ISSN: 1899-0967
Polish Journal of Radiology
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vol. 86
Cardiovascular radiology
Original paper

Main pulmonary artery-to-descending aorta ratio in computed tomography: cut-off value to diagnose pulmonary hypertension in children

Muankwan Saetung
Supika Kritsaneepaiboon
Jirayut Jarutach

Department of Radiology, Faculty of Medicine, Prince of Songkla University, Thailand
Division of Pediatric Cardiology. Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Thailand
© Pol J Radiol 2021; 86: e87-e92
Online publish date: 2021/02/02
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To establish a cut-off value of main pulmonary artery (MPA)/descending aorta (DA) ratio and MPA/ ascending aorta (AA) ratio by computed tomography (CT) to identify pulmonary hypertension (PHT) in children.

Material and methods
A total of 45 children diagnosed with PHT, who underwent both right heart catheterization (RHC) and CT, were enrolled as a case group (PHT), and their CT findings were compared with those from a control group (non-PHT). The widest short-axis diameters of DA at the level of the diaphragmatic outlet, AA, and MPA at its bifurcated level were measured.

The most common indication to order a CT in the PHT group was congenital heart disease (CHD) (n = 30, 66.7%), and in the non-PHT group it was metastatic workup (n = 31, 68.9%). The median (IQR) diameters of MPA in the PHT and the non-PHT groups were 18.7 mm (15.5, 26.7) and 16.4 mm (13.7, 19.5) (p = 0.005). The MPA/ DA ratios were 2.2 and 1.5 in the PHT and non-PHT groups (p < 0.001). The MPA/AA ratios were 1.2 and 1.1 in the PHT and non-PHT groups (p = 0.042). An MPA/DA ratio of 1.8 carried a positive likelihood ratio (LR+) of 7.5 with a sensitivity of 66.67%, specificity of 91%, positive predictive value (PPV) of 88%, and negative predictive value (NPV) of 73.21%.

The MPA/DA ratio > 1.8 suggests PHT in children and may lead to the avoidance of invasive cardiac catheterization particularly in non-CHD patients.


children, computed tomography, pulmonary hypertension, main pulmonary artery, main pulmonary artery-to-descending aorta ratio

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