Diagnostic Value of Computed Tomography Angiography for Detecting Bronchial Artery‐Pulmonary Artery Fistula in Patients With Hemoptysis and Findings Associated With Its Presence

ABSTRACT Background Hemoptysis patients with bronchial artery–pulmonary artery fistula (BPF) have a high incidence of poor prognosis. This study aimed to evaluate the diagnostic performance of computed tomography angiography (CTA) for detecting BPF in hemoptysis patients and to compare the clinical characteristics and computed tomography (CT) findings between patients with and without BPF. Methods We retrospectively enrolled 201 consecutive patients with hemoptysis who underwent bronchial arterial embolization in our hospital from January 2020 to November 2020. The clinical characteristics, preprocedural CT findings, and digital subtraction angiography (DSA) findings were recorded. Patients were categorized into BPF‐positive and BPF‐negative groups based on DSA results. The diagnostic accuracy of CTA for BPF detection was evaluated against that of DSA using receiver operating characteristic curve analysis. Differences in clinical and CT parameters between the two groups were assessed. Multivariate logistic regression analysis was used to discover the independent factors associated with the presence of BPF. Results Among 201 patients with hemoptysis, DSA identified BPF in 75, while CTA identified BPF in 65. The diagnostic agreement between CTA and DSA for BPF detection was excellent (Kappa coefficient: κ = 0.825, p < 0.001). CTA demonstrated high sensitivity (0.827), specificity (0.976), and accuracy (0.920) for BPF detection. Multivariate logistic analysis identified the severity of pulmonary parenchymal lesion and bronchial artery tortuosity as independent predictors of BPF. Conclusions Preprocedural CTA is a reliable examination to identify BPF in patients with hemoptysis. Pulmonary lesion severity and bronchial artery tortuosity are independent factors associated with the presence of BPF in patients with hemoptysis.