Eight-Step CT Guide Simplifies Diagnosis of Pulmonary Hypertension, Suggests Review
A recent review in the Indian Journal of Radiology and Imaging in August 2025 simplifies the diagnosis of pulmonary hypertension by introducing a practical, eight-step CT imaging guide. The step-by-step approach helps clinicians easily confirm high pulmonary pressures, identify the underlying causes, and spot hidden complications.
Pulmonary hypertension (PH) often presents with nonspecific symptoms and early-stage imaging findings that are easily missed, creating a significant diagnostic hurdle. To bridge this clinical gap, Dr. Aparna Irodi and colleagues from Christian Medical College in Vellore, India, outline a stepwise thoracic CT review method empowering clinicians to accurately diagnose PH, assess disease severity, and identify specific etiological patterns.
Therefore, the clinical review synthesizes established radiological data into a practical 8-step CT evaluation algorithm. The primary goal is to accurately confirm pulmonary hypertension (PH) and stratify patient risk. Secondarily, the framework systematically guides clinicians in identifying or ruling out specific underlying causes—including pulmonary, cardiac, vascular, congenital, and infradiaphragmatic etiologies—across all patient profiles.
Key Clinical Findings of the Review Includes:
• Arterial Dilatation: Evaluating scans, the researchers highlighted that a main pulmonary artery (MPA) diameter of 29 mm or greater provides 89% specificity and 97% positive predictive value for diagnosing PH.
• Ventricular Decompensation: Assessing cardiac structures, the review demonstrated that right ventricular (RV) hypertrophy thicker than 4 mm and an RV to left ventricle (LV) ratio greater than 0.9 indicate severe disease progression.
• Occlusion Detection: Highlighting advanced techniques, the investigators noted that dual-energy computed tomography (DECT) with iodine-selective maps achieves 100% sensitivity and specificity for chronic thromboembolic pulmonary hypertension (CTEPH).
• Shunt Identification: Analyzing hemodynamics, the authors emphasized that undetected left-to-right shunts, particularly sinus venosus atrial septal defects (ASDs), require careful tracing of anomalous veins to the superior vena cava (SVC).
• Extracardiac Complications: Reviewing advanced states, the paper revealed that dilated MPAs can precipitate complications like Ortner’s syndrome from recurrent laryngeal nerve compression.
The results suggest that utilizing a structured, eight-step CT interpretation algorithm significantly enhances the clinician's ability to not only diagnose PH through primary indicators, like an MPA to ascending aorta ratio of 1 or greater, but also to accurately unearth the root etiological factors.
Thus, the review concludes that for practicing healthcare professionals, adopting the systematic radiological approach may provide a more reliable framework for early etiological differentiation, thereby potentially guiding more timely and targeted therapeutic interventions for right heart failure or chronic pulmonary embolism.
Although CT inherently possesses a limited capacity to evaluate dynamic functional cardiac status compared to the gold standard of right heart catheterization, it would be beneficial for future research to explore artificial intelligence (AI) models like texture analysis and automated perfusion mapping to optimize noninvasive diagnostic workflows.
Reference
Eapen, K. C., Mane, M., Vimala, L. R., Sahu, S., Rebecca, P. G., & Irodi, A. (2025). A Stepwise Approach to Computed Tomography Imaging of Pulmonary Hypertension. Indian Journal of Radiology and Imaging, 36, 300–315.
