - physiopathology Image reconstruction Imaging Internal Medicine Interventional Radiology Lung - physiopathology Male Medical diagnosis Medical imaging Medicine Medicine & Public Health Middle Aged Model accuracy Model testing Neuroradiology Pulmonary arteries Pulmonary artery Pulmonary Artery - diagnostic imaging Pulmonary Artery - physiopathology Pulmonary hypertension Pulmonary Wedge Pressure - physiology Radiology Regression analysis ROC Curve Thresholds Ultrasound Ventricle Diagnostic imaging Heart ventricles Pulmonary artery Hypertension, pulmonary
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Summary:	Objectives Computed tomography (CT) pulmonary angiography is widely used in patients with suspected pulmonary hypertension (PH). However, the diagnostic and prognostic significance remains unclear. The aim of this study was to (a) build a diagnostic CT model and (b) test its prognostic significance. Methods Consecutive patients with suspected PH undergoing routine CT pulmonary angiography and right heart catheterisation (RHC) were identified. Axial and reconstructed images were used to derive CT metrics. Multivariate regression analysis was performed in the derivation cohort to identify a diagnostic CT model to predict mPAP ≥ 25 mmHg (the existing ESC guideline definition of PH) and > 20 mmHg (the new threshold proposed at the 6th World Symposium on PH). In the validation cohort, sensitivity, specificity and compromise CT thresholds were identified with receiver operating characteristic (ROC) analysis. The prognostic value of the CT model was assessed using Kaplan-Meier analysis. Results Between 2012 and 2016, 491 patients were identified. In the derivation cohort ( n = 247), a CT model was identified including pulmonary artery diameter, right ventricular outflow tract thickness, septal angle and left ventricular area. In the validation cohort ( n = 244), the model was diagnostic, with an area under the ROC curve of 0.94/0.91 for mPAP ≥ 25/> 20 mmHg respectively. In the validation cohort, 93 patients died; mean follow-up was 42 months. The diagnostic thresholds for the CT model were prognostic, log rank, all p < 0.01. Discussion In suspected PH, a diagnostic CT model had diagnostic and prognostic utility. Key Points • Diagnostic CT models have high diagnostic accuracy in a tertiary referral population of with suspected PH. • Diagnostic CT models stratify patients by mortality in suspected PH.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0938-7994 1432-1084
DOI:	10.1007/s00330-020-06846-1