Pulmonary Embolism at Multi–Detector Row CT of Chest: One-year Survival of Treated and Untreated Patients

Engelke, Christoph; Rummeny, Ernst J.; Marten, Katharina

doi:10.1148/radiol.2392050118

Cited by 77 publications

(50 citation statements)

References 34 publications

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“…Moreover, a potential impact of other parameters on the clinical course of patients apart from those we investigated was not analysed. Because the average patient age in our study group was high a substantial number of patients presumably had multiple other diseases potentially influencing the aetiology and severity of PE [32]. Furthermore, categorisations of patients with respect to VCR and VSB were intrinsically not immune to subjectivity.…”

Section: Discussionmentioning

confidence: 99%

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

et al. 2011

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Section: Discussionmentioning

confidence: 99%

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

et al. 2011

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“…This reflects the inclusion of consecutive patients with acute PE diagnosed at CT pulmonary angiographic imaging without specific predilection to severity of disease and patient's cardiopulmonary status. In the literature, few studies address the role of CT pulmonary angiographic parameters for helping predict intermediate and long-term prognosis in patients with PE (14, 17,25,36). Further study with a longer clinical follow-up to examine the significance of clot burden on long-term prognosis of PE will be required.…”

Section: Thoracic Imaging: Ct Pulmonary Angiography: Clot Burden and mentioning

confidence: 99%

Short-term Mortality in Acute Pulmonary Embolism: Clot Burden and Signs of Right Heart Dysfunction at CT Pulmonary Angiography

Furlan¹,

Aghayev²,

Chang³

et al. 2012

Radiology

161

104

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Purpose:To assess the correlation between volumetric measurements of clot, semiquantitative clot burden indexes, and signs of right heart dysfunction at computed tomographic (CT) pulmonary angiography in patients with acute pulmonary embolism (PE) and to determine whether clot burden and signs of right heart dysfunction are associated with short-term mortality. Materials and Methods:This retrospective study was institutional review board approved and HIPAA compliant. CT pulmonary angiographic studies (January 2007 through December 2007) with findings positive for PE were retrieved. Two readers evaluated signs of right heart dysfunction at CT pulmonary angiography, measured clot volume using a dedicated software program, and assessed clot burden using semiquantitative scores (Qanadli and Mastora). Spearman rank coefficient was used to investigate correlation between clot burden measures and signs of right heart dysfunction. Uni-and multivariate analyses were used to test association between CT pulmonary angiographic findings and shortterm mortality. Results:A total of 635 CT pulmonary angiographic studies from 635 patients (304 men, 331 women; mean age, 59 years) were included; 39 (6%) patients died within 30 days. Clot volume was strongly correlated with Qanadli score (r = 0.841, P , .01) and Mastora score (r = 0.863, P , .01) and moderately correlated (r = 0.378, P , .01) with the ratio of right ventricle diameter to left ventricle diameter (RV/LV ratio). Among the pulmonary angiographic signs, only increase in RV/LV ratio (cut-off value, 1.0) was independently associated with short-term mortality in multivariate analysis. Conclusion:Clot volume strongly correlated with semiquantitative CT scores of clot burden, and greater clot volume was associated with higher incidence of right heart dilatation. Increase in RV/LV ratio was associated with short-term mortality; however, measures of clot burden were not.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

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“…For patients treated with VKA, we tested the adequacy of anticoagulation by looking at INR test results throughout the follow-up period. Time with INR at the recommended therapeutic level for PE (INR = 2–3) [10] was not significantly different between the groups (20.4 and 26.5 months for patients with UPE and SPE, respectively, p = 0.11). The two patient groups were similar regarding adequacy of anticoagulation.…”

Section: Resultsmentioning

confidence: 99%

“…While the existence of UPE is well recognized, only limited information exists regarding the clinical characteristics of these patients, especially the prevalence of comorbidities, clinical presentation and whether they are asymptomatic or merely unsuspected, and the prognostic implications of this condition [9]. Engelke et al [10] retrospectively studied the prognosis of patients with UPE who were undiagnosed at the time of the CT scan and hence not treated, and compared it to that of patients with suspected PE (SPE) who were treated with anticoagulation. The two groups did not differ significantly in their 1-year survival rates.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Outcomes of Patients with Clinically Unsuspected Pulmonary Embolism versus Patients with Clinically Suspected Pulmonary Embolism

Shteinberg¹,

Segal-Trabelsy

Adir³

et al. 2012

Respiration

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Background: The routine use of multidetector computed tomography has led to increased detection of unsuspected pulmonary embolism (UPE), with questionable benefit for diagnosis and treatment. Objective: The purpose of this work was to compare the clinical characteristics and prognosis of patients with UPE to patients with suspected PE (SPE). Methods: We retrospectively reviewed the charts of patients diagnosed with PE in a community-based university hospital between the years 2002 and 2007. UPE was defined as PE detected on CT scans performed for indications other than suspicion of PE. We compared patients with UPE to patients with SPE for differences in clinical features, electrocardiogram, imaging and echocardiographic findings. We also assessed the long-term outcomes using electronic patient records. Results: Of 500 patients with PE, 408 had SPE and 92 had UPE. Patients with UPE were similar to patients with SPE regarding age and sex distribution. Malignancy was more prevalent in UPE patients (39 vs. 23%, p < 0.0068). UPE patients had significantly less tachypnea (37 vs. 57%, p = 0.0005), dyspnea (47 vs. 87%, p < 0.0001), chest pain (19 vs. 42%, p < 0.0001) and hypoxemia (36 vs. 55%, p = 0.0011). Mortality was higher in UPE patients (70.3 vs. 53%, p = 0.0029). The hazard ratio after adjustment for confounders including age, sex and malignancy was 1.546 (95% CI: 1.139–2.099, p = 0.0052). Conclusions: We suggest that UPE is more prevalent in patients with a malignancy and is associated with higher mortality despite a less severe clinical presentation. UPE may be a marker of poor prognosis.

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Pulmonary Embolism at Multi–Detector Row CT of Chest: One-year Survival of Treated and Untreated Patients

Abstract: Clinically unsuspected PE may remain undetected at routine chest CT; these patients have favorable short-term outcome without therapeutic ACT.

Cited by 77 publications

References 34 publications

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

Multidetector-CT angiography in pulmonary embolism—can image parameters predict clinical outcome?

Short-term Mortality in Acute Pulmonary Embolism: Clot Burden and Signs of Right Heart Dysfunction at CT Pulmonary Angiography

Clinical Characteristics and Outcomes of Patients with Clinically Unsuspected Pulmonary Embolism versus Patients with Clinically Suspected Pulmonary Embolism

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