Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta‐analysis

Vedovati, Maria Cristina; Germini, Federico; Agnelli, Giancarlo; Becattini, Cecilia

doi:10.1111/jth.12429

Cited by 102 publications

(77 citation statements)

References 44 publications

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“…According to the authors, the differences in prognostic value observed in this study between the location of emboli and Qanadli score may reflect their effect on RV dilatation (62). While multiple small emboli by Qanadli score may not have been able to induce RV dysfunction, central emboli may present more often with RV dysfunction (62). Thus, the location of emboli seems to be more important in predicting the short-term mortality than the percent embolic obstruction of the pulmonary arterial bed.…”

Section: Pe Obstruction Index and Embolus Locationmentioning

confidence: 95%

“…The location method includes the more proximal emboli, but disregards the degree of obstruction. According to the authors, the differences in prognostic value observed in this study between the location of emboli and Qanadli score may reflect their effect on RV dilatation (62). While multiple small emboli by Qanadli score may not have been able to induce RV dysfunction, central emboli may present more often with RV dysfunction (62).…”

Section: Pe Obstruction Index and Embolus Locationmentioning

confidence: 99%

“…The prognostic role of embolic burden as a marker for short-term clinical outcome is a topic of discussion (62). In a meta-analysis, exploring short-term (30-day or threemonth) prognostic value of embolic burden on CT by Qanadli obstruction index (16 studies, 3884 patients) and by embolic location, classified as central (at least lobar branches) or distal (segmental and subsegmental branches), three studies involving 1309 patients demonstrated that the location of emboli in the central pulmonary artery branches was associated with a two-fold increased risk of 30-day mortality, (OR, 2.24; 95% CI, 1.29-3.89) (62).…”

Section: Pe Obstruction Index and Embolus Locationmentioning

confidence: 99%

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The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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A cute pulmonary embolism (PE) is the third most common cardiovascular condition, after coronary artery disease and stroke (1). Due to lack of specific sets of symptoms that accurately predict or exclude the diagnosis of acute PE, the diagnosis strongly relies on noninvasive imaging techniques. Diagnostic strategies for evaluating PE have undergone important changes over the past decades (2). Due to rapid technical advances in speed and spatial resolution, the utility of computed tomography (CT) angiography has been recognized in vascular imaging. Particularly, after the development of multidetector row CT in 1998 (3), CT pulmonary angiography (CTPA) has become the imaging method of choice in the diagnosis of acute PE (4). CTPA has advantages over conventional invasive X-ray pulmonary angiography and nuclear ventilation-perfusion (V/Q) imaging. CT is a widely available, fast and noninvasive technique, has the capability to directly visualize emboli, and may provide alternative diagnoses (4).Despite adequate diagnosis and anticoagulant therapy, death rate after a diagnosis of acute PE is still 8%-15% (5, 6). The prognosis of acute PE mainly depends on residual pulmonary circulation and the severity of right ventricular (RV) dysfunction (7). Recent studies have shown that CT permits the assessment of acute right-sided heart failure. Furthermore, CT can predict adverse clinical outcome by using the RV/left ventricular (LV) diameter ratio (8, 9) or RV ejection fraction in patients with PE (10).The aim of this review is to discuss the developments of CT in PE diagnosis, and to analyze the added value of CT in estimating PE severity and prognosis. Furthermore, CT findings of chronic thromboembolic pulmonary arterial hypertension (CTEPH) as a complication of acute PE will be discussed. CT developments in PE diagnosisHistorically, pulmonary angiography and nuclear planar V/Q-imaging were the main imaging methods used for diagnosing PE. Both methods have recognized limitations. Pulmonary angiography has previously been regarded as reference standard, but the method CHEST IMAGING REVIEW ABSTRACT Pulmonary embolism (PE) is a potentially life threatening condition requiring adequate diagnosis and treatment. Computed tomography pulmonary angiography (CTPA) is excellent for including and excluding PE, therefore CT is the first-choice diagnostic imaging technique in patients suspected of having acute PE. Due to its wide availability and low invasiveness, CTPA tends to be overused. Correct implementation of clinical decision rules in diagnostic workup for PE improves adequate use of CT. Also, CT adds prognostic value by evaluating right ventricular (RV) function. CT-assessed RV dysfunction and to lesser extent central emboli location predicts PE-related mortality in normotensive and hypotensive patients, while PE embolic obstruction index has limited prognostic value. Simple RV/left ventricular (LV) diameter ratio measures >1.0 already predict risk for adverse outcome, whereas ratios <1.0 can safely exclude adverse outcome. Con...

