{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T05:09:39Z","timestamp":1773810579981,"version":"3.50.1"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T00:00:00Z","timestamp":1705968000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T00:00:00Z","timestamp":1705968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Henan Provincial Medical Science and Technology Research Project","award":["LHGJ20220671"],"award-info":[{"award-number":["LHGJ20220671"]}]},{"DOI":"10.13039\/501100006407","name":"Natural Science Foundation of Henan Province","doi-asserted-by":"publisher","award":["232300421304"],"award-info":[{"award-number":["232300421304"]}],"id":[{"id":"10.13039\/501100006407","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100017700","name":"Henan Provincial Science and Technology Research Project","doi-asserted-by":"publisher","award":["222102310533, 222103810052"],"award-info":[{"award-number":["222102310533, 222103810052"]}],"id":[{"id":"10.13039\/501100017700","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Young Elite Scientists Sponsorship Program by Luoyang Association for Science and Technology","award":["2022HLTJ18"],"award-info":[{"award-number":["2022HLTJ18"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Respir Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Computed tomography (CT) scan is commonly performed for pleural effusion diagnostis in the clinic. However, there are limited data assessing the accuracy of thoracic CT for the separation of transudative from exudative effusions. The study aimed to determine the diagnostic value of thoracic CT in distinguishing transudates from exudates in patients with pleural effusion.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This is a two-center retrospective analysis of patients with pleural effusion, a total of 209 patients were included from The First Affiliated Hospital of Henan University of Science and Technology as the derivation cohort (Luoyang cohort), and 195 patients from the First Affiliated Hospital of Zhengzhou University as the validation cohort (Zhengzhou cohort). Patients who underwent thoracic CT scan followed by diagnostic thoracentesis were enrolled. The optimal cut-points of CT value in pleural fluid (PF) and PF to blood CT value ratio for predicting a transudative vs. exudative pleural effusions were determined in the derivation cohort and further verified in the validation cohort.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>In the Derivation (Luoyang) cohort, patients with exudates had significantly higher CT value [13.01 (10.01\u201316.11) vs. 4.89 (2.31\u20139.83) HU] and PF to blood CT value ratio [0.37 (0.27\u20130.53) vs. 0.16 (0.07\u20130.26)] than those with transudates. With a cut-off value of 10.81 HU, the area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of CT value were 0.85, 88.89%, 68.90%, 43.96%, and 95.76%, respectively. The optimum cut-value for PF to blood CT value ratio was 0.27 with AUC of 0.86, yielding a sensitivity of 61.11%, specificity of 86.36%, PPV of 78.57%, and NPV of 73.08%. These were further verified in the Validation (Zhengzhou) cohort.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>CT value and PF to blood CT value ratio showed good differential abilities in predicting transudates from exudates, which may help to avoid unnecessary thoracentesis.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12931-024-02681-w","type":"journal-article","created":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T15:02:51Z","timestamp":1706022171000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Diagnostic accuracy of thoracic CT to differentiate transudative from exudative pleural effusion prior to