Key result
3D volume measurement of the right pulmonary artery on CTPA images significantly improved the prediction of pulmonary hypertension compared to traditional diameter measurements (AUC 0.906 vs 0.822, p=0.042).
Why the study?
This study aimed to evaluate the diagnostic value of central pulmonary artery volume measurement using CTPA for predicting pulmonary hypertension.
Does 3D volume measurement of central pulmonary arteries using CTPA improve diagnostic accuracy for predicting pulmonary hypertension compared to traditional diameter and cross-sectional area measurements in patients with suspected PH?
Observational (n=59)
Single-blind
No
Does 3D volume measurement of central pulmonary arteries using CTPA improve diagnostic accuracy for predicting pulmonary hypertension compared to traditional diameter and cross-sectional area measurements in patients with suspected PH?
Absolute Event Rate: 0.906% vs 0.822%
p-value: p=0.042
3D volume measurement of the main and right pulmonary arteries on CTPA provides higher diagnostic accuracy for predicting pulmonary hypertension than traditional 1D and 2D measurements.
3D CTPA volumes may aid noninvasive PH prediction over diameters; leaves open prospective validation before practice change.
Background This retrospective study aims to evaluate the diagnostic value of volume measurement of central pulmonary arteries using computer tomography pulmonary angiography (CTPA) for predicting pulmonary hypertension (PH). Methods A total of 59 patients in our hospital from November 2013 to April 2021 who underwent both right cardiac catheterization (RHC) and CTPA examination were included. Systolic pulmonary artery pressure (SPAP), mean PAP (mPAP), and diastolic PAP (DPAP) were acquired from RHC testing. Patients were divided into the non-PH group (18 cases) and the PH group (41 cases). The diameters of the main pulmonary artery (D MPA ), right pulmonary artery (D RPA ), and left pulmonary artery (D LPA ) were measured manually. A 3D model software was used for the segmentation of central pulmonary arteries. The cross-sectional areas (A MPA , A RPA , A LPA ) and the volumes (V MPA , V RPA , V LPA ) were calculated. Measurements of the pulmonary arteries derived from CTPA images were compared between the two groups, and correlated with the parameters of RHC testing. ROC curves and decision curve analysis (DCA) were used to evaluate the benefit of the three-dimensional CTPA parameters for predicting PH. A multiple linear regression model with a forward-step approach was adopted to integrate all statistically significant CTPA parameters for PH prediction. Results All parameters (D MPA , D RPA , D LPA , A MPA , A RPA , A LPA, V MPA , V RPA , and V LPA ) of CTPA images exhibited significantly elevated in the PH group in contrast to the non-PH group ( P < 0.05), and showed positive correlations with the parameters of RHC testing (mPAP, DPAP, SPAP) ( r ranged 0.586~0.752 for MPA, 0.527~0.640 for RPA, and 0.302~0.495 for LPA, all with P < 0.05). For the MPA and RPA, 3D parameters showed higher correlation coefficients compared to their one-dimensional and two-dimensional counterparts. The ROC analysis indicated that the V MPA showed higher area under the curves (AUC) than the D MPA and A MPA without significance, and the V RPA showed higher AUC than the D RPA and A RPA significantly (D RPA vs. V RPA , Z = 2.029, P = 0.042; A RPA vs. V RPA , Z = 2.119, P = 0.034). The DCA demonstrated that the three-dimensional parameters could provide great net benefit for MPA and RPA. The predictive equations for mPAP, DPAP, and SPAP were formulated as [8.178 + 0.0006 * V MPA ], [1.418 + 0.0005 * V MPA ], and [-11.137 + 0.0006*V RPA + 1.259 * D MPA ], respectively. Conclusion The 3D volume measurement of the MPA and RPA based on CTPA images maybe more informative than the traditional diameter and cross-sectional area in predicting PH.
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Zhao et al. (2023) conducted an observational in Pulmonary hypertension (n=59). 3D volume measurement of central pulmonary arteries (CTPA) vs. 1D and 2D measurements (diameter and cross-sectional area) was evaluated on Area under the curve (AUC) of right pulmonary artery volume (VRPA) for predicting pulmonary hypertension (95% CI 0.839-0.985, p=0.042). 3D volume measurement of the right pulmonary artery on CTPA images significantly improved the prediction of pulmonary hypertension compared to traditional diameter measurements (AUC 0.906 vs 0.822, p=0.042).
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