title: Cardiovascular CT in the diagnosis of pericardial constriction: predictive value of inferior vena cava cross-sectional area.
abstract: BACKGROUND
  The diagnosis of pericardial constriction remains challenging.
  
  
  OBJECTIVE
  We sought to evaluate the predictive value of cardiovascular CT-based measurements of inferior vena cava (IVC) parameters in the diagnosis of pericardial constriction.
  
  
  METHODS
  Forty-two consecutive patients referred for assessment of pericardial constriction by 64-slice CT were evaluated. The diagnosis of pericardial constriction was confirmed by clinical history, echocardiography, cardiac catheterization, intraoperative findings, histopathology, or a combination. Diameter and cross-sectional area of the suprahepatic IVC and cross-sectional area of the aorta were measured on a single-axial CT image at the level of the esophageal hiatus. Maximum pericardial thickness was measured. Logistic regression and receiver operating curve analyses were performed.
  
  
  RESULTS
  Twenty-two patients had pericardial constriction. Mean age of the 42 patients was 57.1 ± 16.4 years, 57.1% were men. IVC diameter, IVC area, the ratio of IVC to aortic area, and pericardial thickness were all significantly greater in patients with constriction than in patients without (P < .05 for all). IVC-to-aortic area ratio had the highest odds ratio (51; 95% CI, 2.8-922) for the prediction of constriction and remained a significant predictor in multivariable analysis. In nested models, IVC-to-aortic area ratio had incremental value over pericardial thickness for the diagnosis of constriction. IVC-to-aortic area ratio discriminated between patients with and without constriction with an area under the curve of 0.88 on receiver operating curve analysis, with a value ≥ 1.6 having a sensitivity and specificity of 95% and 76%, respectively. Interobserver agreement for IVC-to-aortic area ratio was excellent (intraclass correlation coefficient, 0.98).
  
  
  CONCLUSIONS
  Assessment of IVC-to-aortic area ratio on CT aids with the diagnosis of pericardial constriction and has independent and incremental value over pericardial thickness alone.
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Kate
authors.initials: K
authors.lastname: Hanneman
authors.affiliation: Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Paaladinesh
authors.initials: P
authors.lastname: Thavendiranathan
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Elsie T
authors.initials: ET
authors.lastname: Nguyen
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Hadas
authors.initials: H
authors.lastname: Moshonov
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Narinder S
authors.initials: NS
authors.lastname: Paul
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Wintersperger
authors.affiliation: Department of Medical Imaging, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada; Division of Cardiology, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada. Electronic address: andrew.crean@uhn.ca.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Crean
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D003250:Constriction; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D015588:Observer Variation; D016017:Odds Ratio; D010496:Pericardium / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*
keywords: Cardiac imaging techniques; Computed tomography; Constrictive; Inferior; Pericarditis; Pericardium; Vena cava