thoracentesis"],"prefix":"10.1186","volume":"25","author":[{"given":"Yan","family":"Zhang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyu","family":"Feng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiahuan","family":"Guo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fuyun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Huanhuan","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengnan","family":"Fan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingwei","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxia","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tongsheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yimin","family":"Mao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pengfei","family":"Gao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2024,1,23]]},"reference":[{"key":"2681_CR1","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1056\/NEJMra1403503","volume":"378","author":"D Feller-Kopman","year":"2018","unstructured":"Feller-Kopman D, Light R. Pleural Disease. N Engl J Med. 2018;378:740\u201351.","journal-title":"N Engl J Med"},{"key":"2681_CR2","doi-asserted-by":"publisher","first-page":"507","DOI":"10.7326\/0003-4819-77-4-507","volume":"77","author":"RW Light","year":"1972","unstructured":"Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77:507\u201313.","journal-title":"Ann Intern Med"},{"key":"2681_CR3","doi-asserted-by":"publisher","first-page":"E291","DOI":"10.1503\/cmaj.170420","volume":"190","author":"S Beaudoin","year":"2018","unstructured":"Beaudoin S, Gonzalez AV. Evaluation of the patient with pleural effusion. CMAJ. 2018;190:E291\u20135.","journal-title":"CMAJ"},{"key":"2681_CR4","doi-asserted-by":"publisher","first-page":"803","DOI":"10.1148\/radiology.192.3.8058951","volume":"192","author":"SL Aquino","year":"1994","unstructured":"Aquino SL, Webb WR, Gushiken BJ. Pleural exudates and transudates: diagnosis with contrast-enhanced CT. Radiology. 1994;192:803\u20138.","journal-title":"Radiology"},{"key":"2681_CR5","first-page":"116","volume":"20","author":"N Cullu","year":"2014","unstructured":"Cullu N, Kalemci S, Karakas O, Eser I, Yalcin F, Boyaci FN, Karakas E. Efficacy of CT in diagnosis of transudates and exudates in patients with pleural effusion. Diagn Interv Radiol. 2014;20:116\u201320.","journal-title":"Diagn Interv Radiol"},{"key":"2681_CR6","doi-asserted-by":"publisher","first-page":"513","DOI":"10.1378\/chest.14-0013","volume":"147","author":"JM Porcel","year":"2015","unstructured":"Porcel JM, Pardina M, Bielsa S, Gonzalez A, Light RW. Derivation and validation of a CT scan scoring system for discriminating malignant from benign pleural effusions. Chest. 2015;147:513\u20139.","journal-title":"Chest"},{"key":"2681_CR7","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1136\/thoraxjnl-2014-206054","volume":"70","author":"RJ Hallifax","year":"2015","unstructured":"Hallifax RJ, Haris M, Corcoran JP, Leyakathalikhan S, Brown E, Srikantharaja D, Manuel A, Gleeson FV, Munavvar M, Rahman NM. Role of CT in assessing pleural malignancy prior to thoracoscopy. Thorax. 2015;70:192\u20133.","journal-title":"Thorax"},{"key":"2681_CR8","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1097\/00004728-198104000-00002","volume":"5","author":"JL Doppman","year":"1981","unstructured":"Doppman JL, Rienmuller R, Lissner J. The visualized interventricular septum on cardiac computed tomography: a clue to the presence of severe anemia. J Comput Assist Tomogr. 1981;5:157\u201360.","journal-title":"J Comput Assist Tomogr"},{"key":"2681_CR9","first-page":"26","volume":"54","author":"M Foster","year":"2003","unstructured":"Foster M, Nolan RL, Lam M. Prediction of anemia on unenhanced computed tomography of the thorax. Can Assoc Radiol J. 2003;54:26\u201330.","journal-title":"Can Assoc Radiol J"},{"key":"2681_CR10","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1007\/s00330-008-0950-9","volume":"18","author":"EM Kamel","year":"2008","unstructured":"Kamel EM, Rizzo E, Duchosal MA, Duran R, Goncalves-Matoso V, Schnyder P, Qanadli SD. Radiological profile of anemia on unenhanced MDCT of the thorax. Eur Radiol. 2008;18:1863\u20138.","journal-title":"Eur Radiol"},{"key":"2681_CR11","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1016\/j.ejrad.2018.10.007","volume":"108","author":"QQ Zhou","year":"2018","unstructured":"Zhou QQ, Yu YS, Chen YC, Ding BB, Fang SY, Yang X, Zhang B, Zhang H. Optimal threshold for the diagnosis of anemia severity on unenhanced thoracic CT: a preliminary study. Eur J Radiol. 