The cardiothoracic ratio on postmortem CT as a screening tool for cardiomegaly in the Thai population.

Abstract

Introduction

In forensic radiology, the cardiothoracic ratio (CTR) calculated from postmortem computed tomography (PMCT) images can be used to detect cardiomegaly. In this study, a new measurement method is studied that involves measurement in the anteroposterior (AP) and transverse directions, with a reference level based on the Thai population.

Objective

To screen for cardiomegaly using the CTR calculated from PMCT images.

Research method

A sample size of 116 deceased Thai individuals who underwent PMCT before autopsy was obtained. Individuals were divided into two groups: normal heart weight and overweight heart. Hearts heavier than the mean plus one standard deviation were categorized into the overweight group. The CTR was calculated in both the AP and transverse directions at six reference levels. Receiver operating characteristic curves (ROC) were calculated to determine the CTR cutoff point for the diagnosis of cardiomegaly.

Results

The CTR cutoff values for diagnosing cardiomegaly were as follows: 1) CTR >0.5 in the transverse direction at the mid-vertebra of T7 (sensitivity, 75.6%; specificity, 70.6%; area under the ROC curve 0.81), 2) CTR >0.49 in the transverse direction at the mid-vertebra of T8 (sensitivity 71%, specificity 81.4%, area under the ROC curve 0.80). The selection of the cutoff values depended on the location of the heart. The area under the ROC curve in the AP direction was in the range 0.5-0.7, which is inferior compared to the transverse direction (0.7-0.9).

Conclusion

Calculating the CTR with a reference level on PMCT images can assist in the diagnosis of cardiomegaly.