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Normal pulmonary artery and branch pulmonary artery sizes in children
S Bruce Greenberg1, Sean M Lang2, C Heath Gauss2
1Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Slot #105, 1 Children's Way, Little Rock, AR, 72202, USA. greenbergsbruce@uams.edu.
Insights
This study establishes normal standards for pulmonary artery (PA) and branch pulmonary artery (BPA) effective diameter and cross-sectional area in children using CT scans. Findings reveal many PAs are not round, highlighting the need for accurate measurement techniques.
Area of Science:
- Pediatric Radiology
- Cardiovascular Imaging
- Anatomy and Physiology
Background:
- Accurate measurement of pulmonary artery (PA) and branch pulmonary artery (BPA) dimensions is crucial for diagnosing conditions like dilatation and stenosis in children.
- Existing methods may not adequately account for variations in arterial shape and patient size.
Purpose of the Study:
- To establish normative standards for PA and BPA effective diameter (ED) and cross-sectional area (CSA) in children across a wide size range using computed tomography (CT) data.
- To investigate the roundness of PAs and BPAs using aspect ratio (AR).
- To compare different diameter measurement techniques.
Main Methods:
- Analysis of 108 pediatric CT examinations (age 0-18 years) without PA abnormalities.
- Measurement of ED and CSA for PA and BPA using double-oblique reconstructions.
- Regression modeling relating ED and CSA to patient height; AR calculation to assess arterial roundness.
Main Results:
- Excellent interrater reliability was achieved for all measurements.
- Many PAs (38%) and BPAs (55% right, 37% left) exhibited aspect ratios < 0.9, indicating non-roundness.
- Normal ED and CSA ranges for PA and BPA were determined based on patient size.
Conclusions:
- Normative data for PA and BPA ED and CSA in children were established, aiding in the identification of abnormal vessel sizes.
- The non-round nature of many PAs and BPAs suggests that single-diameter measurements may introduce significant errors.
- Effective diameter derived from CSA is a reliable measure, unlike simple short or long axis measurements.
Abstract:
To establish standards for pulmonary artery and branch pulmonary artery (PA and BPA) effective diameter (ED) and cross-sectional area (CSA) by using computed tomography (CT) data in children of a wide range of sizes and investigate the roundness of arteries. The ED (average of short and long axes) and CSA for the PA and BPA were measured using 1-mm collimation double-oblique reconstructions. Ordinary least squares regression was used to investigate models with various functional forms that related ED and CSA to patient size. Aspect ratio (AR), the short axis divided by long axis, was measured to evaluate roundness. The ideal diameter derived from CSA measurements was compared to ED, short axis, and long axis measurements. 108 CT examinations were analyzed in children without reason for abnormal PA size who ranged in age from 0 to 18 years (mean, 10.9 years; SD, 5.9 years). Interrater reliability was excellent. Data were modeled using a natural log-transformed response variable and a linear term for height as the independent variable. AR for the PA, right pulmonary artery, and left pulmonary artery measured < 0.9 for 38, 55, and 37%, respectively, indicating that many arteries are not round. Ideal diameter was not significantly different than ED but was for short- and long-axis diameter measurements. Normal ED and CSA for PA and BPA were determined for children of different sizes. Measurements outside of the normal range are consistent with dilatation or stenosis. Single diameter techniques are likely to introduce error.
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