Prognostic value of perfusion defect volume at dual energy CTA in patients with pulmonary embolism: Correlation with CTA obstruction scores, CT parameters of right ventricular dysfunction and adverse clinical outcome

Apfaltrer, Paul; Bachmann, Valentin; Meyer, Mathias; Henzler, Thomas; Barraza, J. Michael; Gruettner, Joachim; Walter, Thomas; Schoepf, U. Joseph; Schoenberg, Stefan O.; Fink, Christian

doi:10.1016/j.ejrad.2012.02.008

Cited by 80 publications

(63 citation statements)

References 17 publications

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“…Furthermore, axial and four-chamber view measurements of RV/LV diameter ratio have shown considerable interobserver variability, while volumetric measurements have shown better reproducibility (71). In another study of 60 patients, a RV/LV volumetric ratio >1.28 measured in non-ECG-gated CTPA showed 89% sensitivity, 75% specificity, 42% PPV and 97% NPV to predict adverse clinical outcome (74).…”

Section: Rv Dysfunctionmentioning

confidence: 99%

“…In a study with 260 PE patients, a RV/LV volume ratio >1.2 resulted in a six-fold increased risk for 30-day mortality, while 97.8% survived with a ratio <1.2 (71). Non-ECG-gated volumetric analysis seems to be slightly superior to identify high-risk patients with adverse clinical outcome compared to RV/LV diameter ratio measurements (71,74). Furthermore, axial and four-chamber view measurements of RV/LV diameter ratio have shown considerable interobserver variability, while volumetric measurements have shown better reproducibility (71).…”

Section: Rv Dysfunctionmentioning

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: Rv Dysfunctionmentioning

confidence: 99%

Section: Rv Dysfunctionmentioning

confidence: 99%

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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“…15 studies were initially excluded [10,19,20,22,26,31,33,35,38,39,41,43,46,50,52]. For six of them, the inclusion in the analysis was possible following contact with the authors [22,35,38,39,43,52].…”

Section: Meta-analysis Of Ct Assessed Right Ventricle Dilationmentioning

confidence: 99%

Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis

Becattini

Agnelli

Germini

et al. 2014

European Respiratory Journal

141

100

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The aim of this study was to evaluate whether right ventricle dilation at computed tomography (CT) angiography can be used to assess the risk of death in patients with acute pulmonary embolism.Medline and EMBASE were searched up to April 30, 2013. Studies reporting on the association between right ventricle dilation (right-to-left ventricle diameter) or dysfunction (inter-ventricular septal bowing) at CT angiography and death at 30 days, as well as at 3 months in patients with acute pulmonary embolism, were included in a systematic review and meta-analysis.CT-detected right ventricle dilation was associated with an increased 30 day-mortality in all-comers with pulmonary embolism (OR 2.08 (95% CI 1.63-2.66); p,0.00001) and in haemodynamically stable patients (OR 1.64 (95% CI 1.06-2.52); p50.03), as well as with death due to pulmonary embolism (OR 7.35 (95% CI 3.59-15.09); p,0.00001). An association between right ventricle dilation and 3-month mortality was also observed (OR 4.65 (95% CI 1.79-12.07); p50.002).Right-to-left ventricle dilation as assessed by CT angiography can be used to evaluate risk of death in allcomers with pulmonary embolism and in haemodynamically stable patients. @ERSpublications Multidetector CT can be used to assess short-term risk of death in patients with acute pulmonary embolism

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“…Initially applied to the assessment of acute pulmonary embolism [20][21][22], this technology has more recently been used in the management of patients with chronic thromboembolic disease [14,[23][24][25][26]. All studies have reported the feasibility of perfusion imaging, allowing depiction of perfusion defects beyond chronic clots in a similar approach to that achievable for acute pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

Impact of CT perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience in 62 patients

et al. 2016

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Prognostic value of perfusion defect volume at dual energy CTA in patients with pulmonary embolism: Correlation with CTA obstruction scores, CT parameters of right ventricular dysfunction and adverse clinical outcome

Cited by 80 publications

References 17 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

Computed tomography to assess risk of death in acute pulmonary embolism: a meta-analysis

Impact of CT perfusion imaging on the assessment of peripheral chronic pulmonary thromboembolism: clinical experience in 62 patients

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