Pulmonary trunk to ascending aorta ratio and reference values for diameters of pulmonary arteries and main bronchi in healthy adults

Abstract

Objectives: The ratio of the diameter of pulmonary trunk (PT) to the diameter of the ascending aorta (AA) is used to evaluate cardiopulmonary diseases. Different values have been reported for the normal value of PT:AA ratio (to be less than 0.9, 1 or 1.4). In this study, we aimed to investigate the diameters of the PT, right (RPA) and left pulmonary artery (LPA), AA, right (RMB) and left main bronchus LMB) using multidetector computed tomography (MDCT) and to determine reference values for PT:AA according to age and sex in normal healthy adults. Methods: Thoracic CT images of 200 individuals, (103 males, 97 females; age 18–89 years), without cardiopulmonary pathology and surgery, were retrospectively evaluated using MDCT. Diameters of PT, RPA, LPA, AA were measured at the level of the pulmonary artery bifurcationand PT:AA ratio was calculated. Results: The mean diameters of PT, AA, RPA, LPA, RMB, LMB were found as 2.7±0.51 cm, 3.25±0.63 cm, 1.98±0.46 cm, 1.81±0.43 cm, 1.73±0.35 cm, and 1.66±0.55 cm, respectively. The mean value of PT:AA ratio was 0.84±0.18 cm in males and 0.86±0.13 cm in females. Conclusion: Determining the normal values of related measurements will contribute to diagnosis and treatment of cardiopulmonary diseases.

Keywords

• ascending aorta
• MDCT
• pulmonary trunk

References

1. Tubbs RS, Shoja MM, Loukas M (eds). Bergman’s comprehensive encyclopedia of human anatomic variation. Hoboken (NJ): John Wiley & Sons, Inc; 2016.
2. Frechette E, Deslauriers J. Surgical anatomy of the bronchial tree and pulmonary artery. Semin Thorac Cardiovasc Surg 2006;18:77–84.
3. Ugalde P, Miro S, Frechette E, Deslauriers J. Correlative anatomy for thoracic inlet; glottis and subglottis; trachea, carina, and main bronchi; lobes, fissures, and segments; hilum and pulmonary vascular system; bronchial arteries and lymphatics. Thorac Surg Clin 2007;17:639–59.
4. Nakanishi R, Rana JS, Shalev A, Gransar H, Hayes SW, Labounty TM, Dey D, Peats RM, E.J. T, Friedman JD, Abidov A, Min JK, Berman DS. Mortality risk as a function of the ratio of pulmonary trunk to ascending aorta diameter in patients with suspected coronary artery disease. Am J Cardiol 2013;111:1259-63.
5. Dou S, Zheng C, Ji X, Wang W, Xie M, Cui L, Xiao W. Co-existence of COPD and bronchiectasis: a risk factor for a high ratio of main pulmonary artery to aorta diameter (PA:A) from computed tomography in COPD patients. Int J Chron Obstruct Pulmon Dis 2018;13:675-81.
6. Lee SH, Kim YJ, Lee HJ, Kim HY, Kang YA, Park MS, Kim YS, Kim SK, Chang J, Jung JY. Comparison of CT-determined pulmonary artery diameter, aortic diameter, and their ratio in healthy and diverse clinical conditions. PLoS One 2015;10:e0126646.
7. Wells JM, Washko GR, Han MK, Abbas N, Nath H, Mamary AJ, Regan E, Bailey WC, Martinez FJ, Westfall E, Beaty TH, Curran-Everett D, Curtis JL, Hokanson JE, Lynch DA, Make BJ, Crapo JD, Silverman EK, Bowler RP, Dransfield MT, Investigators COPDGene, Investigators ES. Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med 2012;367:913-21.
8. Rho JY, Lynch DA, Suh YJ, Nah JW, Zach JA, Schroeder JD, Cox CW, Bowler RP, Fenster BE, Dransfield MT, Wells JM, Hokanson JE, Curran-Everett D, Williams A, Han MK, Crapo JD, Silverman EK. CT measurements of central pulmonary vasculature as predictors of severe exacerbation in COPD. Medicine (Baltimore) 2018;97:e9542.

