Diagnostic accuracy of automated 3D volumetry of cardiac chambers by CT pulmonary angiography for identification of pulmonary hypertension due to left heart disease

Abstract

Objectives To assess diagnostic accuracy of automated 3D volumetry of cardiac chambers based on computed tomography pulmonary angiography (CTPA) for the differentiation of pulmonary hypertension due to left heart disease (group 2 PH) from non-group 2 PH compared to manual diameter measurements. Methods Patients with confirmed PH undergoing right heart catheterisation and CTPA within 100 days for diagnostic workup of PH between August 2013 and February 2016 were included in this retrospective, single-centre study. Automated 3D segmentation of left atrium, left ventricle, right atrium and right ventricle (LA/LV/RA/RV) was performed by two independent and blinded radiologists using commercial software. For comparison, axial diameters were manually measured. The ability to differentiate group 2 PH from non-group 2 PH was assessed by means of logistic regression. Results Ninety-one patients (median 67.5 years, 44 women) were included, thereof 19 patients (20.9%) classified as group 2 PH. After adjustment for age, sex and mean pulmonary arterial pressure, group 2 PH was significantly associated with larger LA volume (p < 0.001), larger LV volume (p = 0.001), lower RV/LV volume ratio (p = 0.04) and lower RV/LA volume ratio (p = 0.003). LA volume demonstrated the highest discriminatory ability to identify group 2 PH (AUC, 0.908; 95% confidence interval, 0.835–0.981) and was significantly superior to LA diameter (p = 0.009). Intraobserver and interobserver agreements were excellent for all volume measurements (intraclass correlation coefficients 0.926–0.999, all p < 0.001). Conclusions LA volume quantified by automated, CTPA-based 3D volumetry can differentiate group 2 PH from other PH groups with good diagnostic accuracy and yields significantly higher diagnostic accuracy than left atrial diameter. Key Points • Automated cardiac chamber volumetry using non-gated CT pulmonary angiography can differentiate pulmonary hypertension due to left heart disease from other causes with good diagnostic accuracy. • Left atrial volume yields significantly higher diagnostic accuracy than left atrial axial diameter for identification of pulmonary hypertension due to left heart disease without time-consuming manual processing.

Diagnostic Value of 3D Volume Measurement of Central Pulmonary Artery Based on CTPA Images in the Pulmonary Arterial Hypertension

“…Fabian Rengier. measured the volume of MPA, RPA, and LPA on the magnetic resonance angiography images, and the pulmonary artery volume showed higher sensitivity and speci city for predicting PH compared to pulmonary artery diameters manually measured on axial reconstructions (15). Melzig, C. also measured the volume of MPA, RPA, and LPA with CTPA images, the volume of MPA showed a strong correlation with mPAP (r = 0.76, P < 0.001), and the AUC of the MPA for the prediction of PAH were 0.90 (10).…”

Ventricular volume asymmetry as a novel imaging biomarker for disease discrimination and outcome prediction

“…Prior literature proposes that RV dominant asymmetry, assessed by either RV/LV volume or diameter ratio plays a significant role in the risk stratification of specific conditions such as pulmonary embolism and pulmonary hypertension (14)(15)(16)(17). Our study provides new insights by examining associations of both LV and RV dominant asymmetry and by considering relationships in a population sample without selection on any disease.…”

Diagnostic value of 3D volume measurement of central pulmonary artery based on CTPA images in the pulmonary hypertension

“…These findings are well in accordance with previous studies investigating pulmonary artery diameters. Fabian Rengier measured the volume of MPA, RPA, and LPA on the magnetic resonance angiography images, and the pulmonary artery volume showed higher sensitivity and specificity for predicting PH compared to pulmonary artery diameters manually measured on axial reconstructions [ 18 ]. Melzig, C. also measured the volume of MPA, RPA, and LPA with CTPA images, the volume of MPA showed a strong correlation with mPAP ( r = 0.76, P < 0.001), and the AUC of the MPA for the prediction of PH were 0.90 [ 10 ].…”