Department of Radiology and Medical Imaging, National Taiwan University Hospital, Medical College, National Taiwan University, Taipei, Taiwan.
Department of Pediatrics, National Taiwan University Hospital, Medical College, National Taiwan University, Taipei, Taiwan.
Korean J Radiol. 2019 Jun;20(6):976-984. doi: 10.3348/kjr.2018.0673.
To establish diagnostic criteria for pulmonary arterial hypertension (PAH) in children by using parameters obtained through noninvasive cardiac computed tomography (CCT).
We retrospectively measured parameters from CCT images of children from a single institution in a multiple stepwise process. A total of 208 children with mean age of 10.5 years (range: 4 days-18.9 years) were assessed. The variables were classified into three groups: the great arteries; the ventricular walls; and the bilateral ventricular cavities. The relationship between the parameters obtained from the CCT images and mean pulmonary arterial pressure (mPAP) was tested and adjusted by the children's body size. Reference curves for the pulmonary trunk diameter (PTD) and ratio of diameter of pulmonary trunk to ascending aorta (rPTAo) of children with CCT images of normal hearts, adjusted for height, were plotted. Threshold lines were established on the reference curves.
PTD and rPTAo on the CCT images were significantly positively correlated with mPAP ( > 0.85, < 0.01). Height was the body size parameter most correlated with PTD ( = 0.91, < 0.01) and rPTAo ( = -0.69, < 0.01). On the basis of the threshold lines on the reference curves, PTD and rPTAo both showed 88.9% sensitivity for PAH diagnosis, with negative predictive values of 93.3% and 92.9%, respectively.
PTD and rPTAo measured from CCT images were significantly correlated with mPAP in children. Reference curves and the formula of PTD and rPTAo adjusted for height could be practical for diagnosing PAH in children.
利用非侵入性心脏计算机断层扫描（CCT）获得的参数，为儿童肺动脉高压（PAH）建立诊断标准。
我们对单一机构的 CCT 图像进行了回顾性测量，通过多步骤过程对儿童的参数进行了评估。共有 208 名平均年龄为 10.5 岁（范围：4 天至 18.9 岁）的儿童接受了评估。变量分为三组：大动脉；心室壁；双侧心室腔。测试了 CCT 图像中的参数与平均肺动脉压（mPAP）之间的关系，并通过儿童的体型进行了调整。绘制了 CCT 图像正常心脏的肺动脉干直径（PTD）和肺动脉干与升主动脉直径比（rPTAo）与身高相关的参考曲线。在参考曲线上建立了阈值线。
PTD 和 rPTAo 在 CCT 图像上与 mPAP 呈显著正相关（>0.85，<0.01）。身高是与 PTD（=0.91，<0.01）和 rPTAo（=-0.69，<0.01）相关性最大的体型参数。基于参考曲线的阈值线，PTD 和 rPTAo 对 PAH 的诊断均具有 88.9%的敏感性，阴性预测值分别为 93.3%和 92.9%。
CCT 图像上测量的 PTD 和 rPTAo 与儿童的 mPAP 显著相关。参考曲线和身高校正的 PTD 和 rPTAo 公式可用于诊断儿童 PAH。
