Diagnostic accuracy of CT pulmonary angiography in suspected pulmonary hypertension

Swift, Andrew J., Dwivedi, Krit, Johns, Chris, Garg, Pankaj, Chin, Matthew, Currie, Ben J., Rothman, Alex M K, Capener, Dave, Shahin, Yousef, Elliot, Charlie A, Charalampopolous, Thanos, Sabroe, Ian, Rajaram, Smitha, Hill, Catherine, Wild, Jim M., Condliffe, Robin and Kiely, David G. (2020) Diagnostic accuracy of CT pulmonary angiography in suspected pulmonary hypertension. European Radiology, 30 (9). pp. 4918-4929. ISSN 0938-7994

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Abstract

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.

Item Type: Article
Additional Information: Funding Information: This study has received funding from Wellcome Trust (205188/Z/16/Z), NIHR (NIHR – RP-R3-12-027) and MRC (MR/M008894/1) POLARIS. Bayer support DC.
Uncontrolled Keywords: diagnostic imaging,heart ventricles,hypertension, pulmonary,pulmonary artery,radiology nuclear medicine and imaging ,/dk/atira/pure/subjectarea/asjc/2700/2741
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: LivePure Connector
Date Deposited: 17 Nov 2021 04:51
Last Modified: 24 Nov 2021 03:13
URI: https://ueaeprints.uea.ac.uk/id/eprint/82132
DOI: 10.1007/s00330-020-06846-1

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