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Relationship of Main Pulmonary Artery Diameter to Pulmonary Arterial Pressure in Scleroderma Patients With and Without Interstitial Fibrosis

McCall, Robert K. MD, MSCR; Ravenel, James G. MD; Nietert, Paul J. PhD; Granath, Aleksandra MD, PhD; Silver, Richard M. MD

Journal of Computer Assisted Tomography: March/April 2014 - Volume 38 - Issue 2 - p 163–168
doi: 10.1097/RCT.0b013e3182aa7fc5
Cardiovascular & Thoracic Imaging

Objective This study aimed to determine the relationship between main pulmonary artery diameter (MPAD) and pulmonary hypertension (PH) in scleroderma patients with and without interstitial lung disease.

Methods We retrospectively reviewed 48 subjects with scleroderma who underwent a chest computed tomography (CT) and right heart catheterization with 6 months of each other. Patients were divided into 2 groups based on the absence or presence of interstitial lung disease on chest CT. Subset analysis was performed based on available pulmonary function tests and divided into groups by forced vital capacity (FVC). Computed tomographic scans were scored for extent of fibrosis and ground glass opacity. Pulmonary artery and ascending aorta measurements were obtained by 2 independent observers. Univariate and multivariate models were used to evaluate the correlation between MPAD and mean pulmonary artery pressure (mPAP) measured by right heart catheterization. Receiver operating characteristic analysis was performed for diagnostic accuracy of the MPAD measurement in predicting PH.

Results Strong correlations between mPAP and MPAD were found in this study regardless of the presence or absence of mild to moderate interstitial fibrosis on chest CT. When dividing patients based on FVC, the correlation between mPAP and MPAD was substantially attenuated. An MPAD value of 30.8 mm yielded the highest sensitivity and specificity at 81.3% and 87.5%, respectively.

Conclusions In scleroderma patients, an enlarged main pulmonary artery (>30 mm) predicts PH even in the presence of mild to moderate fibrosis although the relationship may be attenuated in the presence of a low % FVC.

From the *Division of Rheumatology, Department of Medicine, †Department of Radiology and Radiologic Sciences, and ‡Division of Biostatistics and Epidemiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.

Received for publication July 16, 2013; accepted September 6, 2013.

Reprints: James G. Ravenel, MD, Department of Radiology and Radiologic Sciences, Medical University of South Carolina, 96 Jonathan Lucas St, MSC323, Charleston, SC 29425 (e-mail:

PJN and RMS were supported in part by a Multidisciplinary Clinical Research Center grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (Grant P60AR049459).

The authors declare no conflicts of interest.

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