title: Massive hemoptysis: prediction of nonbronchial systemic arterial supply with chest CT.
abstract: OBJECTIVE
  To evaluate the diagnostic accuracy of chest computed tomography (CT) in the prediction of a nonbronchial systemic arterial supply in patients with massive hemoptysis.
  
  
  METHODS
  Forty consecutive patients with massive hemoptysis underwent contrast material-enhanced CT. Massive hemoptysis was defined as the expectoration of 300-600 mL of blood per day. Two CT features were considered to be suggestive of a nonbronchial systemic arterial supply: (a) pleural thickness of more than 3 mm adjacent to the parenchymal lesion and (b) enhancing vascular structures within the extrapleural fat layer. Conventional angiography was used as the standard of reference. CT scans were evaluated by two radiologists in consensus. The CT findings were compared with those of conventional angiography. The sensitivity, specificity, predictive values, and accuracy of CT for predicting the presence of a nonbronchial systemic arterial supply were assessed.
  
  
  RESULTS
  In the determination of a nonbronchial systemic arterial supply, CT had a sensitivity of 80%, specificity of 84%, positive predictive value of 73%, negative predictive value of 91%, and accuracy of 84%. Sensitivity was highest for predicting the branches of subclavian and axillary arterial supply and was lowest for predicting the internal mammary arterial supply. Specificity and accuracy were highest for predicting the intercostal arterial supply.
  
  
  CONCLUSIONS
  CT demonstrates acceptable sensitivity, specificity, and accuracy in the prediction of a nonbronchial systemic arterial supply in patients with massive hemoptysis.
authors.affiliation: Department of Diagnostic Radiology, Chonnam National University Medical School, Chonnam National University Hospital, 8 Hak-1-dong, Dong-gu, Gwangju 501-757, South Korea. radyoon@cnuh.com
authors.forename: Woong
authors.initials: W
authors.lastname: Yoon
authors.forename: Yun Hyeon
authors.initials: YH
authors.lastname: Kim
authors.forename: Jae Kyu
authors.initials: JK
authors.lastname: Kim
authors.forename: Young Cheol
authors.initials: YC
authors.lastname: Kim
authors.forename: Jin Gyoon
authors.initials: JG
authors.lastname: Park
authors.forename: Heoung Keun
authors.initials: HK
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001981:Bronchial Arteries; D005260:Female; D006469:Hemoptysis / Q000209:etiology*; D006801:Humans; D008168:Lung / Q000098:blood supply* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed