UMMS Affiliation

Department of Radiology

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Analytical, Diagnostic and Therapeutic Techniques and Equipment | Radiology | Respiratory Tract Diseases


Purpose: To determine the accuracy of quantitative CT to diagnose pulmonary edema compared to qualitative CT and CXR and to determine a threshold Hounsfield unit (HU) measurement for pulmonary edema on CT examinations.

Method: Electronic medical records were searched for patients with a billing diagnosis of heart failure and a Chest CT and CXR performed within three hours between 1/1/2016 to 10/1/2016, yielding 100 patients. CXR and CT examinations were scored for the presence and severity of edema, using a 0-5 scale, and CT HU measurements were obtained in each lobe. Polyserial correlation coefficients evaluated the association between CT HUs and CXR scores, and receiver operating characteristic (ROC) curve analysis determined a cutoff CT HU value for identification of pulmonary edema.

Results: Correlation between CT HU and CXR score was moderately strong (r=0.585-0.685) with CT HU measurements demonstrating good to excellent accuracy in differentiating between no edema (grade 0) and mild to severe edema (grades 1-5) in every lobe, with AUCs ranging between 0.869 and 0.995. The left upper lobe demonstrated the highest accuracy, using a cutoff value of -825 HU (AUC of 0.995, sensitivity=100 % and specificity=95.1 %). Additionally, qualitative CT evaluation was less sensitive (84 %) than portable CXR in identifying pulmonary edema. However, quantitative CT evaluation was as sensitive as portable CXR (100 %) and highly specific (95 %).

Conclusions: Quantitative CT enables the identification of pulmonary edema with high accuracy and demonstrates a greater sensitivity than qualitative CT in assessment of pulmonary edema.


AUC, area under the curve, CT, CT, computed tomography, CXR, chest X-ray, Chest radiograph, HU, hounsfield unit, Pulmonary edema, Quantitative CT, R, correlation coefficient, ROC, receiver operating characteristic, ROI, region of interest

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© 2020 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (

DOI of Published Version



Barile M, Hida T, Hammer M, Hatabu H. Simple quantitative chest CT for pulmonary edema. Eur J Radiol Open. 2020 Oct 30;7:100273. doi: 10.1016/j.ejro.2020.100273. PMID: 33163584; PMCID: PMC7607389. Link to article on publisher's site

Journal/Book/Conference Title

European journal of radiology open

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Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.