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Section: Pe Obstruction Index and Embolus Locationmentioning

confidence: 95%

Section: Pe Obstruction Index and Embolus Locationmentioning

confidence: 99%

Section: Pe Obstruction Index and Embolus Locationmentioning

confidence: 99%

See 1 more Smart Citation

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Doğan

A²,

Geleijins³

et al. 2015

Diagn Interv Radiol

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“…Central thrombus (saddle embolus or thrombus in one of the main pulmonary arteries) appears to correlate with RV dysfunction, 14 and predicts a higher rate of 30-day mortality or clinical deterioration. [15][16][17] On the other hand, large thrombus burden (as measured by percentage or semi-quantitative indices such as Mastora or Qanadli) does not appear to correlate well with adverse outcomes. [18][19][20] While the criteria for stratification and therefore treatment escalation at present are based upon hemodynamics and RV function, central location of thrombus may be another factor that prompts intervention because thrombus location plays a role in patient selection for catheter-directed therapy and surgical embolectomy.…”

Section: Question 1: Should Submassive Pe Patients Be Treated With Symentioning

confidence: 99%

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

2015

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Submassive pulmonary embolism (PE) remains a vexing entity, and the appropriate use of thrombolytic therapy for this subgroup continues to be actively debated. Catheter-directed thrombolysis has shown efficacy for submassive PE and is gaining momentum because of theoretically improved safety. This review poses and responds to four questions that explore the complex issues surrounding optimal therapy of submassive PE.

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“…thrombus mass) has an effect on symptoms and prognosis in patients with PE. [3][4][5] Therefore, the aim of the present study was to assess how frequently PE occurs in particular CT indications, and analyse embolus distribution in oncologic patients and in unsuspected PE.…”

Section: Introductionmentioning

confidence: 99%

The frequency of incidental pulmonary embolism in different CT examinations

Bach¹,

Meyer²,

Taute³

et al. 2016

BJR

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Objective: Pulmonary embolism (PE) is commonly found in patients with oncologic and non-oncologic disease. The aim of the present study is to assess how frequently suspected, incidental and unreported PE occurs in particular CT examinations. In addition, differences in embolus distribution are to be considered. Methods: In a retrospective, single-centre study that covered a 5.5-year period, every contrast-enhanced CT examination was reviewed. The study group included 7238 patients with 11,747 CT examinations. A detailed pulmonary artery obstruction index (Mastora score) was used to assess thrombus mass and distribution. Results: PE frequency was 3.9% in oncologic patients and 6.6% in non-oncologic patients. PE was unsuspected in 54% of all PE events. Incidental PE was mostly often found in the following CT examinations: evaluation of acute pulmonary disease and follow-up staging. The thrombus mass was higher in non-oncologic patients than in oncologic patients. Furthermore, the thrombus mass was significantly lower in unsuspected PE than in suspected PE. In addition, the thrombus mass was significantly lower in unreported PE than in incidental PE. Conclusion: The radiologist should pay special attention to pulmonary vessels, even when not asked for PE, in the following CT examinations: evaluation of acute pulmonary disease and follow-up staging. Advances in knowledge: Particular CT indications are associated with a high frequency of PE. Whether PE is suspected or not and found or not highly depends on thrombus mass.

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Prognostic role of embolic burden assessed at computed tomography angiography in patients with acute pulmonary embolism: systematic review and meta‐analysis

Abstract: Localization of emboli assessed at CT angiography can be used for risk stratification in patients with acute PE. Moreover, no correlation was observed between obstruction index and prognosis.

Cited by 102 publications

References 44 publications

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

The role of computed tomography in the diagnosis of acute and chronic pulmonary embolism

Four key questions surrounding thrombolytic therapy for submassive pulmonary embolism

The frequency of incidental pulmonary embolism in different CT examinations

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