2018;108:236\u201341.","journal-title":"Eur J Radiol"},{"key":"2681_CR12","doi-asserted-by":"publisher","first-page":"618","DOI":"10.2214\/AJR.08.1286","volume":"192","author":"Y Abramowitz","year":"2009","unstructured":"Abramowitz Y, Simanovsky N, Goldstein MS, Hiller N. Pleural effusion: characterization with CT attenuation values and CT appearance. AJR Am J Roentgenol. 2009;192:618\u201323.","journal-title":"AJR Am J Roentgenol"},{"key":"2681_CR13","doi-asserted-by":"publisher","first-page":"100","DOI":"10.12659\/PJR.898963","volume":"82","author":"K Yalcin-Safak","year":"2017","unstructured":"Yalcin-Safak K, Umarusman-Tanju N, Ayyildiz M, Yucel N, Baysal T. Efficacy of computed tomography (CT) attenuation values and CT findings in the differentiation of Pleural Effusion. Pol J Radiol. 2017;82:100\u20135.","journal-title":"Pol J Radiol"},{"key":"2681_CR14","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/j.acra.2005.05.002","volume":"12","author":"KR Nandalur","year":"2005","unstructured":"Nandalur KR, Hardie AH, Bollampally SR, Parmar JP, Hagspiel KD. Accuracy of computed tomography attenuation values in the characterization of pleural fluid: an ROC study. Acad Radiol. 2005;12:987\u201391.","journal-title":"Acad Radiol"},{"key":"2681_CR15","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1002\/1097-0142(1950)3:1<32::AID-CNCR2820030106>3.0.CO;2-3","volume":"3","author":"WJ Youden","year":"1950","unstructured":"Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32\u20135.","journal-title":"Cancer"},{"key":"2681_CR16","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1007\/s003300050984","volume":"10","author":"J Arenas-Jimenez","year":"2000","unstructured":"Arenas-Jimenez J, Alonso-Charterina S, Sanchez-Paya J, Fernandez-Latorre F, Gil-Sanchez S, Lloret-Llorens M. Evaluation of CT findings for diagnosis of pleural effusions. Eur Radiol. 2000;10:681\u201390.","journal-title":"Eur Radiol"},{"key":"2681_CR17","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1513\/AnnalsATS.201601-082OC","volume":"13","author":"OJ Bintcliffe","year":"2016","unstructured":"Bintcliffe OJ, Hooper CE, Rider IJ, Finn RS, Morley AJ, Zahan-Evans N, Harvey JE, Skyrme-Jones AP, Maskell NA. Unilateral pleural effusions with more Than one apparent etiology. A prospective observational study. Ann Am Thorac Soc. 2016;13:1050\u20136.","journal-title":"Ann Am Thorac Soc"},{"key":"2681_CR18","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1042\/CS20160412","volume":"131","author":"P Thavendiranathan","year":"2017","unstructured":"Thavendiranathan P, Nolan MT. An emerging epidemic: cancer and heart failure. Clin Sci (Lond). 2017;131:113\u201321.","journal-title":"Clin Sci (Lond)"},{"key":"2681_CR19","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.1513\/AnnalsATS.201604-320ED","volume":"13","author":"J Creaney","year":"2016","unstructured":"Creaney J, Lee YC. Diagnoses (not diagnosis) of Pleural Effusion. Time to consider concurrent etiologies. Ann Am Thorac Soc. 2016;13:1003\u20134.","journal-title":"Ann Am Thorac Soc"}],"container-title":["Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-024-02681-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12931-024-02681-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-024-02681-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T15:07:58Z","timestamp":1706022478000},"score":1,"resource":{"primary":{"URL":"https:\/\/respiratory-research.biomedcentral.com\/articles\/10.1186\/s12931-024-02681-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,23]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["2681"],"URL":"https:\/\/doi.org\/10.1186\/s12931-024-02681-w","relation":{},"ISSN":["1465-993X"],"issn-type":[{"value":"1465-993X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,1,23]]},"assertion":[{"value":"8 October 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This retrospective study was approved by the ethics committee of the First Affiliated Hospital of Henan University of Science and Technology (2023-03-K0027), and the ethics review board of the First Affiliated Hospital of Zhengzhou University agreed to participate. Due to the retrospective study design, the requirement for written informed consent was waived.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"53"}}