Saetung Muankwan, Kritsaneepaiboon Supika, Jarutach Jirayut
Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand.
Division of Pediatric Cardiology. Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand.
Pol J Radiol. 2021 Feb 2;86:e87-e92. doi: 10.5114/pjr.2021.103943. eCollection 2021.
To establish a cut-off value of main pulmonary artery (MPA)/descending aorta (DA) ratio and MPA/ascending aorta (AA) ratio by computed tomography (CT) to identify pulmonary hypertension (PHT) in children.
A total of 45 children diagnosed with PHT, who underwent both right heart catheterization (RHC) and CT, were enrolled as a case group (PHT), and their CT findings were compared with those from a control group (non-PHT). The widest short-axis diameters of DA at the level of the diaphragmatic outlet, AA, and MPA at its bifurcated level were measured.
The most common indication to order a CT in the PHT group was congenital heart disease (CHD) ( = 30, 66.7%), and in the non-PHT group it was metastatic workup ( = 31, 68.9%). The median (IQR) diameters of MPA in the PHT and the non-PHT groups were 18.7 mm (15.5, 26.7) and 16.4 mm (13.7, 19.5) ( = 0.005). The MPA/DA ratios were 2.2 and 1.5 in the PHT and non-PHT groups ( < 0.001). The MPA/AA ratios were 1.2 and 1.1 in the PHT and non-PHT groups ( = 0.042). An MPA/DA ratio of 1.8 carried a positive likelihood ratio (LR+) of 7.5 with a sensitivity of 66.67%, specificity of 91%, positive predictive value (PPV) of 88%, and negative predictive value (NPV) of 73.21%.
The MPA/DA ratio > 1.8 suggests PHT in children and may lead to the avoidance of invasive cardiac catheterization particularly in non-CHD patients.
通过计算机断层扫描（CT）建立主肺动脉（MPA）/降主动脉（DA）比值和MPA/升主动脉（AA）比值的临界值，以识别儿童肺动脉高压（PHT）。
选取45例诊断为PHT且同时接受右心导管检查（RHC）和CT检查的儿童作为病例组（PHT），并将其CT检查结果与对照组（非PHT）进行比较。测量膈肌水平DA的最宽短轴直径、AA以及MPA分叉水平的直径。
PHT组进行CT检查最常见的指征是先天性心脏病（CHD）（n = 30，66.7%），非PHT组是转移灶检查（n = 31，68.9%）。PHT组和非PHT组MPA的中位数（IQR）直径分别为18.7 mm（15.5，26.7）和16.4 mm（13.7，19.5）（P = 0.005）。PHT组和非PHT组的MPA/DA比值分别为2.2和1.5（P < 0.001）。PHT组和非PHT组的MPA/AA比值分别为1.2和1.1（P = 0.042）。MPA/DA比值为1.8时，阳性似然比（LR+）为7.5，敏感性为66.67%，特异性为91%，阳性预测值（PPV）为88%，阴性预测值（NPV）为73.21%。
MPA/DA比值>1.8提示儿童存在PHT，尤其在非CHD患者中可能避免进行有创心脏导管检查。
