Diagnosis of Pulmonary Arterial Hypertension in Children by Using Cardiac Computed Tomography.
OBJECTIVE
To establish diagnostic criteria for pulmonary arterial hypertension (PAH) in children by using parameters obtained through noninvasive cardiac computed tomography (CCT).


MATERIALS AND METHODS
We retrospectively measured parameters from CCT images of children from a single institution in a multiple stepwise process. A total of 208 children with mean age of 10.5 years (range: 4 days-18.9 years) were assessed. The variables were classified into three groups: the great arteries; the ventricular walls; and the bilateral ventricular cavities. The relationship between the parameters obtained from the CCT images and mean pulmonary arterial pressure (mPAP) was tested and adjusted by the children's body size. Reference curves for the pulmonary trunk diameter (PTD) and ratio of diameter of pulmonary trunk to ascending aorta (rPTAo) of children with CCT images of normal hearts, adjusted for height, were plotted. Threshold lines were established on the reference curves.


RESULTS
PTD and rPTAo on the CCT images were significantly positively correlated with mPAP (r > 0.85, p < 0.01). Height was the body size parameter most correlated with PTD (r = 0.91, p < 0.01) and rPTAo (r = -0.69, p < 0.01). On the basis of the threshold lines on the reference curves, PTD and rPTAo both showed 88.9% sensitivity for PAH diagnosis, with negative predictive values of 93.3% and 92.9%, respectively.


CONCLUSION
PTD and rPTAo measured from CCT images were significantly correlated with mPAP in children. Reference curves and the formula of PTD and rPTAo adjusted for height could be practical for diagnosing PAH in children.
['Chen|Shyh Jye|SJ|0000-0001-6181-011X', 'Huang|Jou Hsuan|JH|', 'Lee|Wen Jeng|WJ|', 'Lin|Ming Tai|MT|0000-0002-1718-7137', 'Chen|Yih Sharng|YS|', 'Wang|Jou Kou|JK|']
D000293:Adolescent D001011:Aorta D002648:Child D002675:Child, Preschool D005260:Female D006352:Heart Ventricles D006801:Humans D007223:Infant D007231:Infant, Newborn D008297:Male D000081029:Pulmonary Arterial Hypertension D011651:Pulmonary Artery D011859:Radiography D012189:Retrospective Studies D014057:Tomography, X-Ray Computed
Pulmonary arterial hypertension Children Computed tomography