9. Iyer AS, Wells JM, Vishin S, Bhatt SP, Wille KM, Dransfield MT. CT scan-measured pulmonary artery to aorta ratio and echocardiography for detecting pulmonary hypertension in severe COPD. Chest 2014;145:824-32.
10. de-Torres JP, Ezponda A, Alcaide AB, Campo A, Berto J, Gonzalez J, Zulueta JJ, Casanova C, Rodriguez-Delgado LE, Celli BR, Bastarrika G. Pulmonary arterial enlargement predicts long-term survival in COPD patients. PLoS One 2018;13:e0195640.
11. Mi W, Zhang C, Wang H, Cao J, Li C, Yang L, Guo F, Wang X, Yang T. Measurement and analysis of the tracheobronchial tree in Chinese population using computed tomography. PLoS One 2015;10:e0123177.
12. Hautmann H, Gamarra F, Henke M, Diehm S, Huber RM. High Frequency Jet Ventilation in Interventional Fiberoptic Bronchoscopy. Anesth Analg 2000;90:1436-40.
13. Buist AS, McBurnie MA, Vollmer WM, Gillespie S, Burney P, Mannino DM, Menezes AMB, Sullivan SD, Lee TA, Weiss KB, Jensen RL, Marks GB, Gulsvik A, Nizankowska-Mogilnicka E. International variation in the prevalence of COPD (The BOLD Study): a population-based prevalence study. Lancet 2007;370:741-50.
14. Pellicori P, Urbinati A, Zhang J, Joseph AC, Costanzo P, Lukaschuk E, Capucci A, Cleland JGF, Clark AL. Clinical and prognostic relationships of pulmonary artery to aorta diameter ratio in patients with heart failure: a cardiac magnetic resonance imaging study. Clin Cardiol 2018;41:20-7.
15. Edwards PM, Bull RK, Coulden R. CT measurement of main pulmonary artery diameter. The British Journal of Radiology 1998;71:1018-20.
16. Compton GL, Florence J, MacDonald C, Yoo SJ, Humpl T, Manson D. Main Pulmonary Artery-to-Ascending Aorta Diameter Ratio in Healthy Children on MDCT. AJR Am J Roentgenol 2015;205:1322-5.
17. Caro-Dominguez P, Compton G, Humpl T, Manson DE. Pulmonary arterial hypertension in children: diagnosis using ratio of main pulmonary artery to ascending aorta diameter as determined by multi-detector computed tomography. Pediatr Radiol 2016;46:1378-83.
18. Sugimoto K, Nakazato K, Sakamoto N, Yamaki T, Kunii H, Yoshihisa A, Suzuki H, Saitoh S, Takeishi Y. Pulmonary artery diameter predicts lung injury after balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension. Int Heart J 2017;58:584-8.
19. Tonelli AR, Johnson S, Alkukhun L, Yadav R, Dweik RA. Changes in main pulmonary artery diameter during follow-up have prognostic implications in pulmonary arterial hypertension. Respirology 2017;22:1649-55.
20. Raymond TE, Khabbaza JE, Yadav R, Tonelli AR. Significance of main pulmonary artery dilation on imaging studies. Ann Am Thorac Soc 2014;11:1623-32.
21. Chung KS, Kim YS, Kim SK, Kim HY, Lee SM, Seo JB, Oh YM, Jung JY, Lee SD, Korean Obstructive Lung Disease study group. Functional and prognostic implications of the main pulmonary artery diameter to aorta diameter ratio from chest computed tomography in Korean COPD patients. PLoS One 2016;11:e0154584.
22. Ando K, Kuraishi H, Nagaoka T, Tsutsumi T, Hoshika Y, Kimura T, Ienaga H, Morio Y, Takahashi K. Potential role of ct metrics in chronic obstructive pulmonary disease with pulmonary hypertension. Lung 2015;193:911-8.
23. Truong QA, Bhatia HS, Szymonifka J, Zhou Q, Lavender Z, Waxman AB, Semigran MJ, Malhotra R. A four-tier classification system of pulmonary artery metrics on computed tomography for the diagnosis and prognosis of pulmonary hypertension. J Cardiovasc Comput Tomogr 2018;12:60-6.
24. Kim D, Son JS, Ko S, Jeong W, Lim H. Measurements of the length and diameter of main bronchi on three-dimensional images in Asian adult patients in comparison with the height of patients. J Cardiothorac Vasc Anesth 2014;28:890-5.
25. Javidan-Nejad C. MDCT of trachea and main bronchi. Thorac Surg Clin 2010;20:65-84.
26. Boiselle PM, Ernst A. State-of-the-art imaging of the central airways. Respiration 2003;70:383-94.
27. Sauret V, Halson PM, Brown W, Fleming JS, Bailey AG. Study of the three-dimensional geometry of the central conducting airways in man using computed tomographic (CT) images. J Anat 2002;200:123-34.
28. Montaudon M, Desbarats P, Berger P, Dietrich G, Marthan R, Laurent F. Assessment of bronchial wall thickness and lumen diameter in human adults using multi-detector computed tomography: comparison with theoretical models. J Anat 2007;211:579-88.