The cardiothoracic ratio on post-mortem computer tomography
- 269 Downloads
In clinical practice, the cardiothoracic ratio (CTR) was first utilized on plain chest radiography, and subsequently with computed tomography (CT) to diagnose cardiomegaly with a threshold of 0.5. Using CTR in forensic practice could help to detect cardiomegaly on post-mortem CT (PMCT) prior to the autopsy. However, an adaption of the threshold could be necessary because of post-mortem changes. Our retrospective study aimed to measure the CTR on PMCT and test the possible influence of variables. We selected 109 autopsy cases in which the heart weight was within normal limits. A forensic pathologist and a radiologist measured separately the CTR on axial and scout views on PMCT. We tested the statistical concordance between the two readers and between the axial and scout view and identified factors that could be associated with a modification of the CTR. The CTR measurements revealed an overestimation of the measurements made on scout compared to axial view. The inter-reader correlation was very high for both views. Among the different variables statistically tested, heart dilatation and body mass index (BMI) were the only two factors statistically associated with an augmentation of the CTR. The CTR can be useful in the diagnosis of cardiomegaly on PMCT. However, dilatation of the cardiac chambers caused by acute heart failure may be misinterpreted radiographically as cardiomegaly. Inter-observer reliability in our study was very high. CTR may be overestimated when measured on the scout view. Further investigations with larger cohorts, including cases with cardiac hypertrophy, are necessary to better understand the relationship between radiological CTR and the morphology of the heart.
KeywordsCardiothoracic ratio Post-mortem CT scanner PMCT Cardiomegaly Heart dilatation
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 3.Miller J, Singer A, Hinrichs C, Contractor S, Doddakashi S. (1999) Cardiac dimensions derived from helical Ct: correlation with plain film radiography. Internet J Radiat Biol. 1(1)Google Scholar
- 9.Vanhaebost J et al (2013) New reference tables for predicted heart weight. Virchows Arch 463(2):196Google Scholar
- 12.Allen Burke FT (2011) Practical cardiovascular pathology. Ed. W.K. Health. PhiladelphiaGoogle Scholar
- 13.Zeek PM (1946) Heart weight; the effect of tuberculosis on heart weight. Arch Pathol (Chic) 41:526–532Google Scholar