Prognostic Value of Reflux of Contrast into the Inferior Vena Cava and Hepatic Veins on CT Pulmonary Angiography in Patients of Pulmonary Embolism

Abstract

A pulmonary embolism (PE) that obstructs pulmonary arterial blood flow is a medical emergency. Its early detection and appropriate management can be lifesaving. CT pulmonary angiography (CTPA) is currently in use as a standard tool for diagnosis of PE. This study was performed to determine the prognostic accuracy of contrast reflux into the inferior vena cava (IVC) and hepatic veins on CTPA in patients suffering from acute PE. Materials and Methods The study was composed of 285 patients between 15 to 85 years of age that had filling defects in pulmonary arteries on CTPA that were consistent with those of a pulmonary embolism. The extent of contrast reflux into the IVC and hepatic veins was determined on the basis of a Groves scale. The patients were followed for a period of 30 days. Results Of 285 total patients, 200 (70.17%) survived the post PE period of 30 days and were labeled as survivors. The other 85 (29.83%) patients did not survive the 30-day duration and were called non-survivors. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of IVC contrast reflux grading were 65.8%, 90%, 73.68%, 86.12 % and 82.8 % respectively. Conclusion We conclude that IVC contrast reflux grading assessed on helical CT is a beneficial tool for predicting prognosis in cases of acute PE.

Value of computed tomography pulmonary angiography measurements in predicting 30-day mortality among patients with acute pulmonary embolism

“…Similarly, although abnormal interventricular septal positioning or right ventricular strain and increased pulmonary artery obstruction are markers of adverse prognosis [ 4 ], other studies demonstrate inconsistent results [ 5 , 6 ]. Other measures of RV function, such as contrast medium reflux into the inferior vena cava (IVC), size of the pulmonary arteries, or morphology of the right atrium (RA) and left atrium (LA), and coronary artery calcium (CAC) have not been adequately studied, as demonstrated by contradictory results [ 7 , 8 ].…”