CT Pulmonary Angiography for Risk Stratification of Patients with Nonmassive Acute Pulmonary Embolism

Rotzinger, David C.; Knebel, Jean-François; Jouannic, Anne-Marie; Adler, Ghazal; Qanadli, Salah D.

doi:10.1148/ryct.2020190188

Cited by 14 publications

(11 citation statements)

References 40 publications

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“…CT Scans Are Analyzed to Identify: PE related abnormalities: the presence of embolic material, anatomic distribution based on segmental arteries, parenchymal changes and their distribution (PE present in the region of interest subject of parenchymal changes induced by the coronavirus), presence of perfusion defect–using iodine vs. water material decomposition if dual-energy CT was performed–assessment of right ventricle, left atrium, and pulmonary artery dimensions (diameters), and quantification of vascular obstruction using the Qanadli obstruction index (QOI) [ 28 , 29 ] and a modified Qanadli obstruction index (mQOI) based on the segmental analysis as follows: mQOI = (⅀SQOI + ⅀LQOI + ⅀TQOI)/120 where S: segmental QOI calculated for each segmental artery L: lobar QOI calculated for each lobar artery T: troncular QOI calculated for each pulmonary artery Non-PE-related vascular abnormalities consist of visual assessment of VC (arterial and venous), manually drawn regions-of-interest in normal and abnormal parenchyma, quantification of vascular volumes and tissue volumes, quantification of venous dilatation, and arterial enlargement. Non-vascular abnormalities include ground-glass opacities, consolidation, cysts, nodules, and pleural changes.…”

Section: Methodology and Data Analysismentioning

confidence: 99%

“…PE related abnormalities: the presence of embolic material, anatomic distribution based on segmental arteries, parenchymal changes and their distribution (PE present in the region of interest subject of parenchymal changes induced by the coronavirus), presence of perfusion defect–using iodine vs. water material decomposition if dual-energy CT was performed–assessment of right ventricle, left atrium, and pulmonary artery dimensions (diameters), and quantification of vascular obstruction using the Qanadli obstruction index (QOI) [ 28 , 29 ] and a modified Qanadli obstruction index (mQOI) based on the segmental analysis as follows:…”

Section: Methodology and Data Analysismentioning

confidence: 99%

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Vascular Abnormalities Detected with Chest CT in COVID-19: Spectrum, Association with Parenchymal Lesions, Cardiac Changes, and Correlation with Clinical Severity (COVID-CAVA Study)

et al. 2021

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Although vascular abnormalities are thought to affect coronavirus disease 2019 (COVID-19) patients’ outcomes, they have not been thoroughly characterized in large series of unselected patients. The Swiss national registry coronavirus-associated vascular abnormalities (CAVA) is a multicentric cohort of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who underwent a clinically indicated chest computed tomography (CT) aiming to assess the prevalence, severity, distribution, and prognostic value of vascular and non-vascular-related CT findings. Clinical outcomes, stratified as outpatient treatment, inpatient without mechanical ventilation, inpatient with mechanical ventilation, or death, will be correlated with CT and biological markers. The main objective is to assess the prevalence of cardiovascular abnormalities–including pulmonary embolism (PE), cardiac morphology, and vascular congestion. Secondary objectives include the predictive value of cardiovascular abnormalities in terms of disease severity and fatal outcome and the association of lung inflammation with vascular abnormalities at the segmental level. New quantitative approaches derived from CT imaging are developed and evaluated in this study. Patients with and without vascular abnormalities will be compared, which is supposed to provide insights into the prognostic role and potential impact of such signs on treatment strategy. Results are expected to enable the development of an integrative score combining both clinical data and imaging findings to predict outcomes.

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Section: Methodology and Data Analysismentioning

confidence: 99%

Section: Methodology and Data Analysismentioning

confidence: 99%

Vascular Abnormalities Detected with Chest CT in COVID-19: Spectrum, Association with Parenchymal Lesions, Cardiac Changes, and Correlation with Clinical Severity (COVID-CAVA Study)

et al. 2021

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“…In a small study of 35 patients with PE, Praveen Kumar et al found that CTOI was a strong independent predictor of RVD in PE, linearly correlating to several variables associated with increased morbidity and mortality, allowing an accurate risk stratification selection of patients who needed more aggressive treatment [17]. Rotzinger et al recently reported that patients with PE, excluding those with cardiopulmonary comorbidities or pulmonary neoplasms and with CTOI greater than 40%, had significantly higher mortality (p < 0.001) than those with CTOI less than 20% [18]. Patients with PE, cardiopulmonary comorbidities, or pulmonary neoplasms had an increased risk of fatal outcomes regardless of CTOI.…”

Section: Pulmonary Artery Clots Burden Indexesmentioning

confidence: 99%

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

et al. 2022

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Computed Tomography Pulmonary Angiography (CTPA) is considered the gold standard diagnostic technique in patients with suspected acute pulmonary embolism in emergency departments. Several studies have been conducted on the predictive value of CTPA on the outcomes of pulmonary embolism (PE). The purpose of this article is to provide an updated review of the literature reporting imaging parameters and quantitative CT scores to predict the severity of PE.

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“…The role of the Qanadli index in immediate risk stratification is validated but no correlation was observed between the obstruction index and prognosis [ 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ].…”

Section: Pulmonary Embolism and Cardiac Involvementmentioning

confidence: 99%

Role of CT and MRI in Cardiac Emergencies

Liguori¹,

Tamburrini²,

Ferrandino³

et al. 2022

Tomography

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Current strategies for the evaluation of patients with chest pain have significantly changed thanks to the implemented potentiality of CT and MRI. The possible fatal consequences and high malpractice costs of missed acute coronary syndromes lead to unnecessary hospital admissions every year. CT provides consistent diagnostic support, mainly in suspected coronary disease in patients with a low or intermediate pre-test risk. Moreover, it can gain information in the case of cardiac involvement in pulmonary vascular obstructive disease. MRI, on the other hand, has a leading role in the condition of myocardial damage irrespective of the underlying inflammatory or stress related etiology. This article discusses how radiology techniques (CT and MRI) can impact the diagnostic workflow of the most common cardiac and vascular pathologies that are responsible for non-traumatic chest pain admissions to the Emergency Department.

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CT Pulmonary Angiography for Risk Stratification of Patients with Nonmassive Acute Pulmonary Embolism

Cited by 14 publications

References 40 publications

Vascular Abnormalities Detected with Chest CT in COVID-19: Spectrum, Association with Parenchymal Lesions, Cardiac Changes, and Correlation with Clinical Severity (COVID-CAVA Study)

Vascular Abnormalities Detected with Chest CT in COVID-19: Spectrum, Association with Parenchymal Lesions, Cardiac Changes, and Correlation with Clinical Severity (COVID-CAVA Study)

Acute Pulmonary Embolism: Prognostic Role of Computed Tomography Pulmonary Angiography (CTPA)

Role of CT and MRI in Cardiac Emergencies

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