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. 2016 Oct;194(5):813-9.
doi: 10.1007/s00408-016-9926-8. Epub 2016 Jul 16.

Accuracy of CT Pulmonary Artery Diameter for Pulmonary Hypertension in End-Stage COPD

Firdaus A Mohamed Hoesein  1 , Tim Besselink  2 , Esther Pompe  2 , Erik-Jan Oudijk  3 , Ed A de Graaf  4 , J M Kwakkel-van Erp  4 , Pim A de Jong  2 , Bart Luijk  4
Affiliations

Accuracy of CT Pulmonary Artery Diameter for Pulmonary Hypertension in End-Stage COPD

Firdaus A Mohamed Hoesein et al. Lung. 2016 Oct.

Abstract

Introduction: Pulmonary hypertension (PH) in COPD is associated with a higher mortality and an increased risk on exacerbations compared to COPD patients without PH. The aim was to evaluate the diagnostic value of pulmonary artery (PA) measurements on chest computed tomography (CT) for PH in end-stage COPD.

Methods: COPD patients evaluated for eligibility for lung transplantation between 2004 and 2015 were retrospectively analyzed. Clinical characteristics, chest CTs, spirometry, and right-sided heart catheterizations (RHC) were studied. Diameters of PA and ascending aorta (A) were measured on CT. Diagnostic properties of different cut-offs of PA diameter and PA:A ratio in diagnosing PH were calculated.

Results: Of 92 included COPD patients, 30 (32.6 %) had PH at RHC (meanPAP > 25 mm Hg). PA:A > 1 had a negative predictive value (NPV) of 77.9 % and a positive predictive value (PPV) of 63.1 % with an odds ratio (OR (CI 95 %)) of 5.60 (2.00-15.63). PA diameter ≥30 mm had a NPV of 78 % and PPV of 64 % with an OR (CI 95 %) of 6.95 (2.51-19.24).

Conclusion: A small PA diameter and PA:A make the presence of PH unlikely but cannot exclude its presence in end-stage COPD. A large PA diameter and PA:A maybe used to detect PH early.

Keywords: COPD; Pulmonary circulation and pulmonary hypertension; Radiology and other imaging.

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Conflict of interest statement

Compliance with Ethical Standards Conflicts of Interest None.

Figures

Fig. 1
Fig. 1
Examples of measurements of the aorta and the pulmonary artery
Fig. 2
Fig. 2
Plot of positive and negative predictive values of different cut-offs for pulmonary artery to aorta ratio (PA:A). The X-axis shows the PA:A and the Y-axis the responding positive and negative predictive value. The red line with dot represents the negative predictive value and the blue line with squares the positive predictive value
Fig. 3
Fig. 3
Plot of positive and negative predictive value of different cut-offs for pulmonary artery diameters. The X-axis shows the pulmonary artery diameter in millimeters and the Y-axis the responding positive and negative predictive value. The red line with dot represents the negative predictive value and the blue line with squares the positive predictive value
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