Contrast reflux into the inferior vena cava on computer tomographic pulmonary angiography is a predictor of 24-hour and 30-day mortality in patients with acute pulmonary embolism

Abstract

Background Acute pulmonary embolism (PE) is a common disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) represents the current gold standard for the evaluation of patients with suspected PE. Purpose To search possible CTPA predictors of 24-h and 30-day mortality in PE. Material and Methods Overall, 224 patients with PE (46.4% women, mean age 64.7 ± 16.7 years) were acquired. CTPA was performed on a multi-slice CT scanner. The following radiological parameters were estimated: thrombotic obstruction index; diameter of the pulmonary trunk (mm); short axis ratio of right ventricle/left ventricle; diameter of the azygos vein (mm); diameter of the superior and inferior vena cava (mm); and reflux of contrast medium into the inferior vena cava (IVC). Results Patients who died within the first 24 h after admission (n = 32, 14.3%) showed a reflux grade 3 into IVC more often than survivors (odds ratio [OR] 7.6, 95% confidence interval [CI] 3.3–17.7; P < 0.001). Other relevant CTPA parameters were diameter of IVC (OR 1.1, 95% CI 1.01–1.21; P = 0.034) and diameter of the pulmonary trunk (OR 0.91, 95% CI 0.82–1.01, P = 0.074), whereas the Mastora score showed nearly no influence (OR 1.01, 95% CI 0.99–1.02, P = 0.406). Furthermore, 61 (27.2%) patients died within the first 30 days after admission. These patients showed a reflux grade 3 into IVC more often than survivors (OR 3.4, 95% CI 1.7–7.0; P = 0.001). Other CTPA parameters, such as diameter of IVC (OR 1.04, 95% CI 0.97–1.12; P = 0.277) and diameter of the pulmonary trunk (OR 0.96, 95% CI 0.89–1.04; P = 0.291), seem to have no relevant influence, whereas Mastora score did (OR 0.99, 95% CI 0.976–0.999, P = 0.045). Conclusion Subhepatic contrast reflux into IVC is a strong predictor of 24-h and 30-day mortality in patients with acute PE.

Time efficiency and reliability of established computed tomographic obstruction scores in patients with acute pulmonary embolism

“…So, Bach et al could not identify predictive power of Mastora score for 30 days mortality [5]. Similar results were reported also by other authors [6]. Moreover, Mastora score was only weakly correlated with lactate level and not with other serological or clinical parameters [11].…”

“…The patient sample was obtained from a larger study sample, which assessed the associations between Mastora score and clinical features in patients with acute PE [6,11]. Inclusion criteria were sufficient pulmonary vessel contrast and a representative PE manifestation.…”

“…There are several proposed imaging signs, which were identified to have prognostic implications [4]. Potential CT-signs were the ratio right ventricular diameter to left ventricular diameter and contrast media reflux into the inferior vena cava [4][5][6].…”

“…In clinical evaluation, the right ventricle to left ventricle (LV) diameter-ratio was identified to be the strongest predictive value and most robust to predict clinical outcomes in patients with acute PE [3]. The contrast media reflux into the inferior vena cava has been reported as a significant prognostic marker in acute PE [5,6].…”

International Scientific Prize 2021

“…After a formal voting procedure, the section editors of Acta Radiologica have decided that the Acta Radiologica International Prize 2021 should be awarded to Nikolaos Bailis (Fig. 1) from the Department of Radiology, University of Leipzig, Germany for his article “Contrast reflux into the inferior vena cava on computer tomographic pulmonary angiography is a predictor of 24-h and 30-day mortality in patients with acute pulmonary embolism” (1).…”