Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging

Abstract Background Cardiothoracic ratio (CTR) in chest radiographs is still widely used to estimate cardiac size despite the advent of newer imaging techniques. We hypothesise that a universal CTR cut-off value of 50% is a poor indicator of cardiac enlargement. Our aim was to compare CTR with volum...

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Autores principales:	Paulius Simkus, Manuel Gutierrez Gimeno, Audra Banisauskaite, Jurate Noreikaite, David McCreavy, Diana Penha, Monika Arzanauskaite
Formato:	article
Lenguaje:	EN
Publicado:	SpringerOpen 2021
Materias:	Cardiothoracic ratio Cardiac magnetic resonance imaging Chest radiograph Cardiac imaging Medical physics. Medical radiology. Nuclear medicine R895-920
Acceso en línea:	https://doaj.org/article/428709566f6e42a583f8669943c6a1c9
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spelling	oai:doaj.org-article:428709566f6e42a583f8669943c6a1c92021-11-07T12:14:28ZLimitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging10.1186/s13244-021-01097-01869-4101https://doaj.org/article/428709566f6e42a583f8669943c6a1c92021-11-01T00:00:00Zhttps://doi.org/10.1186/s13244-021-01097-0https://doaj.org/toc/1869-4101Abstract Background Cardiothoracic ratio (CTR) in chest radiographs is still widely used to estimate cardiac size despite the advent of newer imaging techniques. We hypothesise that a universal CTR cut-off value of 50% is a poor indicator of cardiac enlargement. Our aim was to compare CTR with volumetric and functional parameters derived from cardiac magnetic resonance imaging (MRI). Methods 309 patients with a chest radiograph and cardiac MRI acquired within a month were reviewed to assess how CTR correlates with multiple cardiac MRI variables: bi-ventricular EDV (absolute and indexed to body surface area), EF, indexed total heart volume and bi-atrial areas. In addition, we have also determined CTR accuracy by creating multiple ROC curves with the described variables. Results All cardiac MRI variables correlate weakly but statistically significantly with CTR. This weak correlation is explained by a substantial overlap of cardiac MRI parameters in patients with normal and increased CTR. For all variables, CTR was only mildly to moderately better than a chance to discriminate cardiac enlargement (AUC 0.6–0.7). Large CTR values (> 55%) are specific but not sensitive, while low CTR values (< 45%) are sensitive but not specific. Values in between are not sensitive nor specific. Conclusions CTR correlates weakly with true chamber size assessed by gold standard cardiac MRI and has a weak discriminatory power. Thus, clinical decisions based on intermediate CTRs (45–55%) should be avoided. Large CTRs (> 55%) are likely indicative of true heart chamber enlargement. Low CTRs (< 45%) are likely indicative of normal heart size.Paulius SimkusManuel Gutierrez GimenoAudra BanisauskaiteJurate NoreikaiteDavid McCreavyDiana PenhaMonika ArzanauskaiteSpringerOpenarticleCardiothoracic ratioCardiac magnetic resonance imagingChest radiographCardiac imagingMedical physics. Medical radiology. Nuclear medicineR895-920ENInsights into Imaging, Vol 12, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Cardiothoracic ratio Cardiac magnetic resonance imaging Chest radiograph Cardiac imaging Medical physics. Medical radiology. Nuclear medicine R895-920
spellingShingle	Cardiothoracic ratio Cardiac magnetic resonance imaging Chest radiograph Cardiac imaging Medical physics. Medical radiology. Nuclear medicine R895-920 Paulius Simkus Manuel Gutierrez Gimeno Audra Banisauskaite Jurate Noreikaite David McCreavy Diana Penha Monika Arzanauskaite Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging
description	Abstract Background Cardiothoracic ratio (CTR) in chest radiographs is still widely used to estimate cardiac size despite the advent of newer imaging techniques. We hypothesise that a universal CTR cut-off value of 50% is a poor indicator of cardiac enlargement. Our aim was to compare CTR with volumetric and functional parameters derived from cardiac magnetic resonance imaging (MRI). Methods 309 patients with a chest radiograph and cardiac MRI acquired within a month were reviewed to assess how CTR correlates with multiple cardiac MRI variables: bi-ventricular EDV (absolute and indexed to body surface area), EF, indexed total heart volume and bi-atrial areas. In addition, we have also determined CTR accuracy by creating multiple ROC curves with the described variables. Results All cardiac MRI variables correlate weakly but statistically significantly with CTR. This weak correlation is explained by a substantial overlap of cardiac MRI parameters in patients with normal and increased CTR. For all variables, CTR was only mildly to moderately better than a chance to discriminate cardiac enlargement (AUC 0.6–0.7). Large CTR values (> 55%) are specific but not sensitive, while low CTR values (< 45%) are sensitive but not specific. Values in between are not sensitive nor specific. Conclusions CTR correlates weakly with true chamber size assessed by gold standard cardiac MRI and has a weak discriminatory power. Thus, clinical decisions based on intermediate CTRs (45–55%) should be avoided. Large CTRs (> 55%) are likely indicative of true heart chamber enlargement. Low CTRs (< 45%) are likely indicative of normal heart size.
format	article
author	Paulius Simkus Manuel Gutierrez Gimeno Audra Banisauskaite Jurate Noreikaite David McCreavy Diana Penha Monika Arzanauskaite
author_facet	Paulius Simkus Manuel Gutierrez Gimeno Audra Banisauskaite Jurate Noreikaite David McCreavy Diana Penha Monika Arzanauskaite
author_sort	Paulius Simkus
title	Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging
title_short	Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging
title_full	Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging
title_fullStr	Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging
title_full_unstemmed	Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging
title_sort	limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging
publisher	SpringerOpen
publishDate	2021
url	https://doaj.org/article/428709566f6e42a583f8669943c6a1c9
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Limitations of cardiothoracic ratio derived from chest radiographs to predict real heart size: comparison with magnetic resonance imaging

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