title: The right sided great vessels by cardiac multidetector computed tomography: normative reference values among healthy adults free of cardiopulmonary disease, hypertension, and obesity.
abstract: OBJECTIVE
  We sought to derive normative reference values for the thoracic great vessels using multidetector computed tomography (MDCT) in a healthy normotensive non-obese population free of cardiovascular disease.
  
  
  METHODS
  Non-gated axial computed tomography (CT) of the chest has traditionally been used to evaluate normal great vessel anatomy for prognosis and management. However, non-gated axial chest CT cannot account for the obliquity, systolic expansion, and non-axial motion of the great vessels during the cardiac cycle and may misclassify patients as normal or abnormal for prognostic and management purposes. To date, normative reference values for double-oblique, short-axis great vessel diameters have not been established using current generation electrocardiogram (ECG)-gated 64-detector row MDCT. A total of 103 (43% women, age 51 +/- 14 years) consecutive normotensive, non-obese adults free of cardiopulmonary or great vessel structural disease, arrhythmias, or significant coronary artery disease were studied by MDCT. Individuals underwent examination for determination of end-diastolic (ED) pulmonary artery (PA) and superior vena cava (SVC) dimensions in double-oblique short axes for comparison with the ascending aorta and the right-sided cardiac chambers.
  
  
  RESULTS
  For right sided great vessels, the 5th to 95th interval was 1.89-3.03 cm for ED PA diameter and 1.08-4.42 cm(2) for SVC cross-sectional area. The pulmonary artery to ascending aortic (PA-to-Ao) ratio was 0.66-1.13. In multivariate analysis, the PA was significantly associated with weight, whereas the PA-to-Ao ratio was inversely associated with age. Axial PA measurements were significantly higher and PA-to-Ao measurements significantly lower than corresponding short axis measurements (P = .04 and P < .001, respectively).
  
  
  CONCLUSIONS
  This study establishes ECG-gated MDCT reference values for right-sided great vessel dimensions derived from a healthy population of individuals free of cardiovascular disease, hypertension, and obesity. The traditional axial PA-to-Ao discriminant value of 1 for pulmonary hypertension is a poor diagnostic tool because it encompasses normal patients and is negatively affected by age. Thoracic great vessels should be measured by CT in ECG-gated double-oblique short-axis for accurate quantitation. These data may serve as a reference to identify right-sided great vessel pathology in individuals being referred for ECG-gated MDCT imaging.
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York Presbyterian Hospital, 520 E 70th Street, New York, NY 10021, USA.
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
authors.forename: Joyce
authors.initials: J
authors.lastname: Meng
authors.forename: Veronica M
authors.initials: VM
authors.lastname: Jow
authors.forename: Lauren
authors.initials: L
authors.lastname: Simprini
authors.forename: Avrum
authors.initials: A
authors.lastname: Jacobs
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
authors.forename: Leslee J
authors.initials: LJ
authors.lastname: Shaw
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Berman
authors.forename: Tracy Q
authors.initials: TQ
authors.lastname: Callister
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000792:Angiography / Q000379:methods*; D049628:Body Size; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009518:New York; D009765:Obesity / Q000000981:diagnostic imaging; D010690:Phlebography / Q000379:methods*; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D013902:Radiography, Thoracic / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*