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Computed Tomography Angiography in Pediatric Pulmonary Hypertension: Evaluating MPA-to-Aortic Ratios as Diagnostic
Ali Nazım Güzelbağ1, Serap Baş2, Demet Kangel1
1Department of Pediatric Cardiology, Saglik Bilimleri University, Basaksehir Cam and Sakura City Hospital, 34480 Istanbul, Turkey.
Insights
Computed tomography angiography (CTA) ratios of the main pulmonary artery to the aorta can help diagnose pediatric pulmonary hypertension (PHT). The main pulmonary artery-to-descending aorta (MPA/DA) ratio shows high accuracy for detecting this serious condition in children.
Area of Science:
- Pediatric Cardiology
- Radiology
- Pulmonary Medicine
Background:
- Pediatric pulmonary hypertension (PHT) is a severe condition requiring early diagnosis to prevent right ventricular failure.
- Computed tomography angiography (CTA) is increasingly used to assess vascular changes indicative of PHT, such as main pulmonary artery (MPA) dilatation.
Purpose of the Study:
- To evaluate the diagnostic utility of main pulmonary artery-to-ascending aorta (MPA/AA) and main pulmonary artery-to-descending aorta (MPA/DA) ratios derived from CTA in pediatric patients with PHT.
- To determine the accuracy of these CTA-derived ratios as non-invasive markers for pediatric PHT.
Main Methods:
- Retrospective cohort study of 76 pediatric patients who underwent cardiac catheterization and thoracic CTA.
- Patients were categorized into PHT (mean pulmonary artery pressure ≥ 25 mmHg) and non-PHT groups.
- MPA/AA and MPA/DA ratios were calculated from CTA measurements; statistical analysis included Mann-Whitney U tests and ROC curve analysis.
Main Results:
- Significantly higher MPA diameter and MPA/AA and MPA/DA ratios were observed in the PHT group compared to controls (p < 0.05).
- ROC analysis demonstrated strong diagnostic performance for both ratios.
- The MPA/DA ratio achieved an AUC of 0.927 (78.5% sensitivity, 94% specificity), and the MPA/AA ratio achieved an AUC of 0.896 (76.5% sensitivity, 95% specificity).
Conclusions:
- Both MPA/AA and MPA/DA ratios are reliable non-invasive indicators for diagnosing pediatric PHT.
- The MPA/DA ratio exhibited slightly superior diagnostic accuracy compared to the MPA/AA ratio.
- CTA-derived vascular ratios, particularly MPA/DA, are effective screening tools in clinical practice for pediatric PHT.
Abstract:
Background: Pulmonary hypertension (PHT) is a rare but serious condition in children, requiring early diagnosis to prevent right ventricular failure. Non-invasive imaging modalities such as computed tomography angiography (CTA) have gained importance in assessing vascular changes, including main pulmonary artery (MPA) dilatation, increased vessel stiffness, and elevated pulmonary vascular resistance, which are characteristic of pulmonary hypertension (PHT). Objective: This study aimed to evaluate the diagnostic value of the main pulmonary artery-to-ascending aorta (MPA/AA) and main pulmonary artery-to-descending aorta (MPA/DA) ratios on CTA in pediatric patients with confirmed PHT. Methods: In this retrospective cohort study, 76 pediatric patients who underwent both cardiac catheterization and thoracic CTA were included. Patients were divided into PHT (mean pulmonary artery pressure ≥ 25 mmHg) and non-PHT groups. Vascular measurements were obtained from CTA, and MPA/AA and MPA/DA ratios were calculated. Statistical analyses included Mann-Whitney U tests and ROC curve analysis. Results: The MPA diameter and MPA/AA and MPA/DA ratios were significantly higher in the PHT group compared to controls (p < 0.05). ROC analysis showed strong diagnostic performance for both ratios. The MPA/DA ratio had an AUC of 0.927 with 78.5% sensitivity and 94% specificity at a cut-off value of 1.85. The MPA/AA ratio had an AUC of 0.896 with 76.5% sensitivity and 95% specificity at a cut-off value of 1.25. Conclusions: Both MPA/AA and MPA/DA ratios are reliable non-invasive indicators of pediatric PHT, with the MPA/DA ratio demonstrating slightly higher diagnostic accuracy. These findings support the use of CTA-derived vascular ratios, especially MPA/DA, as effective screening tools in clinical practice.
