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Combined automated 3D volumetry by pulmonary CT angiography and echocardiography for detection of pulmonary hypertension

Abstract

Objectives

To assess the diagnostic accuracy of automated 3D volumetry of central pulmonary arteries using computed tomography pulmonary angiography (CTPA) for suspected pulmonary hypertension alone and in combination with echocardiography.

Methods

This retrospective diagnostic accuracy study included 70 patients (mean age 66.7, 48 female) assessed for pulmonary hypertension by CTPA and transthoracic echocardiography with estimation of the pulmonary arterial systolic pressure (PASP). Gold standard right heart catheterisation with measurement of the invasive mean pulmonary arterial pressure (invasive mPAP) served as the reference. Volumes of the main, right and left pulmonary arteries (MPA, RPA and LPA) were computed using automated 3D segmentation. For comparison, axial dimensions were manually measured. A linear regression model was established for prediction of mPAP (predicted mPAP).

Results

MPA, RPA and LPA volumes were significantly increased in patients with vs. without pulmonary hypertension (all p < 0.001). Of all measures, MPA volume demonstrated the strongest correlation with invasive mPAP (r = 0.76, p < 0.001). Predicted mPAP using MPA volume and echocardiographic PASP as covariates showed excellent correlation with invasive mPAP (r = 0.89, p < 0.001). Area under the curves for predicting pulmonary hypertension were 0.94 for predicted mPAP, compared to 0.90 for MPA volume and 0.92 for echocardiographic PASP alone. A predicted mPAP > 25.8 mmHg identified pulmonary hypertension with sensitivity, specificity, positive and negative predictive values of 86%, 93%, 95% and 81%, respectively.

Conclusions

Automated 3D volumetry of central pulmonary arteries based on CTPA may be used in conjunction with echocardiographic pressure estimates to noninvasively predict mPAP and pulmonary hypertension as confirmed by gold standard right heart catheterisation with higher diagnostic accuracy than either test alone.

Key Points

• This diagnostic accuracy study derived a regression model for noninvasive prediction of invasively measured mean pulmonary arterial pressure as assessed by gold standard right heart catheterisation.

• This regression model using automated 3D volumetry of the central pulmonary arteries based on CT pulmonary angiography in conjunction with the echocardiographic pressure estimate predicted pulmonary arterial pressure and the presence of pulmonary hypertension with good diagnostic accuracy.

• The combination of automated 3D volumetry and echocardiographic pressure estimate in the regression model provided superior diagnostic accuracy compared to each parameter alone.

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Abbreviations

CT:

Computed tomography

CTPA:

Computed tomography pulmonary angiography

LPA:

Left pulmonary artery

MPA:

Main pulmonary artery

mPAP:

Mean pulmonary arterial pressure

mPAPpredicted :

mPAP predicted by linear regression

mPAPRHC :

mPAP measured by right heart catheterisation

MRI:

Magnetic resonance imaging

PASP:

Transthoracic echocardiographic pulmonary arterial systolic pressure estimate

PH:

Pulmonary hypertension

RHC:

Right heart catheterisation

RPA:

Right pulmonary artery

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Funding

This study was supported by the German Center for Lung Research (DZL) through grants from the German Ministry for Education and Science (BMBF; 82DZL00401, 82DZL00402, 82DZL00404).

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Correspondence to Fabian Rengier.

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The scientific guarantor of this publication is Fabian Rengier.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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One of the authors has significant statistical expertise.

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Melzig, C., Wörz, S., Egenlauf, B. et al. Combined automated 3D volumetry by pulmonary CT angiography and echocardiography for detection of pulmonary hypertension. Eur Radiol 29, 6059–6068 (2019). https://doi.org/10.1007/s00330-019-06188-7

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  • DOI: https://doi.org/10.1007/s00330-019-06188-7

Keywords

  • Pulmonary arteries
  • Pulmonary artery volumetry
  • Pulmonary artery pressure
  • Pulmonary hypertension
  • Computed tomography angiography